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BonEssential 2021

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

No 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

Upfront Payments to hospitals: 

Co-payments apply for certain procedures, varying between R1 570 and R7 840. See 2021 brochure for details

Casualty / Emergency Visits: 
No benefit
Specialists: 
Unlimited at 100% of BR. Network specialists covered in full, non-network specialists paid at 100% of the BR
Other healthcare professionals eg. Physio, Occupational, Dietician: 
PMB only
Radiology and pathology: 
Unlimited at 100% of BR
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy): 
Co-payment of R1 570 in a network day hospital. An additional co-payment of R2 200 may apply if performed in hospital
MRI and CT scans: 
Subject to pre-authorisation. Co-payment of R1 500 per scan, except for PMBs. R16 620 per family, in- and out-of-hospital
ICU and High Care: 
Unlimited at 100% of BR
Dialysis: 
Unlimited at DSPs, otherwise a 20% co-payment will apply
Organ Transplants: 
PMBs only
Oncology / Cancer: 
PMBs only at a DSP. Sub-limit of R44 200 per beneficiary for Brachytherapy
Neck and Back Operations: 
Subject to registration and a personalised treatment plan on the Documentation Based Care(DBC) Managed Care Programme
Joint Replacements: 
PMB cover only. Managed Care protocols apply
Prosthesis: 

Subject to Managed Care protocols and DSPs.
Internal: R32 220 per family.
External: PMB only

Medical and Surgical Appliances: 
No benefit
Maternity Confinements: 
Unlimited at 100% of BR
In Hospital Dentistry: 
No benefit
Take home Medicine: 
R405 per beneficiary
Rehabilitation, Hospice and Step-down facilities: 
Physical rehabilitation limited to R52 320 per family. Hospice and Step-down facilities: R17 450 per family, subject to Managed Care protocols
Treatment for Mental Health: 
R33 310 per family. No cover for physiotherapy
HIV / AIDS: 
Unlimited, subject to registration on the HIV/Aids Managed Care Programme. Medication must be obtained from the DSP
Ambulance Service: 
ER24 in an emergency
International Travel Benefit: 
Up to R10m cover per family for medical emergencies when you travel outside South Africa. Subject to registration prior to departure
Day-to-day benefits
GP consultations: 

No benefit

Specialist consultations: 

No benefit

Acute medicine: 

No benefit

Over-the-counter (OTC) Medicine: 

No benefit

Optometry benefits: 
No benefit
Basic dentistry: 
No benefit
Specialised Dentistry: 
No benefit
Orthodontics: 

No benefit

MRI and CT Scans (Out of Hospital): 
Subject to pre-authorisation. Co-payment of R1 500 per scan, except for PMBs. R16 620 per family, in- and out-of-hospital
Radiology and Pathology: 
No benefit
Pregnancy benefits: 
Access to the Bonitas Maternity Programme. 6 antenatal consults with a gynaecologist, GP or midwife, 2x 2D scans, 1 amniocentesis and 4 consults with a midwife after delivery. (1 of these can be used to consult a lactation specialist)
Physiotherapy and Occupational Therapy day to day: 
No benefit
Chronic Conditions
Provider: 
Pharmacy Direct and formulary medication
Chronic Conditions: 

Diagnosis, treatment and care costs of 26 chronic conditions that fall under the Prescribed Minimum Benefit (PMB) Chronic Disease List (CDL), issued by the Council for Medical Schemes. Subject to pre-authorisation, protocols, and DSPs

Additional Chronic Conditions: 
None
Preventative Care Benefits
Preventative Benefits: 

1 wellness screening per beneficiary at a participating pharmacy, biokineticist or Bonitas wellness day, 1 HÌV test and 1 flu vaccine per beneficiary. Women: Contraceptives R1 330 per family for women up to 50, subject to DSP. Age and frequency specific tests for mammogram and pap smear. Childcare: Newborns; 1 hearing screening in- or out-of-hospital. < 1 month; congenital hypothyroidism screening. < 3 years; 24/7 Babyline helpline for medical advice. 2 - 12 years; 1 GP consult. Men: 1 prostate screening between ages 45 - 69. Elderly: 1 pneumococcal vaccine per 5 years > 65 years, 1 stool test for colon cancer between 50 - 75 years. Wellness Extender of R940 per family available after completing a wellness assessment

Total Contributions
Total Contribution Main Member: 
1962.00
Total Contribution Adult: 
1501.00
Total Contribution Child*: 
575.00
BonEssential