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BONITAS BONCOMPREHENSIVE 2019

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Type of Medical Aid Plan: 
Threshold
Medical Aid Year: 
2019
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.

Main member : Savings: R14 568 Self-payment gap: R 4 000 Threshold level: R16 878 Above Threshold benefit: Unlimited

Adult dependant Savings: R13 740 Self-payment gap: R 3 310 Threshold level: R15 474 Above Threshold benefit: Unlimited

Child dependant Savings: R 2 964 Self-payment gap: R 1 520 Threshold level: R 4 114 Above Threshold benefit: Unlimited

 

Once your savings for the year are finished, you will need to pay for day-to-day medical expenses
yourself until you have paid the full self-payment gap. You will then have access to your above
threshold benefit. Please submit all claims you have paid towards the self-payment gap to us, so
that we can let you know when you have access to your above threshold benefit.

In Hospital Benefits
Hospital Rate of Payment: 
consultations & treatment at 300% of the Bonitas Rate
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.

Hearing aids: 10% co-payment applies. You must use a preferred supplier.

Chronic benefits: If you choose to use medicine that is not on the formulary, you will have to pay a 40% co-payment.

Specialists: 
Specialist consultations/ treatment. Unlimited, covered at 300% of the Bonitas Rate
Other healthcare professionals eg. Physio, Occupational, Dietician: 
Paid from available savings or above threshold benefit
Radiology and pathology: 
Unlimited. Pre-authorisation required.
MRI and CT scans: 
R31 330 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: 
R618 500 per family R245 400 of this can be used for specialised drugs (including biological drugs) Sublimit of R44 220 per beneficiary for Brachytherapy
Prosthesis: 

Internal prosthesis R55 100 per family

External prosthesis R55 100 per family Sublimit of R5 250 per breast prosthesis (limited to 2 per year)

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

Internal nerve stimulators R165 600 per family

Medical and Surgical Appliances: 
R8 390 per family An additional R6 160 per family will apply should Stoma Care and CPAP machines exceed the general medical appliances limit You must use a preferred supplier
Maternity Confinements: 
Private ward after delivery
Take home Medicine: 
R545 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: 
R46 880 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 managed care programme
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: 

Paid from available savings or above threshold benefit

Specialist consultations: 

Paid from available savings or above threshold benefit

You must get a referral from your GP

Acute medicine: 

Paid from available savings or above threshold benefit

Over-the-counter (OTC) Medicine: 

Paid from available savings or above threshold benefit

Optometry benefits: 
Paid from available savings or above threshold benefit Limited to R3 020 per beneficiary
Basic dentistry: 
Paid from available savings or above threshold benefit Pre-authorisation required for plastic dentures
Specialised Dentistry: 
Paid from available savings or above threshold benefit Pre-authorisation required
Orthodontics: 

Paid from available savings

MRI and CT Scans (Out of Hospital): 
R31 330 per family, in and out-of-hospital Pre-authorisation required
Radiology and Pathology: 
R31 330 per family, in and out-of-hospital Pre-authorisation required
Pregnancy benefits: 
12 antenatal consultations with a gynaecologist, GP or midwife 2 2D ultrasound scans R1 220 for antenatal classes 1 amniocentesis Private ward after delivery 4 consultations with a midwife after delivery A Bonitas baby bag (you must register for this)
Physiotherapy and Occupational Therapy day to day: 
1 wellness screening per beneficiary at a participating pharmacy, biokineticist or a Bonitas wellness day
Chronic Conditions
Provider: 
You can get your medicine from any pharmacy.
Chronic Conditions: 

BonComprehensive offers extensive cover for the 60 chronic conditions listed below.

This is limited to R13 830 per beneficiary and R27 550 per family on the applicable formulary. Pre-authorisation is required.

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.

Once the amount above is finished, you will still be covered for the 27 Prescribed Minimum Benefits, listed below.

Prescribed Minimum Benefits covered Addison’s Disease, Hyperlipidaemia, Asthma, Diabetes Insipidus, Hypertension, Bipolar Mood Disorder, Diabetes Type 1, Hypothyroidism, Bronchiectasis, Diabetes Type 2, Multiple Sclerosis, Cardiac Failure, Dysrhythmias, Parkinson’s Disease, Cardiomyopathy, Epilepsy, Rheumatoid Arthritis, Chronic Obstructive Pulmonary Disease, Glaucoma, Schizophrenia, Chronic Renal Disease, Haemophilia, Systemic Lupus Erythematosus, Coronary Artery Disease, Crohn’s Disease, HIV/AIDS, Ulcerative Colitis

 

Additional conditions covered Acne, Dermatomyositis, Obsessive Compulsive Disorder, Allergic Rhinitis, Depression, Osteoporosis, Alzheimer’s Disease (early onset), Eczema, Paget’s Disease, Ankylosing Spondylitis, Gastro-Oesophageal Reflux Disease (GORD), Panic Disorder, Anorexia Nervosa, Generalised Anxiety Disorder, Polyarteritis Nodosa, Attention Deficit Disorder (in children aged 5-18), Gout, Post-Traumatic Stress Disorder, Barrett’s Oesophagus, Huntington’s Disease, Pulmonary Interstitial Fibrosis, Behcet’s Disease, Hyperthyroidism, Psoriatic Arthritis, Bulimia Nervosa, Myaesthenia Gravis,Systemic Sclerosis, Cystic Fibrosis, Narcolepsy, Tourette’s Syndrome, Dermatitis, Neuropathies, Zollinger-Ellison Syndrome

Additional Chronic Conditions: 
33 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
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: 
6438.00
Total Contribution Adult: 
6072.00
Total Contribution Child*: 
1310.00
BonComprehensive
Annual Medical Savings Account
Annual Medical Savings Main Member: 
14568.00
Annual Medical Savings Adult: 
13740.00
Annual Medical Savings Child*: 
2964.00
Risk Contributions
Risk Contribution Main Member: 
6438.00
Risk Contribution Adult: 
6072.00
Risk Contribution Child: 
1310.00
Medical Aid Plan Name Term: 
Any