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BONITAS HOSPITAL STANDARD 2019

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Type of Medical Aid Plan: 
Hospital
Medical Aid Year: 
2019
Day to day Benefits: 

Not applicable.

In Hospital Benefits
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 450 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 680 co-payment:

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

R7 250 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 at the Bonitas Rate 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 450 co-payment
MRI and CT scans: 
R26 100 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: 
R7 250 co-payment
Joint Replacements: 
R7 250 co-payment
Prosthesis: 

Internal prosthesis

R44 210 per family (excluding joint replacement prosthesis)
Managed Care protocols apply
You must use a preferred supplier

In Hospital Dentistry: 
R3 500 co-payment for hospital admissions Managed Care protocols apply
Take home Medicine: 
R465 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 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 Pharmacy Direct
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: 

Not applicable.

R1 270 per family which can be used for consultations and
treatment

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): 
R26 100 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 (you must register for this after obtaining pre-authorisation for the delivery)
Physiotherapy and Occupational Therapy day to day: 
R1 270 per family which can be used for consultations and treatment
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 Benefits listed
below on the applicable formulary. 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
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

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: 
2040.00
Total Contribution Adult: 
1720.00
Total Contribution Child*: 
776.00
Bonitas 2019 Hospital Standard
Risk Contributions
Risk Contribution Main Member: 
2040.00
Risk Contribution Adult: 
1720.00
Risk Contribution Child: 
776.00
Medical Aid Plan Name Term: 
Any