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Bonitas 2018 BonClassic

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Type of Medical Aid Plan: 
New Generation
Medical Aid Year: 
2018
Day to day Benefits: 

These benefits provide cover for consultations with your GP or specialist, acute medicine, x-rays, blood tests and other out-of-hospital medical expenses.

Savings Main member: R 6 804

Adult dependant: R 5 844

Child dependant: R 1 680

In Hospital Benefits
Are you prepared to use designated hospitals?: 
Yes
Hospital Rate of Payment: 
Unlimited, network specialists covered in full Unlimited, non-network specialists paid at 100% of the Bonitas Rate.
Hospitals: 

Members have access to all private hospitals. A 30% co-payment may apply to admissions at specific 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.

Spinal Surgery. You will have to pay a R5 650 co-payment if you do not go for an assessment through the back and neck program.

Hip and knee replacements. You will have to pay a R5 650 co-payment if you do not use the preferred provider.

 

 

Specialists: 
Unlimited, network specialists covered in full. Unlimited, non-network specialists paid at 100% of the Bonitas Rate.
Other healthcare professionals eg. Physio, Occupational, Dietician: 
Unlimited, covered at 100% of the Bonitas Rate. Your therapist must get a referral from the doctor treating you in hospital.
Radiology and pathology: 
R27 610 per family, in and out of hospital. Pre-authorisation required.
MRI and CT scans: 
R27 610 per family, in and out of hospital. Pre-authorisation required.
Dialysis: 
Unlimited. You must use a Designated Service Provider, or a 20% co-payment will apply.
Organ Transplants: 
Unlimited. Sublimit of R30 000 per beneficiary for corneal grafts.
Oncology / Cancer: 
R390 900 per family. You must use a preferred provider. Sublimit of R42 110 per beneficiary for Brachytherapy.
Neck and Back Operations: 
Spinal Surgery. You will have to pay a R5 650 co-payment if you do not go for an assessment through the back and neck program.
Joint Replacements: 
Hip and knee replacements. You will have to pay a R5 650 co-payment if you do not use the preferred provider.
Prosthesis: 

Internal and external prostheses, R52 000 per family.

Managed Care protocols apply.

Sublimit of R5 000 per breast prosthesis (limited to 2 per year).

You must use a preferred supplier.

Medical and Surgical Appliances: 
R7 410 per family.
Take home Medicine: 
R445 per beneficiary, per hospital stay.
Rehabilitation, Hospice and Step-down facilities: 
Physical rehabilitation, R47 250 per family. Alternatives to hospital (hospice, step-down facilities) R15 760 per family.
Treatment for Mental Health: 
R39 250 per family. No cover for physiotherapy for mental health admissions. You must use a Designated Service Provider.
HIV / AIDS: 
Unlimited, if you register on the HIV/AIDS programme. Chronic medicine must be obtained from the Designated Service Provider.
International Travel Benefit: 
International travel benefit of up to R10 million per family per trip.
Day-to-day benefits
GP consultations: 

Paid from available savings.

Specialist consultations: 

Paid from available savings. You must get a referral from your GP.

Acute medicine: 

Paid from available savings.

Over-the-counter (OTC) Medicine: 

Paid from available savings.

Optometry benefits: 
R5 300 per family, once every 2 years (based on the date of your previous claim). Each beneficiary can choose glasses or contact lenses.
Basic dentistry: 
R4 450 per family, per year. Covered at the Bonitas Dental Tariff. 2 annual check-ups per beneficiary (once every 6 months).
Specialised Dentistry: 
R5 350 per family, per year. Covered at the Bonitas Dental Tariff.
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 granted up to 100% of the Bonitas Dental Tariff.

Benefit for orthodontic treatment will be granted where function is impaired (not granted for cosmetic reasons).

Only 1 family member may begin orthodontic treatment in a calendar year. Benefit for fixed comprehensive treatment is limited to beneficiaries from age 9 and younger than 18 years.

Managed Care protocols apply. Pre-authorisation required.

