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Type of Medical Aid Plan: 
Traditional
Medical Aid Year: 
2020
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 = R5 940; M + 1 = R9 030; M + 2 = R10 440; M + 3 = R11 400; M + 4 or more = R12 420. 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

Casualty / Emergency Visits: 
No benefit
Specialists: 
Unlimited at 100% of BR
Other healthcare professionals eg. Physio, Occupational, Dietician: 
Unlimited at 100% of BR. Your therapist must get a referral from the doctor treating you in hospital
Radiology and pathology: 
Unlimited at 100% of BR
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy): 
100% of BR
MRI and CT scans: 
R26 620 per family available, 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: 
Unlimited at 100% of BR. Sub-limit of R32 130 applies per beneficiary for corneal grafts
Oncology / Cancer: 
R344 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: 
Subject to a co-payment of R10 000 if you do not go for an assessment through the back and neck programme
Joint Replacements: 
Subject to a co-payment of R10 000 if you do not use the preferred provider
Prosthesis: 

Internal and external: R45 090 per family
Managed Care protocols apply and the use of a preferred supplier.
Sublimit of R5 360 per breast prosthesis; limited to 2 per annum

Medical and Surgical Appliances: 
R7 820 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: 
R475 per beneficiary, per hospital stay
Rehabilitation, Hospice and Step-down facilities: 
Physical rehabilitation R50 600 per family. Hospice and step-down facilities; R16 880 per family. Terminal care; unlimited
Treatment for Mental Health: 
Hospitalisation R40 600 per family with R15 890 per family available for In- or out-of-hospital consultations. No cover for physiotherapy for mental health admissions. 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: 

Subject to the use of a GP on the Bonitas GP Network.
Network GP consultation benefit: M = R4 250; M + 1 = R6 230; M + 2 = R6 910; M + 3 = R7 250; M + 4 or more = R7 870. This benefit reduces if non-network GPs are consulted

Specialist consultations: 

Subject to available day-to-day benefits, on referral from your GP: M = R5 940; M + 1 = R9 030; M + 2 = R10 440; M + 3 = R11 400; M + 4 or more = R12 420

Acute medicine: 

Subject to available day-to-day benefits: M = R5 940; M + 1 = R9 030; M + 2 = R10 440; M + 3 = R11 400; M + 4 or more = R12 420

Over-the-counter (OTC) Medicine: 

Limited to R790 per beneficiary and R2 400 per family. Subject to available day-to-day benefits: M = R5 940; M + 1 = R9 030; M + 2 = R10 440; M + 3 = R11 400; M + 4 or more = R12 420. Formulary and Bonitas Pharmacy Network applies. 20% co-payment for non-network or non-formulary use

Optometry benefits: 
Subject to limit of R6 115 per family, once every 24 months. Cover for one eye test per beneficiary, at a network provider, frame and clear single vision, bifocal or multifocal lenses. You can choose a set of contact lenses instead of glasses
Basic dentistry: 
Subject to Bonitas Dental Tariff and use of a DENIS network provider. 2 annual check-ups per beneficiary, 2 scale and polish treatments, x-rays, fillings, root canal and extractions. 1 set of plastic dentures pb, per 4 years. Managed Care Protocols apply
Specialised Dentistry: 
Covered at Bonitas Dental Tariff. 1 partial metal frame dentures per beneficiary, per 5 years. Managed Care Protocols apply. 1 crown per family, per annum. Pre-authorisation required
Orthodontics: 

Orthodontic treatment is granted once per beneficiary, per lifetime. Limited to beneficiaries 9 years and younger than 18 years. Only 1 family member may begin treatment in a calendar year. Managed Care Protocols apply. Pre-authorisation cases will be clinically assessed by using an orthodontic needs analysis and benefit allocation is subject to the outcome. Funding can be granted up to 80% of Bonitas Dental Tariff

MRI and CT Scans (Out of Hospital): 
R26 620 per family available, in- or out-of hospital. Subject to pre-authorisation
Radiology and Pathology: 
Subject to available day-to-day benefits: M = R5 940; M + 1 = R9 030; M + 2 = R10 440; M + 3 = R11 400; M + 4 or more = R12 420
Pregnancy benefits: 
12 antenatal consultations with a gynae, GP or midwife, 2 2D scans, 1 amniocentesis, R1 240 for antenatal classes, 4 consults with a midwife after delivery. 1 of these may be used for a consult with a lactation specialist. Maternity support for pregnancy
Physiotherapy and Occupational Therapy day to day: 
Subject to available day-to-day benefits: M = R5 940; M + 1 = R9 030; M + 2 = R10 440; M + 3 = R11 400; M + 4 or more = R12 420
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: 
18 conditions. Your chronic medicine benefit is limited to R9 800 per beneficiary and R19 670 per family on the applicable formulary. Once the amount is finished you will still be covered for the 27 PMBs above
Preventative Care Benefits
Preventative Benefits: 

Contraceptives for women up to 50, limited to R1 610 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: 2 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 and frequency specific tests for: 1 full lipogram; pap smear; mammogram; prostate screening; pneumococcal vaccine and stool test for colon cancer. Wellness Extender benefit of R1 750 per family, available after completing a wellness screening test

Total Contributions
Total Contribution Main Member: 
3888.00
Total Contribution Adult: 
3371.00
Total Contribution Child*: 
1140.00
Standard
Medical Aid Plan Name Term: 
Standard