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BonCap R8 521 - R13 840

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Type of Medical Aid Plan: 
Capitation
Medical Aid Year: 
2020
Income Level: 
R8 521 to R13 840
Day to day Benefits: 

Primary care benefits for Family Practitioners(FPs), dentists, optometrists and pharmacies, are available through the Bonitas Boncap network of healthcare providers, subject to network formularies. Unlimited FP consultations subject to seeing up to 2 nominated FP's. There is a monetary limit per family for FP referred pathology, radiology and acute medication. Specialist consults are available on referral from the FP

In Hospital Benefits
Are you prepared to use designated hospitals?: 
Yes
Hospital Rate of Payment: 
Unlimited at 100% of Bonitas Rate (BR)
Hospitals: 

BonCap Network Hospital

Upfront Payments to hospitals: 

R10 000 co-payment applies if you use a non-network hospital, except for emergencies, or if you do not get pre-authorisation within 48 hours of admission

Casualty / Emergency Visits: 
No benefit
Specialists: 
Unlimited at 100% of BR
Other healthcare professionals eg. Physio, Occupational, Dietician: 
PMB only. Your therapist must have a referral from the doctor treating you
Radiology and pathology: 
Unlimited at 100% of BR
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy): 
No benefit
MRI and CT scans: 
R11 840 per family. Pre-authorisation required
ICU and High Care: 
100% of BR
Dialysis: 
Unlimited. You must use a Designated Service Provider (DSP), or a 20% co-payment will apply. Pre-authorisation required
Organ Transplants: 
Unlimited. Pre-authorisation required
Oncology / Cancer: 
PMB only. Subject to the use of a Designated Service Provider (DSP). Pre-authorisation required
Neck and Back Operations: 
No benefit
Joint Replacements: 
No benefit
Prosthesis: 

PMB only for internal and external prosthesis. Managed Care Protocols apply and preferred supplier

Medical and Surgical Appliances: 
General medical appliances such as wheelchairs and crutches, R5 550 per family. You must use a preferred supplier
Maternity Confinements: 
Unlimited at 100% of BR
In Hospital Dentistry: 
No benefit
Take home Medicine: 
R390 per beneficiary, per hospital stay
Rehabilitation, Hospice and Step-down facilities: 
Physical rehabilitation R50 600 per family. Hospice and step-down facilities; R14 570 per family. Pre-authorisation required
Treatment for Mental Health: 
PMB only. No cover for physiotherapy for mental health admissions. Subject to the use of a DSP
HIV / AIDS: 
Unlimited if you register on the HIV/AIDS programme. Chronic medicine must be obtained from Pharmacy Direct
Ambulance Service: 
ER24 in an emergency
International Travel Benefit: 
No benefit
Day-to-day benefits
GP consultations: 

Subject to the BonCap FP Network. Unlimited FP consultations, subject to seeing up to 2 nominated FP's. From the 8th visit, subject to pre-authorisation and Managed Care Protocols. Out-of-network FP consultations: 1 consultation per beneficiary and 2 consultations per family per annum, limited to R1 050 and 20% co-payment

Specialist consultations: 

Limited to 3 consultations or R3 170 per beneficiary and/or 5 consultations or R4 710 per family per annum. Limit includes all acute medication, out-of-hospital specialised radiology, basic radiology and pathology. Subject to referral from FP and authorisation

Acute medicine: 

Subject to the BonCap acute formulary and Bonitas Pharmacy Network. 20% co-payment for non-network or non-formulary use. M = R1 880; M +1 = R3 120; M + 2 = R3 730; M + 3 = R4 080; M + 4 or more = R4 530

Over-the-counter (OTC) Medicine: 

Formulary and Bonitas Pharmacy Network applies. 20% co-payment for non-network or non-formulary use. Limited to R95 per event. Maximum of R270 per beneficiary per annum

Optometry benefits: 
Cover for one eye test per beneficiary every 24 months, at a contracted service provider. There is a specific range of glasses to choose from. You can choose a set of contact lenses instead of glasses. Subject to limits
Basic dentistry: 
Subject to the use of a provider on the DENIS network. Cover for 1 consultation per beneficiary per annum, x-rays, fillings and extractions. Managed Care Protocols and limits apply
Specialised Dentistry: 
No benefit
Orthodontics: 

No benefit

MRI and CT Scans (Out of Hospital): 
Included in specialist consultation benefit and subject to pre-authorisation
Radiology and Pathology: 
Included in specialist consultation benefit
Pregnancy benefits: 
Antenatal consultations are subject to the FP and specialist consultations benefits. 4 consultations with a midwife after delivery. 1 of these may be used for a consultation with a lactation specialist
Physiotherapy and Occupational Therapy day to day: 
PMB only
Chronic Conditions
Provider: 
Pharmacy Direct and formulary medication. A 40% co-payment applies for non-use of the network pharmacy or formulary
Chronic Conditions: 

Diagnosis, treatment and care costs of 26 chronic conditions that fall under the PMB Chronic Disease List (CDL), issued by the Council for Medical Schemes

Additional Chronic Conditions: 
None
Preventative Care Benefits
Preventative Benefits: 

1 wellness screening test per beneficiary at a wellness network provider. Contraceptives for women up to 50, limited to R1070 per family. Hearing screening for newborns, in- or out-of hospital. Congenital hypothyroidism screening for infants under 1 month. Babyline 24/7 helpline for children under 3 years. 1 HIV test and 1 Flu vaccine per beneficiary. Age specific tests for: pap smear, mammogram, prostate screening, pneumococcal vaccine and stool test for colon cancer

Total Contributions
Total Contribution Main Member: 
1372.00
Total Contribution Adult: 
1297.00
Total Contribution Child*: 
630.00
BonCap R8 521 to R13 840
Medical Aid Plan Name Term: 
BonCap