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Bonitas 2018 BonComprehensive

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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: R13 068 Self-payment gap: R 3 810 Threshold level: R16 878 Above Threshold benefit: Unlimited

Adult dependant Savings: R12 324 Self-payment gap: R 3 150 Threshold level: R15 474 Above Threshold benefit: Unlimited

Child dependant Savings: R 2 664 Self-payment gap: R 1 450 Threshold level: R 4 114 Above Threshold benefit: Unlimited

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.

Please submit all claims you have paid while in the self-payment gap to us, so that we can keep a record.

Claims accumulate at the Bonitas Rate. Not all claims accumulate to the threshold level.

Please note: You must get a GP referral for specialist consultations (excluding consultations with oncologists and ophthalmologists; maternity consultations and consultations with paediatricians for children under age 2).

In Hospital Benefits
Are you prepared to use designated hospitals?: 
No
Hospital Rate of Payment: 
Unlimited, covered at 300% 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.

Hearing aids: 10% co-payment applies. You must use a preferred supplier.

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

Specialists: 
Specialist consultations/ treatment. Unlimited, covered at 300% 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: 
Unlimited. Pre-authorisation required.
MRI and CT scans: 
Unlimited. 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: 
Cancer treatment: R589 000 per family. R233 700 of this can be used for specialised drugs (including biological drugs). Sublimit of R42 110 per beneficiary for Brachytherapy.
Prosthesis: 

Cochlear implants R264 500 per family. You must use a preferred supplier.
Internal nerve stimulators R157 700 per family.
Internal prosthesis R52 480 per family.
External prosthesis R52 480 per family. Sublimit of R5 000 per breast prosthesis (limited to 2 per year).

 

Medical and Surgical Appliances: 
R7 990 per family. An additional R5 870 per family will apply should Stoma care and CPAP machines exceed the general medical appliances limit. You must use a preferred supplier.
Maternity Confinements: 
Private ward after delivery.
Take home Medicine: 
R520 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: 
Mental health hospitalisation, R44 650 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.
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: 
Limited to R2 880 per beneficiary. Subject to available savings and/or above threshold benefit. R19 780 per family Pre-authorisation required.
Basic dentistry: 
Paid from available savings and/or above threshold benefit.
Specialised Dentistry: 
Paid from available savings and/or above threshold benefit.
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): 
R29 840 per family. Pre-authorisation required.
Radiology and Pathology: 
R29 840 per family. 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: 
R2420 per family. Once each adult beneficiary has completed a wellness screening, you may choose from additional benefits like: Biokineticist consultation(s), Dietician consultation(s), Physiotherapy consultation(s).All claims are paid at the Bonitas Rate
Chronic Conditions
Provider: 
You can get your medicine from any pharmacy.
Chronic Conditions: 

BonComprehensive offers extensive cover for the 60 chronic conditions listed below.

This is limited to R13 170 per beneficiary and R26 240 per family on the applicable formulary. Pre-authorisation is required.

If you choose to use medicine that is not on the formulary, you will have to pay a 40% co-payment. You can get your medicine from any pharmacy.

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

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, Dermatomyositis, Obsessive Compulsive Disorder, Allergic Rhinitis, Depression, Osteoporosis, Alzheimer’s Disease (early onset), Eczema, Paget’s Disease, Ankylosing Spondylitis, Gastro-Oesophageal Reflux Disease (GORD), Panic Disorder, Anorexia Nervosa, Generalised Anxiety Disorder, Polyarteritis Nodosa, Attention Deficit Disorder (in children aged 5-18), Gout, Post-Traumatic Stress Disorder, Barrett’s Oesophagus, Huntington’s Disease, Pulmonary Interstitial Fibrosis, Behcet’s Disease, Hyperthyroidism, Psoriatic Arthritis, Bulimia Nervosa, Myaesthenia Gravis,Systemic Sclerosis, Cystic Fibrosis, Narcolepsy, Tourette’s Syndrome, Dermatitis, Neuropathies, Zollinger-Ellison Syndrome

Additional Chronic Conditions: 
33 Additional conditions covered.
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).

Men’s health: 1 prostate screening antigen test (for men between ages 55 and 69, who are considered to be at high risk for prostate cancer).

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: 
5774.00
Total Contribution Adult: 
5446.00
Total Contribution Child*: 
1175.00
BonComprehensive
Annual Medical Savings Account
Annual Medical Savings Main Member: 
13068.00
Annual Medical Savings Adult: 
12324.00
Annual Medical Savings Child*: 
2664.00
Annual Threshold Amounts
Annual Threshold Main Member: 
16878.00
Annual Threshold Adult: 
15474.00
Annual Threshold Child*: 
4114.00
Risk Contributions
Risk Contribution Main Member: 
5774.00
Risk Contribution Adult: 
5446.00
Risk Contribution Child: 
1175.00
How many times per annum do you and your dependants visit a doctor?: 
20
How much do you spend on Acute medication per annum?: 
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