User login

You are here

Home

Bonitas 2018 Standard Select

Add to compare
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 R 5 540
Main member + 1 dependant R 8 430
Main member + 2 dependants R 9 750
Main member + 3 dependants R10 650
Main member + 4 or more dependants R1 1 600

 

In Hospital Benefits
Are you prepared to use designated hospitals?: 
Yes
Hospital Rate of Payment: 
100% of Scheme Rate
Hospitals: 

You must use a hospital on the Standard Select network or you will have to pay a 30% co-payment.

 

Upfront Payments to hospitals: 

You must use a hospital on the Standard Select network or you will have to pay a 30% co-payment.

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

In Hospital Dentistry, A co-payment of R3 000 per hospital admission and admission protocols 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, 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: 
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: 
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 programme.
Joint Replacements: 
You must use the Designated Service 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.

Cochlear implants: R264 500 per family.

You must use a preferred supplier.

Medical and Surgical Appliances: 
General medical appliances(wheelchairs,crutches) R7300/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: 
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: 
R38 670 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 R3 970 (R1 290 of this can be used for non-network GP consultations)
Main member + 1 dependant R5 820 (R1 990 of this can be used for non-network GP consultations)
Main member + 2 dependants R6 450 (R2 170 of this can be used for non-network GP consultations)
Main member + 3 dependants R6 770 (R2 270 of this can be used for non-network GP consultations)
Main member + 4 or more dependants R7 350 (R2 450 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: 

R740 per beneficiary.

R2 240 per family.

Paid from available day-to-day benefits.

Optometry benefits: 
R5550/family/2 years. Eye tests, 1/beneficiary/2years at a network provider & rates OR R350/beneficiary/2years at a non-network provider. Frames R850/beneficiary/2years. Contact lenses R1850/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: 
Covered at the Bonitas Dental Tariff. 1 partial frame (an upper or lower) /beneficiary/5years. Managed Care protocols apply. 1 crown/family/year. Benefit for crowns will be granted once/tooth/5years. A treatment plan and x-rays may be requested.
Orthodontics: 

Orthodontic treatment is granted once per beneficiary, per lifetime.
Pre-authorisation cases will be clinically assessed by using an orthodontic needs analysis.
Benefi t allocation is subject to the outcome of the needs analysis and funding can be granted up to 80% 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.

Periodontics: Benefit is limited to conservative, non-surgical therapy only and will only be applied to members who are registered on the Periodontal Programme.
Managed Care protocols apply. Pre-authorisation required

MRI and CT Scans (Out of Hospital): 
R24 860 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: 
R1 670 per family. Once each adult beneficiary has completed a wellness screening, you may choose additional benefits which include Physiotherapy consultation(s)
Chronic Conditions
Provider: 
You can get your medicine from any pharmacy on our network.
Chronic Conditions: 

The Standard Option offers cover for 45 chronic conditions. Cover is limited to R9 150 per beneficiary and R18 360 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 on our network.

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

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

Additional conditions covered:

28. Acne
29. Allergic Rhinitis
30. Ankylosing Spondylitis
31. Attention Deficit Disorder (in children aged 5-18)
32. Barrett’s Oesophagus
33. Behcet’s Disease
34. Dermatitis
35. Depression
36. Eczema
37. Gastro-Oesophageal Refl ux Disease (GORD)
38. Generalised Anxiety Disorder
39. Gout
40. Narcolepsy
41. Obsessive Compulsive Disorder
42. Panic Disorder
43. Post-Traumatic Stress Disorder
44. Tourette’s Syndrome
45. Zollinger-Ellison Syndrome

Additional Chronic Conditions: 
18 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).

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: 
2828.00
Total Contribution Adult: 
2447.00
Total Contribution Child*: 
828.00
Bonitas 2018 Standard Select
Risk Contributions
Risk Contribution Main Member: 
2828.00
Risk Contribution Adult: 
2447.00
Risk Contribution Child: 
828.00
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?: 
More than R 5000
Will you or any of your dependants require specialised Dentistry: 
Yes