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BonComprehensive 2021

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Type of Medical Aid Plan: 
Threshold
Medical Aid Year: 
2021
Day to day Benefits: 

Day-to-day medical expenses such as GP and specialist consults, acute medicine, radiology, pathology, optometry, dentistry 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 unlimited.

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 150% 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: 
R33 050 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 R33 220 for corneal grafts
Oncology / Cancer: 
R618 500 available per family; R245 400 of this can be used for specialised drugs. Sub-limit of R44 200 per beneficiary for Brachytherapy. Non-cancer specialised drugs R200 100 per family
Neck and Back Operations: 
For spinal surgery: you will have a co-payment of R15 000 if you do not go for an assessment through the back and neck program
Joint Replacements: 
You will have a co-payment of R30 000 if you do not use the preferred provider
Prosthesis: 

Internal: R58 110 per family
External:R58 110 per family
Sublimit of R5 540 per breast prosthesis, limited to 2 per annum.
Internal nerve stimulator; R174 600 per family: Deep brain stimulation; R246 100 per beneficiary: Cochlear implants; R292 900 per family, subject to the use of a preferred supplier

Medical and Surgical Appliances: 
Subject to available savings or above threshold benefit. Hearing aids; R27 190 per family available once in 5 years, with a 10% co-payment. Subject to the use of a preferred supplier
Maternity Confinements: 
Unlimited at 100% of BR
Take home Medicine: 
R575 per beneficiary, per hospital stay
Rehabilitation, Hospice and Step-down facilities: 
Physical rehabilitation R52 320 per family. Hospice and step-down facilities; R17 450 per family. Terminal Care; unlimited
Treatment for Mental Health: 
Hospitalisation; R48 470 per family with R16 430 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, with a limit of R3 330 per beneficiary, once every 24 months. Sublimits apply. You can choose a set of 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: 
Subject to available savings or above threshold benefit. Covered at Bonitas Dental Tariff. 1 partial metal frame dentures per beneficiary, per 5 years. Managed Care Protocols apply. 2 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): 
R33 050 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: 
12 antenatal consults with a gynae, GP or midwife, 2 2D scans, 1 amniocentesis, R1 240 for antenatal classes, after delivery access to private ward and 4 consults with a midwife. 1 may be used for a consult with a lactation specialist. Maternity support
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: 
33 conditions. Your chronic medicine benefit is limited to R14 100 per beneficiary and R28 100 per family on the applicable formulary. Once the amount is finished you will still be covered for the 27 PMBs above
Preventative Care Benefits
Preventative Benefits: 

Contraceptives for women up to 50, limited to R1 660 per family. 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: 3 per child, per annum, under 1 year and 2 per child between 1 and 2 years; 2 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, stool test for colon cancer and a bone density screening. Wellness Extender benefit of R2 540 per family, available after completing a wellness screening test

Total Contributions
Total Contribution Main Member: 
7715.00
Total Contribution Adult: 
7276.00
Total Contribution Child*: 
1570.00
BonComprehensive
Annual Medical Savings Account
Annual Medical Savings Main Member: 
17460.00
Annual Medical Savings Adult: 
16464.00
Annual Medical Savings Child*: 
3552.00
Monthly Medical Savings
Savings Child*: 
296.00
Savings Adult: 
1372.00
Savings Main Member: 
1455.00
Medical Aid Plan Name Term: 
BonComprehensive