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Bonitas 2018 Primary

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

Out-of-hospital claims will be paid from available day-to-day benefits. There is a separate benefit for GP consultations. 

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

There is a separate benefit for tests and consultations for PMB treatment plans (excluding GP consultations). Therefore this will not affect your day-to-day benefits.

Main member only R2 010
Main member + 1 dependant R3 600
Main member + 2 dependants R4 230
Main member + 3 dependants R4 550
Main member + 4 or more dependants R4 920

In Hospital Benefits
Are you prepared to use designated hospitals?: 
No
Hospital Rate of Payment: 
100% of Scheme Rate
Hospitals: 

Members have access to all private 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.

Unlimited, consultations & treatment at 100% - network doctors and specialists paid in full.

Upfront Payments to hospitals: 

A 30% co-payment may apply to admissions at specific hospitals.

In Hospital Dentistry, A co-payment of R3 000 per hospital admission and admission protocols 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.
MRI and CT scans: 
R12 380 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: 
PMB only.
Oncology / Cancer: 
R157 600 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 prostheses: R30 000 per family (excluding joint replacement prostheses).

Managed Care protocols apply. You must use a preferred supplier.

 

Medical and Surgical Appliances: 
General medical appliances(wheelchairs,crutches) R6560/family. An additional R6240/family will apply should Stoma care & CPAP machines exceed the general medical appliances limit. Hearing aids, R15240/family/2years, 20% co-payment. Preferred suppliers.
In Hospital Dentistry: 
A co-payment of R3 000 per hospital admission and admission protocols apply. General anaesthetic only for children < 5 for extensive dental treatment. General anaesthetic benefit is available for the removal of impacted teeth. Managed Care protocols apply
Take home Medicine: 
R360 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: 
R15 080 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: 

If you do not use a GP on our network, your benefit for GP consultations will be limited to the non-network GP consultation benefit. This is shown in the table below.

Main member only R1 900 (R615 of this can be used for non-network GP consultations)
Main member + 1 dependant R3 490 (R1 160 of this can be used for non-network GP consultations)
Main member + 2 dependants R4 130 (R1 320 of this can be used for non-network GP consultations)
Main member + 3 dependants R4 440 (R1 480 of this can be used for non-network GP consultations)
Main member + 4 or more dependants R5 030 (R1 750 of this can be used for non-network GP consultations)

Specialist consultations: 

Paid from available day-to-day benefits. You must get a referral from your GP.

Acute medicine: 

Paid from available day-to-day benefits.

Over-the-counter (OTC) Medicine: 

R465 per beneficiary.

R1360 per family.

Paid from available day-to-day benefits.

Optometry benefits: 
R4270/family/2 years. Eye tests, 1/beneficiary/2years at a network provider & rates OR R350/beneficiary/2years at a non-network provider. Frames R350/beneficiary/2years. Contact lenses R1225/beneficiary. Lenses 100% network rates or non network limits.
Basic dentistry: 
Covered at the Bonitas Dental Tariff. 2 annual check-ups/beneficiary/6 months. X-rays: Intra-oral, Root canal and extractions, Managed Care protocols apply. X-rays: Extra-oral 1/beneficiary/3 years. Fillings, once per tooth, in 365 days.
Specialised Dentistry: 
No Benefit.
Orthodontics: 

No Benefit.

MRI and CT Scans (Out of Hospital): 
R12 380 per family, in and out of hospital. Pre-authorisation required.
Radiology and Pathology: 
Paid from available day-to-day benefits.
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: 
R1210 per family. Once each adult beneficiary has completed a wellness screening, you may choose 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: 

The Primary Option 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.

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: 
2076.00
Total Contribution Adult: 
1624.00
Total Contribution Child*: 
661.00
Bonitas 2018 Primary
Risk Contributions
Risk Contribution Main Member: 
2076.00
Risk Contribution Adult: 
1624.00
Risk Contribution Child: 
661.00
How many times per annum do you and your dependants visit a doctor?: 
5
How much do you spend on Acute medication per annum?: 
Less than R 1000
How much do you spend on Chronic medication per annum?: 
R1000 - R4999
Will you or any of your dependants require specialised Dentistry: 
No