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Bonitas 2018 BonComplete

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Type of Medical Aid Plan: 
Threshold
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.

Main member : Savings: R5 772 Self-payment gap: R1 660 Threshold level: R7 432 Above Threshold benefit: R4 390

Adult dependant Savings: R4 620 Self-payment gap: R1 400 Threshold level: R6 020 Above Threshold benefit: R2 590

Child dependant Savings: R 1 572 Self-payment gap: R 355 Threshold level: R1 927 Above Threshold benefit: R1 120

Once your savings for the year are finished, you will need to pay for day-to-day medical expenses out of your own pocket until you have paid the full self-payment gap.

You will then reach the threshold level and have access to your above threshold benefit.

 

In Hospital Benefits
Are you prepared to use designated hospitals?: 
No
Hospital Rate of Payment: 
Unlimited, consultations & treatment at 100% - network doctors and specialists paid in full.
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.

Dialysis: Unlimited. You must use a Designated Service Provider, or a 20% co-payment will apply.

 

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, network specialists covered in full. Unlimited, non-network specialists paid at 100% of the Bonitas Rate.
Radiology and pathology: 
R22 220 per family, in and out of hospital. Pre-authorisation required.
MRI and CT scans: 
R22 220 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: 
R328 100 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, R42 100 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: 
Paid from available savings and/or above threshold benefit. You must use a preferred supplier.
Take home Medicine: 
R390 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: 
R30 680 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: 
R5 million per beneficiary, R10 million per family Per trip Including cover for mandatory vaccines You must register for this benefit.
Day-to-day benefits
GP consultations: 

Paid from available savings and/or above threshold benefit.

Specialist consultations: 

Paid from available savings and/or above threshold benefit. You must get a referral from your GP.

Acute medicine: 

Paid from available savings and/or above threshold benefit.

Over-the-counter (OTC) Medicine: 

Paid from available savings and/or above threshold benefit.

Optometry benefits: 
Paid from available savings, once every 2 years (based on the date of your previous claim). Each beneficiary can choose glasses or contact lenses.
Basic dentistry: 
Covered at the Bonitas Dental Tariff. 2 annual check-ups per beneficiary (once every 6 months).
Specialised Dentistry: 
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): 
R22 220 per family, in and out of hospital. Pre-authorisation required.
Radiology and Pathology: 
R22 220 per family, in and out of hospital. Pre-authorisation required.
Pregnancy benefits: 
6 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: 
Paramedical/Allied medical professionals (such as physiotherapists, occupational therapists, dieticians and biokineticists) Paid from available savings and/or above threshold benefit.
Chronic Conditions
Provider: 
You must use our Designated Service Provider to get your medicine. If you choose not to use the Designated Service Provider or if you choose to use medicine that is not on the formulary, you will have to pay a 40% co-payment.
Chronic Conditions: 

BonComplete off ers cover for 31 chronic conditions, using the applicable formulary.

Pre-authorisation is required. You must use our Designated Service Provider to get your medicine. If you choose not to use the Designated Service Provider or if you choose to use medicine that is not on the formulary, 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 Acne (children up to 21 years), Allergic Dermatitis/Eczema (children up to 21 years), Attention Deficit Disorder(in children aged 5-18), Allergic Rhinitis (children up to 21 years)

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).

Total Contributions
Total Contribution Main Member: 
3212.00
Total Contribution Adult: 
2572.00
Total Contribution Child*: 
873.00
BonComplete
Annual Medical Savings Account
Annual Medical Savings Main Member: 
5772.00
Annual Medical Savings Adult: 
4620.00
Annual Medical Savings Child*: 
1572.00
Annual Threshold Amounts
Annual Threshold Main Member: 
7432.00
Annual Threshold Adult: 
6020.00
Annual Threshold Child*: 
1927.00
Above Threshold Benefit Limits
Above Threshold Benefit Main Member: 
4390.00
Above Threshold Benefit Adult: 
2590.00
Above Threshold Benefit Child*: 
1120.00
Risk Contributions
Risk Contribution Main Member: 
3212.00
Risk Contribution Adult: 
2572.00
Risk Contribution Child: 
873.00
How many times per annum do you and your dependants visit a doctor?: 
20
How much do you spend on Acute medication per annum?: 
R1000 - R4999
How much do you spend on Chronic medication per annum?: 
R1000 - R4999
Will you or any of your dependants require specialised Dentistry: 
Yes