| HOSPITAL NETWORK |
Yes. Members have access to all private hospitals. A 30% co-payment will apply to admissions at specific hospitals.
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| MONTHLY CONTRIBUTIONS |
M: R3 648
A: R3 132
C: R900
Your 4th and subsequent children will be covered free of charge
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| SAVINGS |
M: R6 192
A: R5 316
C: R1 524
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| GP BENEFIT |
Subject to savings
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| DAY-TO-DAY BENEFIT |
N/A
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| SELF PAYMENT GAP |
N/A
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| THRESHOLD LEVEL |
N/A
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| ABOVE THRESHOLD BENEFIT |
N/A
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| B |
IN-HOSPITAL
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| CO-PAYMENTS FOR CERTAIN PROCEDURES |
Co-payments will apply to certain procedures in hospital
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| GP CONSULTATIONS(IH) |
Unlimited, covered at 100% of the Bonitas Rate
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| SPECIALIST CONSULTATIONS(IH) |
Unlimited
Network specialists covered in full
Non-network specialists paid at 100% of the Bonitas Rate
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| BLOOD TESTS AND X-RAYS |
Unlimited, covered at 100% of the Bonitas Rate
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| MRI AND CT SCANS |
R26 100 per family, in and out of hospital
Pre-authorisation required
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| PARAMEDICAL/ALLIED MEDICAL PROFESSIONALS |
Unlimited, covered at 100% of the Bonitas Rate
Your therapist must get a referral from the doctor treating you in hospital
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| INTERNAL AND EXTERNAL PROSTHESES |
Internal and external prostheses
R49 150 per family
If you do not use the preferred provider for hip and knee replacements, you will have to pay a R5 300 co-payment
Managed Care protocols apply
Pre-authorisation required
You must use a preferred supplier
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| INTERNAL NERVE STIMULATORS |
N/A
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| COCHLEAR IMPLANTS |
R250 000 per family
You must use a preferred supplier
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| MENTAL HEALTH HOSPITALISATION AND CONSULTATIONS |
Hospitalisation
R37 100 per family
No cover for physiotherapy for mental health admissions
You must use a Designated Service Provider
Consultations (in and out of hospital)
R14 300 per family
In and out of hospital for consultations (included in the mental health hospitalisation benefit)
No cover for educational psychologists for beneficiaries older than 21 years
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| TAKE-HOME MEDICINE |
R420 per beneficiary, per hospital stay
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| PHYSICAL REHABILITATION |
R44 650 per family
Pre-authorisation required
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| ALTERNATIVES TO HOSPITAL (HOSPICE, STEP-DOWN FACILITIES) |
R14 900 per family
Pre-authorisation required
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| CANCER TREATMENT |
R369 500 per family, at the preferred provider
Pre-authorisation required
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| NON-CANCER SPECIALISED DRUGS |
R110 400 per family
10% co-payment applies
Managed Care protocols apply
Pre-authorisation required
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| ORGAN TRANSPLANTS |
Unlimited, covered at 100% of the Bonitas Rate
Pre-authorisation required
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| KIDNEY DIALYSIS |
Unlimited, at a preferred provider
Pre-authorisation required
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| HIV/AIDS |
Unlimited, if you register on the HIV/AIDS programme
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| C |
OUT-OF-HOSPITAL
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| GP CONSULTATIONS |
Paid from available savings
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| SPECIALIST CONSULTATIONS |
Paid from available savings
You must get a referral from your GP
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| BLOOD TESTS AND OTHER LABORATORY TESTS |
R2 800 per beneficiary
R6 200 per family
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| X-RAYS AND ULTRASOUNDS |
R2 800 per beneficiary
R4 340 per family
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| MRI AND CT SCANS (SPECIALISED RADIOLOGY) |
R26 100 per family, in and out of hospital
Pre-authorisation required
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| ACUTE AND OVER-THE-COUNTER MEDICINE |
Paid from available savings
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| PARAMEDICAL/ALLIED MEDICAL PROFESSIONALS (SUCH AS PHYSIOTHERAPISTS, OCCUPATIONAL THERAPISTS, DIETICIANS AND BIOKINETICISTS) |
M: R2 670
M+1: R4 090
M+2: R4 720
M+3: R5 040
M+4+: R5 400
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| OPTOMETRY |
R5 300 per family, once every 2 years (based on the date of your previous claim)
Each beneficiary can choose glasses or contact lenses
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| BASIC DENTISTRY |
R4 200 per family, per year
Covered at the Bonitas Dental Tariff
Managed Care protocols apply
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| SPECIALISED DENTISTRY |
R5 050 per family, per year
Covered at the Bonitas Dental Tariff
Managed Care protocols apply
You must use a provider on the DENIS network for crowns
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| CHRONIC BENEFITS |
Cover for 48 chronic conditions
R10 200 per beneficiary
R21 100 per family
Applicable formulary applies, 40% co-payment for out of formulary medicine
Once the amount above is finished, you will still be covered for the 27 PMB conditions at the Designated Service Provider. 40% co-payment for out of formulary medicine or use of a non-Designated Service Provider
Pre-authorisation required
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| D |
SUPLEMENTARY-BENEFITS
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| INTERNATIONAL TRAVEL BENEFIT |
R5 million per beneficiary per journey for both in and out of hospital treatment (R10 million per family)
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| MATERNITY CARE PER PREGNANCY |
12 antenatal consultations with a gynaecologist, GP or midwife
2 2D ultrasound scans
R1 100 for antenatal classes
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)
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| BABYLINE For children under 2 1⁄2 years |
Access to telephone helpline for 24/7 medical advice, including weekends and holidays
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| INFANT PAEDIATRIC BENEFIT CHILDREN UNDER 1 YEAR |
N/A
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| INFANT PAEDIATRIC BENEFIT CHILDREN BETWEEN AGES 1 AND 2 |
N/A
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| CHILDHOOD ILLNESS BENEFIT CHILDREN BETWEEN AGES 2 AND 12 |
N/A
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| D1 |
PREVENTATIVE-CARE
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| GENERAL HEALTH |
1 HIV test per beneficiary
1 flu vaccine per beneficiary
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| CARDIAC HEALTH |
1 full lipogram every 5 years, for members aged 20 and over
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| CHILDREN’S HEALTH |
N/A
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| WOMEN’S HEALTH |
1 mammogram every 2 years, for women between ages 40 and 74
1 pap smear every 3 years, for women between ages 21 and 65
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| MEN’S HEALTH |
N/A
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| 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 over 65
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| D2 |
WELLNESS BENEFITS
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| WELLNESS SCREENING |
1 wellness screening per beneficiary at a participating pharmacy, biokineticist or a Bonitas wellness day
Wellness screening includes the following:
• Blood pressure
• Glucose
• Cholesterol
• Body mass index
• Waist-to-hip ratio
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| WELLNESS EXTENDER |
R1 450 per family
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