2017-boncomplete-02

Bonitas Boncomplete

R2,923.00R7,645.00

This generous savings option offers a wide range of medical aid benefits, in and out of hospital.

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Product Description

Please note: This document provides a high-level overview of our plans and benefits. For full benefit information, please refer to the 2017 Product Brochure. Where there is a discrepancy between the content provided in this document, the brochure, the website and the Scheme Rules, the Scheme Rules prevail. The Scheme Rules are available on request. Benefits are subject to approval from the Council for Medical Schemes.

Additional Information

HOSPITAL NETWORK

Yes. Members have access to all private hospitals. A 30% co-payment will apply to admissions at specific hospitals.

MONTHLY CONTRIBUTIONS

M: R3 648
A: R3 132
C: R900
Your 4th and subsequent children will be covered free of charge

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

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

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

KIDNEY DIALYSIS

Unlimited, at a preferred provider
Pre-authorisation required

HIV/AIDS

Unlimited, if you register on the HIV/AIDS programme

C

OUT-OF-HOSPITAL

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

BASIC DENTISTRY

R4 200 per family, per year
Covered at the Bonitas Dental Tariff
Managed Care protocols apply

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

D

SUPLEMENTARY-BENEFITS

INTERNATIONAL TRAVEL BENEFIT

R5 million per beneficiary per journey for both in and out of hospital treatment (R10 million per family)

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)

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

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
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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

D2

WELLNESS BENEFITS

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

WELLNESS EXTENDER

R1 450 per family
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