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Primary 2021

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

Set limit for consultations with a specialist, on referral from your GP; acute medicine; x-rays; blood tests and other out-of-hospital medical expenses: M = R2 750; M + 1 = R4 920; M + 2 = R5 780; M + 3 = R6 210; M + 4 or more = R6 730 There is a separate benefit for network GP consultations, mental health consultations, optometry and basic dentistry

In Hospital Benefits
Are you prepared to use designated hospitals?: 
No
Hospital Rate of Payment: 
Unlimited at 100% of Bonitas Rate (BR)
Hospitals: 

Any

Upfront Payments to hospitals: 

Day surgery procedures must be done in a day-hospital or a R2 200 co-payment will apply. Co-payments apply to certain procedures performed in hospital: R1 570 for minor procedures; R3 980 for Arthroscopy, Diagnostic Laparoscopy, Laparoscopic Hysterectomy and Percutaneous Rhizotomies; R7 840 for Back Surgery including Spinal Fusions, Laparoscopic Pyeloplasty, Laparoscopic Radical Prostatectomy and Reflux surgery

Casualty / Emergency Visits: 
No benefit
Specialists: 
Unlimited at 100% of BR
Other healthcare professionals eg. Physio, Occupational, Dietician: 
Subject to referral by treating practitioner and day-to-day benefit, except for PMB's
Radiology and pathology: 
Unlimited at 100% of BR
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy): 
Co-payment of R1 570 applies if performed in-hospital
MRI and CT scans: 
R13 710 available per family, in- or out-of hospital. Subject to pre-authorisation
ICU and High Care: 
Unlimited at 100% of BR
Dialysis: 
Unlimited at 100% of BR. You must use a Designated Service Provider(DSP), or a 20% co-payment will apply
Organ Transplants: 
PMB only
Oncology / Cancer: 
R165 500 available per family. Subject to the use of a preferred provider. Sub-limit of R44 200 per beneficiary for Brachytherapy
Neck and Back Operations: 
Co-payment of R7 840. Managed Care Protocols apply and the use of a preferred supplier
Joint Replacements: 
No benefit
Prosthesis: 

Internal: R33 220 per family.
Managed Care protocols apply and the use of a preferred supplier

Medical and Surgical Appliances: 
R7 030 available per family. An additional R6 680 per family will apply should Stoma Care and CPAP machines exceed the appliance limit. You must use a preferred supplier
Maternity Confinements: 
Unlimited at 100% of BR
In Hospital Dentistry: 
Co-payment of R3 500 per admission. General anaesthetic only available for extensive treatment to children under 5 years, once per lifetime, and for impacted wisdom teeth. Pre-authorisation required. Managed Care Protocols apply
Take home Medicine: 
R405 per beneficiary, per hospital stay
Rehabilitation, Hospice and Step-down facilities: 
Physical rehabilitation R52 350 per family. Hospice and step-down facilities; R17 450 per family. Terminal Care; unlimited
Treatment for Mental Health: 
Hospitalisation R16 370 per family. Subject to the use of a DSP
HIV / AIDS: 
Unlimited if you register on the HIV/AIDS programme. Chronic medicine must be obtained from Pharmacy Direct
Ambulance Service: 
ER24 in an emergency
International Travel Benefit: 
Cover for medical emergencies when you travel outside South Africa. Subject to registration
Day-to-day benefits
GP consultations: 

You must choose 1 GP on the Bonitas Select Network for each beneficiary. This is your nominated GP for the year. Network GP consultation benefit: M = R1 960; M + 1 = R3 610; M + 2 = R4 270; M + 3 = R4 590; M + 4 or more = R5 200. This benefit reduces if non-network GPs are consulted

Specialist consultations: 

Paid from available day-to-day benefits, on referral from your nominated Select Network GP: M = R2 750; M + 1 = R4 920; M + 2 = R5 780; M + 3 = R6 210; M + 4 or more = R6 730

Acute medicine: 

Subject to available day-to-day benefits: M = R2 750; M + 1 = R4 920; M + 2 = R5 780; M + 3 = R6 210; M + 4 or more = R6 730

Over-the-counter (OTC) Medicine: 

Subject to day-to-day benefits. Limited to R515 per beneficiary and R1 510

per family. You must use a Bonitas Pharmacy Network or a 20% co-payment will apply.

A 20% co-payment will apply if you use medicine that is not on the formulary

Optometry benefits: 
Subject to limit of R4 955 per family, once every 24 months. Cover for one eye test per beneficiary at a network provider, frame, clear single vision, bifocal or multifocal lenses. You can choose a set of contact lenses instead of glasses
Basic dentistry: 
Subject to the Bonitas Dental Tariff and the use of a DENIS network provider. 2 annual check-ups per beneficiary; 2 scale and polish treatments, x-rays, fillings, root canal and extractions. Managed Care Protocols apply
Specialised Dentistry: 
No benefit
Orthodontics: 

No benefit

MRI and CT Scans (Out of Hospital): 
R13 710 per family available, in- or out-of hospital. Subject to pre-authorisation. R1500.00 co-payment per scan
Radiology and Pathology: 
Subject to available day-to-day benefits: M = R2 750; M + 1 = R4 920; M + 2 = R5 780; M + 3 = R6 210; M + 4 or more = R6 730
Pregnancy benefits: 
6 antenatal consultations with a gynaecologist, GP or midwife, 2 2D scans,1 amniocentesis, 4 consultations with a midwife after delivery. 1 of these may be used for a consultation with a lactation specialist. Maternity support for pregnant moms
Physiotherapy and Occupational Therapy day to day: 
Subject to available day-to-day benefits: M = R2 750; M + 1 = R4 920; M + 2 = R5 780; M + 3 = R6 210; M + 4 or more = R6 730
Chronic Conditions
Provider: 
Pharmacy Direct and formulary medication. A 40% co-payment applies for non-use of the network pharmacy or formulary
Chronic Conditions: 

Diagnosis, treatment and care costs of 27 chronic conditions that fall under the PMB Chronic Disease List (CDL), issued by the Council for Medical Schemes

Additional Chronic Conditions: 
No benefit
Preventative Care Benefits
Preventative Benefits: 

Contraceptives for women up to 50, limited to R1 660 per family. Subject to the DSP for pharmacy-dispensed contraceptives. CHILDCARE: Hearing screening for newborns, in- or out-of hospital; Congenital hypothyroidism screening for infants under 1 month; Babyline 24/7 helpline for children under 3 years; Paediatrician or GP consultations: 1 per child, per annum, up to 2 years; 1 GP consultation per child, from 2 - 12 years; Immunisation according to South African Expanded Programme. OTHER: 1 wellness screening test per beneficiary at a wellness network provider; 1 HIV test and 1 Flu vaccine per beneficiary; Age specific tests for: pap smear; mammogram; prostate screening; pneumococcal vaccine and stool test for colon cancer. Wellness Extender benefit of R1 270 per family available after completing a wellness screening test

Total Contributions
Total Contribution Main Member: 
2537.00
Total Contribution Adult: 
1985.00
Total Contribution Child*: 
807.00
Primary
Risk Contributions
Risk Contribution Main Member: 
2537.00
Risk Contribution Adult: 
1985.00
Risk Contribution Child: 
807.00
Medical Aid Plan Name Term: 
Primary