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Type of Medical Aid Plan: 
Threshold
Medical Aid Year: 
2020
Day to day Benefits: 

Day-to-day medical expenses such as GP and specialist consults, acute medicine, radiology, pathology, optometry and mental health consultations are paid from the available funds in your savings account. Once your savings for the year are finished, you will need to pay for your day-to-day medical expenses yourself, until you have paid the full Self-payment gap. You will then have access to your Above Threshold benefit. Claims must still be sent to Bonitas during this time, so that Bonitas can let you know when you have access to the Above Threshold benefit. The Above Threshold benefit is limited. Dentistry benefits are paid from your unlimited overall annual benefit

In Hospital Benefits
Are you prepared to use designated hospitals?: 
No
Hospital Rate of Payment: 
Unlimited at 100% of Bonitas Rate (BR)
Hospitals: 

Any

Casualty / Emergency Visits: 
No benefit
Specialists: 
Unlimited at 100% of BR
Other healthcare professionals eg. Physio, Occupational, Dietician: 
Unlimited at 100% of BR
Radiology and pathology: 
Unlimited at 100% of BR
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy): 
Unlimited at 100% of BR
MRI and CT scans: 
R23 800 per family available, in- or out-of hospital. Subject to pre-authorisation
ICU and High Care: 
Unlimited at 100% of BR
Dialysis: 
Unlimited at 100% of BR. You must use a Designated Service Provider(DSP), or a 20% co-payment will apply
Organ Transplants: 
Unlimited at 100% of BR. Sub-limit of R32 130 per beneficiary for corneal grafts
Oncology / Cancer: 
R344 500 available per family. Subject to the use of a preferred provider. Sub-limit of R44 200 per beneficiary for Brachytherapy
Neck and Back Operations: 
For spinal surgery: you will have a co-payment of R10 000 if you do not go for an assessment through the back and neck program
Joint Replacements: 
You will have a co-payment of R10 000 if you do not use the preferred provider
Prosthesis: 

Internal and external: R45 090 per family
Sublimit of R5 360 per breast prosthesis, limited to 2 per annum.
Managed Care protocols apply and the use of a preferred supplier

Medical and Surgical Appliances: 
Subject to available savings or above threshold benefit. Hearing aids available once in 5 years. Subject to the use of a preferred supplier
Maternity Confinements: 
Unlimited at 100% of BR
In Hospital Dentistry: 
Co-payment of R3 500 per admission. General anaesthetic only available for extensive treatment to children under 5 years, once per lifetime and for impacted wisdom teeth. Pre-authorisation required. Managed Care Protocols apply
Take home Medicine: 
R420 per beneficiary, per hospital stay
Rehabilitation, Hospice and Step-down facilities: 
Physical rehabilitation R50 600 per family. Hospice and step-down facilities; R16 880 per family. Terminal Care; unlimited
Treatment for Mental Health: 
Hospitalisation; R32 210 per family with R15 890 per family available for In- or out-of-hospital consultations. 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: 
Cover for medical emergencies when you travel outside South Africa. Subject to registration
Day-to-day benefits
GP consultations: 

Subject to available savings or above threshold benefit

Specialist consultations: 

Subject to available savings or above threshold benefit and a referral from your GP

Acute medicine: 

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

Over-the-counter (OTC) Medicine: 

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

Optometry benefits: 
Subject to available savings or above threshold benefit, once every 24 months. Cover for one eye test per beneficiary, at a network provider, frame and clear single vision, bifocal or multifocal lenses. You can choose contact lenses instead of glasses
Basic dentistry: 
Subject to Bonitas Dental Tariff. 2 annual check-ups per beneficiary, 2 scale and polish treatments, x-rays, fillings, root canal and extractions. 1 set of plastic dentures pb, per 4 years. Managed Care Protocols apply
Specialised Dentistry: 
Covered at Bonitas Dental Tariff. 1 partial metal frame dentures per beneficiary, per 5 years. Managed Care Protocols apply. 1 crown per family, per annum. Pre-authorisation required
Orthodontics: 

Orthodontic treatment is granted once per beneficiary, per lifetime. Limited to beneficiaries 9 years and younger than 18 years. Only 1 family member may begin treatment in a calendar year. Managed Care Protocols apply. Pre-authorisation cases will be clinically assessed by using an orthodontic needs analysis and benefit allocation is subject to the outcome. Funding can be granted up to 65% of Bonitas Dental Tariff

MRI and CT Scans (Out of Hospital): 
R23 800 per family available, in- or out-of hospital. Subject to pre-authorisation
Radiology and Pathology: 
Subject to available savings or above threshold benefit
Pregnancy benefits: 
6 antenatal consultations with a gynae, GP or midwife, 2 2D scans, 1 amniocentesis, R1 240 for antenatal classes, 4 consults with a midwife after delivery. 1 of these may be used for a consult with a lactation specialist. Maternity support for pregnancy
Physiotherapy and Occupational Therapy day to day: 
Subject to available savings or above threshold benefit
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 27 chronic conditions that fall under the PMB Chronic Disease List (CDL), issued by the Council for Medical Schemes

Additional Chronic Conditions: 
4 conditions
Preventative Care Benefits
Preventative Benefits: 

Contraceptives for women up to 50, limited to R1 610 per family. Subject to the DSP for pharmacy-dispensed contraceptives. CHILDCARE: 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; Paediatrician or GP consultations: 2 per child, per annum, under 1 year and 1 per child between 1 and 2 years; 1 GP consultation per child from 2 - 12 years; Immunisation according to South African Expanded Programme. OTHER: 1 wellness screening test per beneficiary at a wellness network provider; 1 HIV test and 1 Flu vaccine per beneficiary; Age and frequency specific tests for: 1 full lipogram; pap smear; mammogram; prostate screening; pneumococcal vaccine and stool test for colon cancer. Wellness Extender benefit of R1 750 per family available after completing a wellness screening test

Total Contributions
Total Contribution Main Member: 
4009.00
Total Contribution Adult: 
3211.00
Total Contribution Child*: 
1089.00
BonComplete
Annual Medical Savings Account
Annual Medical Savings Main Member: 
7200.00
Annual Medical Savings Adult: 
5772.00
Annual Medical Savings Child*: 
1956.00
Monthly Medical Savings
Savings Child*: 
163.00
Savings Adult: 
481.00
Savings Main Member: 
600.00
Annual Threshold Amounts
Annual Threshold Main Member: 
8970.00
Annual Threshold Adult: 
7272.00
Annual Threshold Child*: 
2341.00
Above Threshold Benefit Limits
Above Threshold Benefit Main Member: 
4700.00
Above Threshold Benefit Adult: 
2770.00
Above Threshold Benefit Child*: 
1200.00
Risk Contributions
Risk Contribution Main Member: 
3409.00
Risk Contribution Adult: 
2730.00
Risk Contribution Child: 
926.00
Medical Aid Plan Name Term: 
BonComplete