BONITAS STANDARD 2019

Type of Medical Aid Plan:

Traditional

Medical Aid Year:

2019

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 5 820
Main member + 1 dependant R 8 850
Main member + 2 dependants R10 240
Main member + 3 dependants R11 180
Main member + 4 or more dependants R12 180

In Hospital Benefits

Hospital Rate of Payment:

100% of Scheme Rate

Hospitals:

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.

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:

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

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:

R26 100 per family, in and out-of-hospital Pre-authorisation required

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:

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

Cochlear implants R277 700 per family You must use a preferred supplier

Medical and Surgical Appliances:

R7 670 per family An additional R6 550 per family will apply should Stoma Care and CPAP machines exceed the general medical appliances limit You must use a preferred supplier

In Hospital Dentistry:

A co-payment of R3 500 per hospital admission and admission protocols apply

Take home Medicine:

R380 per beneficiary, per hospital stay

Rehabilitation, Hospice and Step-down facilities:

R380 per beneficiary, per hospital stay. Alternatives to hospital (hospice, step-down facilities) R16 550 per family

Treatment for Mental Health:

R40 600 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:

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 R4 170 (R1 350 of this can be used for
non-network GP consultations)
Main member + 1 dependant R6 110 (R2 090 of this can be used for
non-network GP consultations)
Main member + 2 dependants R6 770 (R2 280 of this can be used for
non-network GP consultations)
Main member + 3 dependants R7 110 (R2 380 of this can be used for
non-network GP consultations)
Main member + 4 or more dependants R7 720 (R2 570 of this can be used for
non-network GP consultations)

Specialist 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:

R775 per beneficiary
R2 350 per family
Paid from available day-to-day benefits

Optometry benefits:

R5 825 per family, 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

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 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

MRI and CT Scans (Out of Hospital):

R26 100 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 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-authorisatio

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:

Standard offers generous cover for the 45 chronic conditions listed below. Your chronic medicine
benefit is R9 610 per beneficiary and R19 280 per family on the applicable formulary. 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. Pre-authorisation is required.
Once the amount above is finished, you will still be covered for the 27 Prescribed Minimum Benefits,
listed below, through Pharmacy Direct our Designated Service Provider. If you choose not to use
Pharmacy Direct, you will have to pay a 40% co-payment.

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 conditions covered
28. Acne 34. Dermatitis 40. Narcolepsy
29. Allergic Rhinitis 35. Depression 41. Obsessive Compulsive
Disorder
30. Ankylosing Spondylitis 36. Eczema 42. Panic Disorder
31. Attention Deficit
Disorder
(in children aged 5-18)

37. Gastro-Oesophageal
Reflux Disease
(GORD)

43. Post-Traumatic Stress
Disorder

32. Barrett’s Oesophagus 38. Generalised Anxiety
Disorder

44. Tourette’s Syndrome
33. Behcet’s Disease 39. Gout 45. Zollinger-Ellison
Syndrome

Additional Chronic Conditions:

18 additional conditions covered.

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:

3556.00

Total Contribution Adult:

3083.00

Total Contribution Child*:

1043.00

Bonitas 2019 Standard

Risk Contributions

Risk Contribution Main Member:

3556.00

Risk Contribution Adult:

3083.00

Risk Contribution Child:

1043.00

Medical Aid Plan Name Term:

Any

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BONITAS STANDARD 2019