2017-boncomprehensive-02

Bonitas Boncomprehensive

R5,254.00R13,417.00

This first-class medical savings plan offers savings, an above threshold benefit and extensive hospital cover.

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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: R5 254
A: R4 956
C: R1 069
Your 4th and subsequent children will be covered free of charge

SAVINGS

M: R11 892
A: R11 220
C: R 2 424
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GP BENEFIT

Subject to savings and/or above threshold benefit
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DAY-TO-DAY BENEFIT

N/A
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SELF PAYMENT GAP

M: R3 600
A: R2 980
C: R1 370
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THRESHOLD LEVEL

M: R15 492
A: R14 200
C: R3 794
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ABOVE THRESHOLD BENEFIT

Unlimited

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B

IN-HOSPITAL
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CO-PAYMENTS FOR CERTAIN PROCEDURES

N/A
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GP CONSULTATIONS(IH)

Unlimited, covered at 300% of the Bonitas Rate
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SPECIALIST CONSULTATIONS(IH)

Unlimited, covered at 300% 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

Unlimited
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 prosthesis
R49 600 per family

External prosthesis
R49 600 per family

Pre-authorisation required

INTERNAL NERVE STIMULATORS

R149 100 per family
Pre-authorisation required
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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
R42 200 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

R 490 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

R556 700 per family
R220 900 of this can be used for specialised drugs (including biological drugs)
Pre-authorisation required

NON-CANCER SPECIALISED DRUGS

R176 700 per family

Managed Care protocols apply
Pre-authorisation required
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ORGAN TRANSPLANTS

Unlimited
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 and/or above threshold benefit
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SPECIALIST CONSULTATIONS

Paid from available savings and/or above threshold benefit
You must get a referral from your GP
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BLOOD TESTS AND OTHER LABORATORY TESTS

Paid from available savings and/or above threshold benefit
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X-RAYS AND ULTRASOUNDS

Paid from available savings and/or above threshold benefit
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MRI AND CT SCANS (SPECIALISED RADIOLOGY)

R28 200 per family
Pre-authorisation required
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ACUTE AND OVER-THE-COUNTER MEDICINE

Paid from available savings and/or above threshold benefit
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PARAMEDICAL/ALLIED MEDICAL PROFESSIONALS (SUCH AS PHYSIOTHERAPISTS, OCCUPATIONAL THERAPISTS, DIETICIANS AND BIOKINETICISTS)

Paid from available savings and/or above threshold benefit
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OPTOMETRY

Limited to R2 880 per beneficiary, once every 2 years (based on the date of your previous claim)
Paid from available savings and/or above threshold benefits

BASIC DENTISTRY

Paid from available savings and/or above threshold benefit
Managed Care protocols apply

SPECIALISED DENTISTRY

Paid from available savings and/or above threshold benefit
Managed Care protocols apply
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CHRONIC BENEFITS

Cover for 62 chronic conditions
R12 450 per beneficiary
R24 800 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
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

Private ward after delivery
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

3 consultations with a paediatrician
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INFANT PAEDIATRIC BENEFIT CHILDREN BETWEEN AGES 1 AND 2

2 consultations with paediatrician
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CHILDHOOD ILLNESS BENEFIT CHILDREN BETWEEN AGES 2 AND 12

2 GP consultations
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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

1 thyroid stimulating hormone test for infants under 1 month old
Childhood immunisations according to Expanded Programme on Immunisation in South Africa
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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

1 prostate screening antigen test for men between ages 55 and 69, who are considered to be at high risk for prostate cancer
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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

R2 100 per family
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