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BonCap R13 841 to R18 900 2019

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Type of Medical Aid Plan: 
Capitation
Medical Aid Year: 
2019
Day to day Benefits: 

Basic day-to-day benefits with GP consultations at a network provider

In Hospital Benefits
Hospital Rate of Payment: 
100% of Scheme Rate
Hospitals: 

Members have access to certain network hospitals

Upfront Payments to hospitals: 

"A 30% co-payment may apply to admissions at specific hospitals.

Kidney dialysis: You must use a Designated Service Provider, or a 20% co-payment will apply.
In Hospital Dentistry, A co-payment of R3 500 per hospital admission and admission protoco...

Casualty / Emergency Visits: 
1 specific (emergency) consultation for pain and sepsisper beneficiary
Specialists: 
Unlimited, covered at 100% of the Bonitas Rate
Other healthcare professionals eg. Physio, Occupational, Dietician: 
PMB onlyYour therapist must have a referral from the doctor treating you
Radiology and pathology: 
R11 840 per familyPre-authorisation required
Dialysis: 
UnlimitedYou must use a Designated Service Provider, or a20% co-payment will applyPre-authorisation required
Oncology / Cancer: 
Uses the ICON network of oncology specialistsUses the Bonitas Oncology Medicine Network(20% co-payment applies for use of a non-network provider)
Medical and Surgical Appliances: 
R5 550 per familyYou must use a preferred supplier
In Hospital Dentistry: 
You must use a provider on the DENIS networkCovered at the Bonitas Dental TariffManaged Care protocols apply
Take home Medicine: 
Limited to R95 per eventMaximum of R270 per beneficiary, per yearFormulary and Bonitas Pharmacy Network applies(20% co-payment for non-network or non-formulary use)
Rehabilitation, Hospice and Step-down facilities: 
R50 600 per familyPre-authorisation required
Treatment for Mental Health: 
PMB onlyNo cover for physiotherapy for mental health admissionsSubject to using the Designated Service Provider
HIV / AIDS: 
Provides you with appropriate treatment and tools to live anormal lifeCovers medicine to treat HIV (including drugs to preventmother-to-child transmission and infection after sexual assaultor needle-stick injury). Response to therapy and to detec...
International Travel Benefit: 
Cover for medical emergencies when you travel outside SouthAfricaYou must register for this benefit
Day-to-day benefits
GP consultations: 

Paid from available savings or above threshold benefit

Specialist consultations: 

Paid from available savings or above threshold benefit
You must get a referral from your GP

Acute medicine: 

Paid from available savings or above threshold benefit
Formulary and Bonitas Pharmacy Network applies to above
threshold benefit
20% co-payment for non-network or non-formulary use in above
threshold benefit

Optometry benefits: 
You must use the contracted service providerManaged Care protocols apply
Basic dentistry: 
You must use a provider on the DENIS networkCovered at the Bonitas Dental TariffManaged Care protocols apply
Orthodontics: 

Orthodontic treatment is granted once per beneficiary,
per lifetime
Pre-authorisation cases will be clinically assessed by using an
orthodontic needs analysis
Benefit allocation is subject to the outcome of the needs
analysis and funding can be grant...

Radiology and Pathology: 
R11 840 per familyPre-authorisation required
Chronic Conditions
Chronic Conditions: 

1. Addison’s Disease 10. Crohn’s Disease 19. Hyperlipidaemia
2. Asthma 11. Diabetes Insipidus 20. Hypertension
3. Bipolar Mood Disorder 12. Diabetes Type 1 21. Hypothyroidism
4. Bronchiectasis 13. Diabetes Type 2 22. Multiple Sclerosis
5. Cardiac Fai...

Total Contributions
BonCap
Medical Aid Plan Name Term: 
Any