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BONITAS BONCAP R8 031 to R13 050 - 2019

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Medical Aid Year: 
2019
In Hospital Benefits
Hospital Rate of Payment: 
100% of Scheme Rate
Hospitals: 

Hospitalisation is covered at 100% of the Bonitas Rate at all hospitals on the BonCap Network. You
must get pre-authorisation for your hospital admission. You will have to pay a R6 700 co-payment if
you use a non-network hospital (except for emergencies) or you do not get pre-authorisation within
48 hours of admission.

Upfront Payments to hospitals: 

You will have to pay a R6 700 co-payment if
you use a non-network hospital

Specialists: 
Unlimited, covered at 100% of the Bonitas Rate
Other healthcare professionals eg. Physio, Occupational, Dietician: 
R4 340 per family Your therapist must have a referral from the doctor treating you
Radiology and pathology: 
R11 610 per family Pre-authorisation required
MRI and CT scans: 
Pre-authorisation required for MRIs and CT scans
Dialysis: 
Unlimited. You must use a Designated Service Provider, or a 20% co-payment will apply Pre-authorisation required.
Organ Transplants: 
Unlimited Pre-authorisation required
Oncology / Cancer: 
PMB only. Subject to using the Designated Service Provider.
Neck and Back Operations: 
Not covered.
Joint Replacements: 
Not covered.
Prosthesis: 

Internal and external
prostheses

PMB only
Managed Care protocols apply
Pre-authorisation required
You must use a preferred supplier

Medical and Surgical Appliances: 
R5 440 per family You must use a preferred supplier
Maternity Confinements: 
100% scheme tariff
In Hospital Dentistry: 
PMB only Pre-authorisation from DENIS required
Take home Medicine: 
R380 per beneficiary, per hospital stay
Rehabilitation, Hospice and Step-down facilities: 
R14 280 per family Pre-authorisation required
Treatment for Mental Health: 
R49 610 per family Pre-authorisation required
HIV / AIDS: 
Unlimited, if you register on the HIV/AIDS programme Chronic medicine must be obtained from Pharmacy Direct
International Travel Benefit: 
No benefit
Day-to-day benefits
GP consultations: 

Network GP consultations

Unlimited consultations, using a maximum of 2 network GPs
Approval is required from the 8th GP consultation per
beneficiary

Non-network GP
consultations

1 out-of-network consultation per beneficiary
Maximum of 2 consultations per family, limited to R1 050
20% co-payment applies

Specialist consultations: 

Specialist consultations
(this benefit includes prescribed
acute medicine, blood tests,
x-rays, MRIs and CT scans)

Limited to 3 visits or R3 110 per beneficiary
Limited to 5 visits or R4 620 per family
Subject to referral from a network GP
Pre-authorisation required for MRIs and CT scans

Acute medicine: 

GP-referred acute
medicine, x-rays and blood
tests

Main member only  R1 840
Main member + 1 dependant  R3 060
Main member + 2 dependants  R3 660
Main member + 3 dependants  R4 000
Main member + 4 or more dependants  R4 440

 

Over-the-counter (OTC) Medicine: 

Limited to R95 per event

Maximum of R265 per beneficiary, per year

Optometry benefits: 
You must use the contracted service provider Managed Care protocols apply
Basic dentistry: 
You must use a provider on the DENIS network. Covered at the Bonitas Dental Tariff. Managed Care protocols apply. 1 consultation /beneficiary/year. 1 specific (emergency) consultation for pain and sepsis /beneficiary. Emergency root canal therapy.
Specialised Dentistry: 
No benefit
Orthodontics: 

No benefit

MRI and CT Scans (Out of Hospital): 
Limited to 3 visits or R3 110 per beneficiary Limited to 5 visits or R4 620 per family Subject to referral from a network GP Pre-authorisation required for MRIs and CT scans
Radiology and Pathology: 
Limited to 3 visits or R3 110 per beneficiary Limited to 5 visits or R4 620 per family Subject to referral from a network GP Pre-authorisation required for MRIs and CT scans
Pregnancy benefits: 
Antenatal consultations are subject to the GP consultations and specialist consultations benefits 4 consultations with a midwife after delivery
Physiotherapy and Occupational Therapy day to day: 
No benefit
Chronic Conditions
Provider: 
If you do not use the Desginated Service Provider or if you use medicine that is not on the formulary, you will have to pay a 40% co-payment
Chronic Conditions: 

BonCap ensures that you are covered for the 27 Prescribed Minimum Benefits listed below. You

must use Pharmacy Direct, our Designated Service Provider, to get your medicine.

 

1. Addison’s Disease 10. Crohn’s Disease 19. Hyperlipidaemia
2. Asthma 11. Diabetes Insipidus 20. Hypertension
3. Bipolar Mood Disorder 12. Diabetes Type 1 21. Hypothyroidism
4. Bronchiectasis 13. Diabetes Type 2 22. Multiple Sclerosis
5. Cardiac Failure 14. Dysrhythmias 23. Parkinson’s Disease
6. Cardiomyopathy 15. Epilepsy 24. Rheumatoid Arthritis
7. Chronic Obstructive
Pulmonary Disease

16. Glaucoma 25. Schizophrenia
8. Chronic Renal Disease 17. Haemophilia 26. Systemic Lupus
Erythematosus
9. Coronary Artery Disease 18. HIV/AIDS 27. Ulcerative Colitis

Additional Chronic Conditions: 
No benefit
Preventative Care Benefits
Preventative Benefits: 

General health 1 HIV test per beneficiary
1 flu vaccine per beneficiary

Women’s health 1 mammogram every 2 years, for women over 40
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 45 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

Total Contributions
Total Contribution Main Member: 
1226.00
Total Contribution Adult: 
1159.00
Total Contribution Child*: 
563.00
Bonitas 2019 Boncap R8 031 to R13 050
Medical Aid Plan Name Term: 
Any