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Bonitas 2018 Hospital Standard

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

Not applicable.

In Hospital Benefits
Are you prepared to use designated hospitals?: 
No
Hospital Rate of Payment: 
Unlimited, consultations & treatment at 100%.
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.

A co-payment will apply to the following procedures in hospital:

R1 380 co-payment:

Colonoscopy, Conservative Back Treatment, Cystoscopy, Facet Joint Injections, Flexible Sigmoidoscopy, Functional Nasal Surgery, Gastroscopy, Hysteroscopy(not Endometrial Ablation), Myringotomy, Tonsillectomy and Adenoidectomy, Umbilical Hernia Repair, Varicose Vein Surgery.

R3 500 co-payment:

Arthroscopy, Diagnostic Laparoscopy, Laparoscopic Hysterectomy, Laparoscopic Appendectomy, Percutaneous Radiofrequency Ablations (Percutaneous Rhizotomies).

R6 900 co-payment:

Back Surgery including Spinal Fusion, Joint Replacements, Laparoscopic Pyeloplasty, Laparoscopic Radical Prostatectomy, Nissen Fundoplication (Reflux Surgery).

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: 
Unlimited, covered at 100% of the Bonitas Rate.
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy): 
R1 380 co-payment.
MRI and CT scans: 
R24 860 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: 
Back Surgery including Spinal Fusion, R6 900 co-payment
Joint Replacements: 
R6 900 co-payment.
Prosthesis: 

Internal prosthesis:
R42 100 per family.  Managed Care protocols apply. You must use a preferred supplier.

External prosthesis:
PMB only. Managed Care protocols apply. You must use a preferred supplier.

 

In Hospital Dentistry: 
General anaesthetic is only available to children under the age of 5 years for extensive dental treatment. General anaesthetic benefits are available for the removal of impacted teeth. R3 000 co-payment for hospital admissions Managed Care protocols apply
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: 
R30 680 per family. Physiotherapy will be excluded for all 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. R5 million per beneficiary. Including cover for mandatory vaccines. You must register for this benefit.
Day-to-day benefits
GP consultations: 

Not applicable.

On Wellness extender. R1 210 per family. Once each adult beneficiary has completed a wellness screening, you may choose from additional benefits which include GP consultation(s).

Specialist consultations: 

Not applicable.

Acute medicine: 

Not applicable.

Over-the-counter (OTC) Medicine: 

Not applicable.

Optometry benefits: 
Not applicable.
Basic dentistry: 
Not applicable.
Specialised Dentistry: 
Not applicable.
Orthodontics: 

Not applicable.

MRI and CT Scans (Out of Hospital): 
R24 860 per family, in and out of hospital. Pre-authorisation required.
Radiology and Pathology: 
Not applicable.
Pregnancy benefits: 
6 antenatal consultations with a gynaecologist, GP or midwife. 2 2D ultrasound scans. 1 amniocentesis. 4 consultations with a midwife after delivery. A Bonitas baby bag.
Physiotherapy and Occupational Therapy day to day: 
Wellness extender. R1210 per family. Once each adult beneficiary has completed a wellness screening, you may choose from additional benefits which include Physiotherapy consultation(s).
Chronic Conditions
Provider: 
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: 

Hospital Standard ensures that you are covered for the 27 Prescribed Minimum Benefi ts listed below on the applicable formulary.

Pre-authorisation is required.

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:

1. Addison’s Disease
2. Asthma
3. Bipolar Mood Disorder
4. Bronchiectasis
5. Cardiac Failure
6. Cardiomyopathy
7. Chronic Obstructive Pulmonary Disease
8. Chronic Renal Disease
9. Coronary Artery Disease
10. Crohn’s Disease
11. Diabetes Insipidus
12. Diabetes Type 1
13. Diabetes Type 2
14. Dysrhythmias
15. Epilepsy
16. Glaucoma
17. Haemophilia
18. HIV/AIDS
19. Hyperlipidaemia
20. Hypertension
21. Hypothyroidism
22. Multiple Sclerosis
23. Parkinson’s Disease
24. Rheumatoid Arthritis
25. Schizophrenia
26. Systemic Lupus Erythematosus
27. Ulcerative Colitis

Preventative Care Benefits
Preventative Benefits: 

Preventative care.

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

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: 
1830.00
Total Contribution Adult: 
1543.00
Total Contribution Child*: 
696.00
Bonitas 2018 Hospital Standard
Risk Contributions
Risk Contribution Main Member: 
1830.00
Risk Contribution Adult: 
1543.00
Risk Contribution Child: 
696.00
How many times per annum do you and your dependants visit a doctor?: 
0
How much do you spend on Acute medication per annum?: 
0
How much do you spend on Chronic medication per annum?: 
Less than R 1000
Will you or any of your dependants require specialised Dentistry: 
No