MRI and CT Scans (Out of Hospital): 
R27 610 per family, in and out of hospital. Pre-authorisation required.
Radiology and Pathology: 
R27 610 per family, in and out of hospital. Pre-authorisation required.
Pregnancy benefits: 
12 antenatal consultations with a gynaecologist, GP or midwife. 2 2D ultrasound scans. R1 160 for antenatal classes. 1 amniocentesis. 4 consultations with a midwife after delivery. A Bonitas baby bag.
Physiotherapy and Occupational Therapy day to day: 
Physical therapy (such as physiotherapists and biokineticists) R1 460 per beneficiary, R2 960 per family.
Chronic Conditions
Provider: 
You can get your medicine from any pharmacy on our network.
Chronic Conditions: 

BonClassic offers generous cover for 47 chronic conditions.

Cover is limited to R10 790 per beneficiary and R22 320 per family on the applicable formulary.

If you choose to use medicine that is not on the formulary, you will have to pay a 40% co-payment.

Pre-authorisation is required. You can get your medicine from any pharmacy on our network.

Once the amount above is finished, you will still be covered for the 27 Prescribed Minimum Benefits, listed below, from our Designated Service Provider.

If you choose not to use the Designated Service Provider, you will have to pay a 40% co-payment.

Please note: For HIV/AIDS medicine, you must use the Designated Service Provider or you will have to pay a 40% co-payment.

Prescribed Minimum Benefits covered Addison’s Disease, Hyperlipidaemia, Asthma, Diabetes Insipidus, Hypertension, Bipolar Mood Disorder, Diabetes Type 1, Hypothyroidism, Bronchiectasis, Diabetes Type 2, Multiple Sclerosis, Cardiac Failure, Dysrhythmias, Parkinson’s Disease, Cardiomyopathy, Epilepsy, Rheumatoid Arthritis, Chronic Obstructive Pulmonary Disease, Glaucoma, Schizophrenia, Chronic Renal Disease, Haemophilia, Systemic Lupus Erythematosus, Coronary Artery Disease, Crohn’s Disease, HIV/AIDS, Ulcerative Colitis Additional conditions covered Alzheimer’s Disease (early onset), Gastro-Oesophageal Refl ux Disease (GORD), Polyarteritis Nodosa, Ankylosing Spondylitis, Generalised Anxiety Disorder, Pulmonary Interstitial Fibrosis, Attention Deficit Disorder (in children aged 5-18), Gout, Post-Traumatic Stress Disorder, Barrett's Oesophagus, Obsessive Compulsive Disorder, Scleroderma, Benign Prostatic Hypertrophy, Osteoporosis, Tourette's Syndrome, Depression, Paget's Disease, Zollinger-Ellison Syndrome, Eczema, Panic Disorder

Preventative Care Benefits
Preventative Benefits: 

Preventative care.

General health: 1 HIV test per beneficiary, 1 flu vaccine per beneficiary.

Cardiac health: 1 full lipogram every 5 years (for members aged 20 and over).

Women’s health: 1 mammogram every 2 years (for women between ages 40 and 74), 1 pap smear every 3 years (for women between ages 21 and 65).

Elderly health: 1 pneumococcal vaccine every 5 years (for members aged 65 and over), 1 stool test for colon cancer (for members between ages 50 and 75), 1 bone density screening every 5 years (for women aged 65 and over and men aged 70 and over).

Total Contributions
Total Contribution Main Member: 
4009.00
Total Contribution Adult: 
3442.00
Total Contribution Child*: 
990.00
BonClassic
Annual Medical Savings Account
Annual Medical Savings Main Member: 
6804.00
Annual Medical Savings Adult: 
5844.00
Annual Medical Savings Child*: 
1680.00
Risk Contributions
Risk Contribution Main Member: 
4009.00
Risk Contribution Adult: 
3442.00
Risk Contribution Child: 
990.00
How many times per annum do you and your dependants visit a doctor?: 
10
How much do you spend on Acute medication per annum?: 
More than R 5000
How much do you spend on Chronic medication per annum?: 
More than R 5000
Will you or any of your dependants require specialised Dentistry: 
Yes