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BonStart 2021

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Type of Medical Aid Plan: 
Hybrid
Medical Aid Year: 
2021
Day to day Benefits: 

Subject to completing the Online Wellness Assessment. Cover for unlimited Virtual Care network GP and Nurse consultations and GP referred acute medicine, x-rays and blood tests with a limit of R1 500 per family. There is a limited over-the-counter (OTC) medicine benefit. The following benefits are subject to a co-payment of R110 per visit; unlimited network GP consultations, eye and dental check-ups, 2 physiotherapy consultations for sport-related injuries on referral from the network GP.

In Hospital Benefits
Are you prepared to use designated hospitals?: 
Yes
Hospital Rate of Payment: 
Unlimited at 100% of Bonitas Rate (BR)
Hospitals: 

BonStart Hospital Network

Upfront Payments to hospitals: 

R1 500 standard upfront payment applies per admission, except for motor vehicle accidents, maternity confinements and emergency treatment. If you use a hospital outside of the BonStart Hospital Network there will be a co-payment of 30%. Admissions to a facility outside of the BonStart Day Surgery Network for defined procedures, results in an upfront payment of R10 650

Casualty / Emergency Visits: 
No benefit
Specialists: 
Unlimited at 100% of BR
Other healthcare professionals eg. Physio, Occupational, Dietician: 
PMB only and subject to referral by treating practitioner
Radiology and pathology: 
Unlimited at 100% of BR
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy): 
Subject to use of a day hospital, or a R10 650 co-payment will apply
MRI and CT scans: 
R11 840 per family, subject to a co-payment of R2 500 per scan, except for PMB. Pre-authorisation required
ICU and High Care: 
Unlimited at 100% of BR
Dialysis: 
PMB only. Pre-authorisation required and subject to use of a Designated Service Provider(DSP), or a 30% upfront co-payment will apply
Organ Transplants: 
PMB only. Pre-authorisation required and subject to use of a Designated Service Provider(DSP), or a 30% upfront co-payment will apply
Oncology / Cancer: 
PMB only. Pre-authorisation required and subject to use of a Designated Service Provider(DSP), or a 30% upfront co-payment will apply
Neck and Back Operations: 
PMB only. Pre-authorisation required and subject to use of a preferred supplier. Managed Care Protocols apply
Joint Replacements: 
PMB only
Prosthesis: 

Internal: PMB only. Pre-authorisation required and subject to use of a preferred supplier. Managed Care Protocols apply.
External: PMB only. Subject to use of a preferred supplier

Medical and Surgical Appliances: 
PMB only. Subject to use of a preferred supplier
Maternity Confinements: 
Unlimited on the BonStart Hospital Network. R10 650 co-payment at non-network hospitals. Emergency approved Caesarian sections only. Managed Care Protocols apply
In Hospital Dentistry: 
PMB only
Take home Medicine: 
R390 per hospital stay
Rehabilitation, Hospice and Step-down facilities: 
Physical rehabilitation R50 600 per family. Hospice and step-down facilities limited to R14 570 per family. Pre-authorisation required. Managed Care Protocols apply
Treatment for Mental Health: 
PMB only. Subject to use of a DSP. No cover for physiotherapy for mental health admissions
HIV / AIDS: 
Unlimited if you register on the HIV/AIDS programme. Chronic medicine must be obtained from the DSP, or a 30% co-payment will apply
Ambulance Service: 
ER24 in an emergency
International Travel Benefit: 
Up to R10m cover per family for medical emergencies when you travel outside South Africa. Subject to registration prior to departure. Africa Benefit: in- or out-of-hospital treatment at 100% of BR. Subject to authorisation
Day-to-day benefits
GP consultations: 

Subject to completing the Online Wellness Assessment. Cover for unlimited Virtual Care network GP and Nurse consultations. Unlimited network GP consultations. Subject to a co-payment of R110 per visit. Authorisation required after the 6th visit

Specialist consultations: 

No benefit

Acute medicine: 

GP referred acute medicine, x-rays and blood tests with a limit of R1 500 per family. A 20% co-payment applies per script. Formulary and Bonitas Pharmacy Network applies. 40% co-payment for non-network or non-formulary use

Over-the-counter (OTC) Medicine: 

Limited to R95 per event and a maximum of R460 per family per annum. Formulary and Bonitas Pharmacy Network applies. 40% co-payment for non-network or non-formulary use

Optometry benefits: 
Cover for 1 eye test per beneficiary at a network optometrist, with a co-payment of R110
Basic dentistry: 
Cover for 1 dental consultation per beneficiary at a network optometrist, with a co-payment of R110
Specialised Dentistry: 
No benefit
Orthodontics: 

No benefit

MRI and CT Scans (Out of Hospital): 
No benefit
Radiology and Pathology: 
GP referred acute medicine, x-rays and blood tests with a limit of R1 500 per family
Pregnancy benefits: 
Access to the Bonitas Maternity Programme
Physiotherapy and Occupational Therapy day to day: 
2 physiotherapy consultations for sport-related injuries on referral from the network GP.
Preventative Care Benefits
Preventative Benefits: 

1 wellness screening per beneficiary at a participating pharmacy, biokineticist or Bonitas wellness day, 1 HIV test and 1 flu vaccine per beneficiary. Women: Contraceptives R1 070 per family for women up to 50 subject to DSP, otherwise a co-payment of 40% applies, and pap smear every 3 years between 21 and 65. Childcare: < 3 years; 24/7 Babyline helpline for medical advice.

Total Contributions
Total Contribution Main Member: 
1452.00
Total Contribution Adult: 
1452.00
Total Contribution Child*: 
1452.00
BonStart
Medical Aid Plan Name Term: 
Any