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BONITAS PRIMARY 2019

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

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 R2 310
Main member + 1 dependant R4 140
Main member + 2 dependants R4 860
Main member + 3 dependants R5 230
Main member + 4 or more dependants R5 660

In Hospital Benefits
Hospital Rate of Payment: 
100% of Scheme Rate
Hospitals: 

Members have access to all private 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.

Unlimited, consultations & treatment at 100% - network doctors and specialists paid in full.

Upfront Payments to hospitals: 

30% co-payment may apply to admissions at specific hospitals.

In Hospital Dentistry, A co-payment of  R3 500 per hospital admission and admission protocols apply.

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

R1 450co-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 250co-payment:

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

Specialists: 
Paid from available day-to-day benefits You must get a referral from your GP
Other healthcare professionals eg. Physio, Occupational, Dietician: 
Paid from available day-to-day benefits
Radiology and pathology: 
Paid from available day-to-day benefits
MRI and CT scans: 
R13 000 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: 
PMB only
Oncology / Cancer: 
R165 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

R31 500 per family (excluding joint replacement prosthesis)
Managed Care protocols apply
You must use a preferred supplier

Medical and Surgical Appliances: 
R6 890 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 Managed Care protocols apply Pre-authorisation required
Take home Medicine: 
R380 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: 
R9 560 per family In and out-of-hospital consultations (included in the mental health hospitalisation benefit) Cover for educational psychologists for beneficiaries up to the age of 21 years
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: 

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 R1 900 (R615 of this may be used for
non-network GP consultations)
Main member + 1 dependant R3 490 (R1 160 of this may be used for
non-network GP consultations)
Main member + 2 dependants R4 130 (R1 320 of this may be used for
non-network GP consultations)
Main member + 3 dependants R4 440 (R1 480 of this may be used for
non-network GP consultations)
Main member + 4 or more dependants R5 030 (R1 750 of this may be used for
non-network GP consultations)

Specialist consultations: 

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

Over-the-counter (OTC) Medicine: 

Paid from available day-to-day benefits

Optometry benefits: 
R4 480 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 You must use a provider on the DENIS network
Specialised Dentistry: 
No Benefit.
Orthodontics: 

No Benefit.

MRI and CT Scans (Out of Hospital): 
R13 000 per family, in and out-of-hospital Pre-authorisation required
Radiology and Pathology: 
Paid from available day-to-day benefits.
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: 

Primary ensures that you are covered for the 27 Prescribed Minimum Benefits listed below. 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: 
2240.00
Total Contribution Adult: 
1752.00
Total Contribution Child*: 
713.00
Bonitas 2019 Primary
Risk Contributions
Risk Contribution Main Member: 
2240.00
Risk Contribution Adult: 
1752.00
Risk Contribution Child: 
713.00
Medical Aid Plan Name Term: 
Any