User login

You are here

Home

BONITAS BONCOMPLETE 2019

Add to compare
Type of Medical Aid Plan: 
Threshold
Medical Aid Year: 
2019
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: R6 432 Self-payment gap: R1 740  Above Threshold benefit: R4 610

Adult dependant Savings: R5 148 Self-payment gap: R1 470 Above Threshold benefit: R2 720

Child dependant Savings: R 1 752 Self-payment gap: R 375  Above Threshold benefit: R1 180

Once your savings for the year are finished, you will need to pay for day-to-day medical expenses
yourself, until you have paid the full self-payment gap. You will then have access to your above
threshold benefit. Please submit all claims you have paid towards the self-payment gap to us, so
that we can let you know when you have access to your above threshold benefit.

In Hospital Benefits
Hospital Rate of Payment: 
consultations & treatment at 100% 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.

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

Specialists: 
Paid from available savings or above threshold benefit You must get a referral from your GP
Other healthcare professionals eg. Physio, Occupational, Dietician: 
Paid from available savings or above threshold benefit
Radiology and pathology: 
R23 330 per family, in and out-of-hospital Pre-authorisation required
MRI and CT scans: 
R23 330 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 R31 500 per beneficiary for corneal grafts
Oncology / Cancer: 
R344 500 per family You must use a preferred provider Sublimit of R44 220 per beneficiary for Brachytherapy
Neck and Back Operations: 
You will have to pay a R6 000 co-payment if you do not go for an assessment through the back and neck programme
Joint Replacements: 
You will have to pay a R6 000 co-payment if you do not use the preferred provider
Prosthesis: 

Internal and external
prostheses

R44 210 per family
Managed Care protocols apply
Sublimit of R5 250 per breast prosthesis (limited to 2 per year)
You must use a preferred supplier

 

 

Medical and Surgical Appliances: 
Paid from available savings or above threshold benefit You must use a preferred supplier
In Hospital Dentistry: 
A co-payment of R3 500 per hospital admission and admission protocols apply General anaesthetic is only available to children under the age of 5 for extensive dental treatment Managed Care protocols apply Pre-authorisation required
Take home Medicine: 
R410 per beneficiary, per hospital stay
Rehabilitation, Hospice and Step-down facilities: 
Physical rehabilitation R49 610 per family Alternatives to hospital (hospice, step-down facilities) R16 550 per family
Treatment for Mental Health: 
R32 210 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: 
R5 million per beneficiary R10 million per family Including cover for mandatory vaccines You must register for this benefit
Day-to-day benefits
GP consultations: 

Paid from available savings and/or above threshold benefit.

Specialist consultations: 

Paid from available savings and/or above threshold benefit.

Acute medicine: 

Paid from available savings and/or above threshold benefit.

Over-the-counter (OTC) Medicine: 

Paid from available savings and/or above threshold benefit.

Optometry benefits: 
Paid from available savings, once every 2 years (based on the date of your previous claim) Each beneficiary can choose glasses or contact lenses
Basic dentistry: 
Covered at the Bonitas Dental Tariff 2 annual check-ups per beneficiary (once every 6 months)
Specialised Dentistry: 
Covered at the Bonitas Dental Tariff
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 65% 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): 
R23 330 per family, in and out-of-hospital Pre-authorisation required
Radiology and Pathology: 
R23 330 per family, in and out-of-hospital Pre-authorisation required
Pregnancy benefits: 
6 antenatal consultations with a gynaecologist, GP or midwife 2 2D ultrasound scans R1 220 for antenatal classes 1 amniocentesis 4 consultations with a midwife after delivery A Bonitas baby bag (you must register for this after obtaining pre-authorisation
Physiotherapy and Occupational Therapy day to day: 
Paramedical/Allied medical professionals (such as physiotherapists, occupational therapists, dieticians and biokineticists) Paid from available savings and/or above threshold benefit.
Chronic Conditions
Provider: 
You must use our Designated Service Provider to get your medicine. 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: 

BonComplete offers cover for 31 chronic conditions, using the applicable formulary.
Pre-authorisation is required.
You must use Pharmacy Direct, our Designated Service Provider, to get your medicine. If you choose
not to use Pharmacy Direct or if you choose to use medicine that is not on the formulary, you will
have to pay a 40% co-payment.

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 (children up to 21 years), Allergic Dermatitis/Eczema (children up to 21 years), Attention Deficit Disorder(in children aged 5-18), Allergic Rhinitis (children up to 21 years)

Preventative Care Benefits
Preventative Benefits: 

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 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: 
3581.00
Total Contribution Adult: 
2868.00
Total Contribution Child*: 
973.00
BonComplete
Annual Medical Savings Account
Annual Medical Savings Main Member: 
6432.00
Annual Medical Savings Adult: 
5148.00
Annual Medical Savings Child*: 
1752.00
Annual Threshold Amounts
Above Threshold Benefit Limits
Above Threshold Benefit Main Member: 
4610.00
Above Threshold Benefit Adult: 
2720.00
Above Threshold Benefit Child*: 
1180.00
Risk Contributions
Risk Contribution Main Member: 
3581.00
Risk Contribution Adult: 
2868.00
Risk Contribution Child: 
973.00
Medical Aid Plan Name Term: 
Any