2017-Bonitas-primary

Bonitas Primary

R1,924.00R5,268.00

This traditional option offers simple day-to-day medical benefits and 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: R1 924
A: R1 505
C: R 6 1 3
Your 4th and subsequent children will be covered free of charge

SAVINGS

N/A
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GP BENEFIT

If you do not use a GP on our network, your benefit for GP consultations will be limited to the non-network GP consultation benefit as indicated below.

M: R1 800 (R580 of this may be used for non-network GP consultations)
M+1: R3 300 (R1 100 of this may be used for non-network GP consultations)
M+2: R3 900 (R1 250 of this may be used for non-network GP consultations)
M+3: R4 200 (R1 400 of this may be used for non-network GP consultations)
M+4+: R4 750 (R1 650 of this may be used for non-network GP consultations)

DAY-TO-DAY BENEFIT

M: R1 900
M + 1: R3 400
M + 2: R4 000
M + 3: R4 300
M + 4+: R4 650
You must get a GP referral for specialist consultations (excluding consultations with oncologists and ophthalmologists; maternity consultations and consultations with paediatricians for children under the age of 2)

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

R11 700 per family, in and out of hospital
Pre-authorisation required

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
PMB only
Managed Care protocols apply
Pre-authorisation required
You must use a preferred supplier

INTERNAL NERVE STIMULATORS

N/A
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COCHLEAR IMPLANTS

N/A
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MENTAL HEALTH HOSPITALISATION AND CONSULTATIONS

Hospitalisation
R14 250 per family
No cover for physiotherapy for mental health admissions
You must use a Designated Service Provider

Consultations (in and out of hospital)
R8 600 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

R340 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

R149 000 per family, at the preferred provider
Pre-authorisation required

NON-CANCER SPECIALISED DRUGS

N/A
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ORGAN TRANSPLANTS

PMB only
Pre-authorisation required

KIDNEY DIALYSIS

Unlimited, at a Designated Service Provider
Pre-authorisation required

HIV/AIDS

Unlimited, if you register on the HIV/AIDS programme

C

OUT-OF-HOSPITAL

GP CONSULTATIONS

Paid from available GP benefit
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SPECIALIST CONSULTATIONS

Paid from available day-to-day benefits
You must get a referral from your GP
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BLOOD TESTS AND OTHER LABORATORY TESTS

Paid from available day-to-day benefits
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X-RAYS AND ULTRASOUNDS

Paid from available day-to-day benefits
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MRI AND CT SCANS (SPECIALISED RADIOLOGY)

R11 700 per family, in and out of hospital
Pre-authorisation required
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ACUTE AND OVER-THE-COUNTER MEDICINE

Acute medicine
Paid from available day-to-day benefits
Over-the-counter medicine
R 440 per beneficiary
R1 290 per family
Sublimit applies to over-the-counter medicine only

PARAMEDICAL/ALLIED MEDICAL PROFESSIONALS (SUCH AS PHYSIOTHERAPISTS, OCCUPATIONAL THERAPISTS, DIETICIANS AND BIOKINETICISTS)

Paid from available day-to-day benefits
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OPTOMETRY

R4 270 per family, once every 2 years (based on the date of your previous claim)
Each beneficiary can choose glasses or contact lenses

BASIC DENTISTRY

Covered at the Bonitas Dental Tariff
You must use a provider on the DENIS network
Managed Care protocols apply

SPECIALISED DENTISTRY

N/A
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CHRONIC BENEFITS

Cover for the 27 PMB chronic conditions at the Designated Service Provider
Applicable formulary applies, 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

6 antenatal consultations with a gynaecologist, GP or midwife
2 2D ultrasound scans
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

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

1 consultation with a paediatrician
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CHILDHOOD ILLNESS BENEFIT CHILDREN BETWEEN AGES 2 AND 12

1 GP consultation
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D1

PREVENTATIVE-CARE

GENERAL HEALTH

1 HIV test per beneficiary
1 flu vaccine per beneficiary

CARDIAC HEALTH

N/A
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CHILDREN’S HEALTH

N/A
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WOMEN’S HEALTH

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

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 050 per family
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