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BONITAS BONCLASSIC 2019

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Type of Medical Aid Plan: 
New Generation
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.

Savings Main member: R7 584

Adult dependant: R6 516

Child dependant: R1 872

 

In Hospital Benefits
Hospital Rate of Payment: 
Unlimited consultations & treatment at 100% 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.

Spinal Surgery. You will have to pay a R6 000 co-payment if you do not go for an assessment through the back and neck program.

Hip and knee replacements. You will have to pay a R6 000 co-payment if you do not use the preferred provider.

Specialists: 
Unlimited, network specialists covered in full at the Bonitas Rate Unlimited, non-network specialists paid at 100% of the Bonitas Rate
Other healthcare professionals eg. Physio, Occupational, Dietician: 
Main member only R2 960 Main member + 1 dependant R4 550 Main member + 2 dependants R5 240 Main member + 3 dependants R5 600 Main member + 4 or more dependants R6 000
Radiology and pathology: 
R28 990 per family, in and out-of-hospital Pre-authorisation required
MRI and CT scans: 
R28 990 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: 

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

Medical and Surgical Appliances: 
R7 780 per family
In Hospital Dentistry: 
A co-payment of R3 500 per hospital admission and admission protocols apply
Take home Medicine: 
R465 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: 
R41 210 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: 

Paid from available savings

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: 
R5 565 per family, once every 2 years (based on the date of your previous claim) Each beneficiary can choose glasses or contact lenses
Basic dentistry: 
R4 700 per family, per year 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 100% 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): 
R28 990 per family, in and out-of-hospital Pre-authorisation required
Radiology and Pathology: 
R28 990 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 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 750 per family which can be used for consultations and treatment
Chronic Conditions
Provider: 
You can get your medicine from any pharmacy on our network.
Chronic Conditions: 

BonClassic offers generous cover for the 47 chronic conditions listed below. Your chronic medicine
benefit is R11 330 per beneficiary and R23 440 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.

 

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 Alzheimer’s Disease (early onset), Gastro-Oesophageal Refl ux Disease (GORD), Polyarteritis Nodosa, Ankylosing Spondylitis, Generalised Anxiety Disorder, Pulmonary Interstitial Fibrosis, Attention Deficit Disorder (in children aged 5-18), Gout, Post-Traumatic Stress Disorder, Barrett's Oesophagus, Obsessive Compulsive Disorder, Scleroderma, Benign Prostatic Hypertrophy, Osteoporosis, Tourette's Syndrome, Depression, Paget's Disease, Zollinger-Ellison Syndrome, Eczema, Panic Disorder

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: 
4470.00
Total Contribution Adult: 
3838.00
Total Contribution Child*: 
1104.00
BonClassic
Annual Medical Savings Account
Annual Medical Savings Main Member: 
7584.00
Annual Medical Savings Adult: 
6516.00
Annual Medical Savings Child*: 
1872.00
Risk Contributions
Risk Contribution Main Member: 
4470.00
Risk Contribution Adult: 
3838.00
Risk Contribution Child: 
1104.00
Medical Aid Plan Name Term: 
Any