2017-standard-select-02

Bonitas Standard Select

R2,597.00R7,124.00

This traditional option offers rich day-to-day benefits and comprehensive 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

You must use a hospital on the Standard Select network or you will have
to pay a 30% co-payment

MONTHLY CONTRIBUTIONS

M: R2 597
A: R2 247
C: R 760
Your 4th and subsequent children will be covered free of charge

SAVINGS

N/A

GP BENEFIT

You must choose 1 GP on our network for each beneficiary. This is your nominated GP for the year.
If you do not use your nominated GP, your benefit will be limited to the non- nominated GP consultation benefit as indicated below.

M: R3 750
(R1 220 of this can be used for non-nominated GP consultations)

M+1: R5 500
(R1 880 of this can be used for non-nominated GP consultations)

M+2: R6 100
(R2 050 of this can be used for non-nominated GP consultations)

M+3: R6 400
(R2 150 of this can be used for non-nominated GP consultations)

M+4+: R6 950
(R2 320 of this can be used for non-nominated GP consultations)

DAY-TO-DAY BENEFIT

M: R5 232
M + 1: R7 970
M + 2: R9 214
M + 3: R10 062
M + 4+: R10 966
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
[This is not applicable to this plan]

THRESHOLD LEVEL

N/A
[This is not applicable to this plan]

ABOVE THRESHOLD BENEFIT

N/A

[This is not applicable to this plan]

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

R23 500 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
R39 800 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

R149 100 per family
Pre-authorisation required
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COCHLEAR IMPLANTS

R250 000 per family
You must use a preferred supplier

MENTAL HEALTH HOSPITALISATION AND CONSULTATIONS

Hospitalisation
R36 550 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

R310 150 per family, at the preferred provider
Pre-authorisation required

NON-CANCER SPECIALISED DRUGS

N/A
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ORGAN TRANSPLANTS

Unlimited, covered at 100% of the Bonitas Rate
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)

R23 500 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 700 per beneficiary
R2 121 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

R5 550 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
Managed Care protocols apply

SPECIALISED DENTISTRY

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

CHRONIC BENEFITS

Cover for 44 chronic conditions
R8 650 per beneficiary
R17 350 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

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

2 consultations with a 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

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

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 450 per family
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