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Bonitas 2018 BonSave

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Type of Medical Aid Plan: 
Traditional
Medical Aid Year: 
2018
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.

Savings

Main member: R4 428

Adult dependant: R3 432

Child dependant: R1 332

 

In Hospital Benefits
Are you prepared to use designated hospitals?: 
No
Hospital Rate of Payment: 
Unlimited, consultations & treatment at 150% - network doctors and specialists paid in full.
Hospitals: 

Members have access to all private hospitals. A 30% co-payment may apply to admissions at specific hospitals.

Unlimited, consultations & treatment at 150% - 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.

A co-payment will apply to the following procedures in hospital:

R1 380 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 500 co-payment:

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

R6 900 co-payment:

Back Surgery including Spinal Fusion, Joint Replacements, Laparoscopic Pyeloplasty, Laparoscopic Radical Prostatectomy, Nissen Fundoplication (Reflux Surgery).

 

 

Specialists: 
Unlimited, covered at 150% 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.
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy): 
R1 380 co-payment.
MRI and CT scans: 
R22 220 per family, in and out of hospital.
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: 
R6 900 co-payment. Back Surgery including Spinal Fusion
Joint Replacements: 
R6 900 co-payment.
Prosthesis: 

Internal prosthesis R30 000 per family.

Medical and Surgical Appliances: 
General medical appliances(such as wheelchairs and crutches) R6 560 per family. An additional R6 240 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 000 per hospital admission and admission protocols apply. General anaesthetic is only available to children under the age of 5 for extensive dental treatment General anaesthetic benefit is available for the removal of impacted teeth.
Take home Medicine: 
R360 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: 
R30 680 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 benefi t of up to R10 million per family per trip.
Day-to-day benefits
GP consultations: 

Paid from available savings.

Additional GP consultations. 
If you use all your savings for the year, your family will still get a maximum of 6 GP consultations (limited to 3 per beneficiary) paid at the Bonitas Rate.

 

Specialist consultations: 

Paid from available savings. You must get a referral from your GP.

Acute medicine: 

Paid from available savings.

Over-the-counter (OTC) Medicine: 

Paid from available savings.

Optometry benefits: 
Paid from available savings.
Basic dentistry: 
Covered at the Bonitas Dental Tariff. 2 annual check-ups per benefi ciary (once every 6 months).
Specialised Dentistry: 
No benefit.
Orthodontics: 

No benefit.

MRI and CT Scans (Out of Hospital): 
R22 220 per family, in and out of hospital. Pre-authorisation required.
Radiology and Pathology: 
Paid from available savings.
Pregnancy benefits: 
6 antenatal consultations with a gynaecologist, GP or midwife. R1 160 for antenatal classes. 2 2D ultrasound scans. 1 amniocentesis. 4 consultations with a midwife after delivery. A Bonitas baby bag.
Physiotherapy and Occupational Therapy day to day: 
Paid from available savings.
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: 

BonSave ensures that you are covered for the 27 Prescribed Minimum Benefi ts listed below on the applicable formulary.

Pre-authorisation is required.

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.
Please note: For HIV/AIDS medicine, you must use the Designated Service Provider or you will have to pay a 40% co-payment.

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

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: 
2304.00
Total Contribution Adult: 
1785.00
Total Contribution Child*: 
690.00
Bonitas 2018 BonSave
Annual Medical Savings Account
Annual Medical Savings Main Member: 
4428.00
Annual Medical Savings Adult: 
3432.00
Annual Medical Savings Child*: 
1332.00
Risk Contributions
Risk Contribution Main Member: 
2304.00
Risk Contribution Adult: 
1785.00
Risk Contribution Child: 
690.00
How many times per annum do you and your dependants visit a doctor?: 
10
How much do you spend on Acute medication per annum?: 
R1000 - R4999
How much do you spend on Chronic medication per annum?: 
R1000 - R4999
Will you or any of your dependants require specialised Dentistry: 
No