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WHY BONITAS? page 2
IMPORTANT INFORMATION page 3
OUR PLANS BONCOMPREHENSIVE page 4
BONCLASSIC page 1 0
BONCOMPLETE page 1 6
BONSAVE page 22
BONFIT page 27
STANDARD page 31
STANDARD SELECT page 37
PRIMARY page 43
BONESSENTIAL page 49
EXCLUSIONS page 52
HOW-TO GUIDEHOW TO CLAIM page 56
GET THE BONITAS BABY BAG page 56
FIND A NETWORK PROVIDER page 57
FIND A SERVICE PROVIDER page 58
INDEX
Please note: Product rules, limits, terms and conditions apply. Where there is a discrepancy between the content provided in this brochure, the website and the Scheme Rules, the Scheme Rules will prevail. The Scheme Rules are available on request. Benefits are subject to approval from the Council for Medical Schemes.
IND
EX
Page 2All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
A�ordable, quality healthcare with *93% payout on valid claims
Largest GP network and a specialist network to give more value for money
Simple-to-use plans to meet the needs of all South Africans
Benefits for cancer, mental health, HIV/AIDS, diabetes and more
Preventative care and wellness benefits paid from risk so benefits last longer
Cover for up to 62 chronic conditions and free medicine delivery
Separate benefits for dentistry and optometry on several options
Partnerships with quality service providers and healthcare professionals
Managed Care programmes to help members manage chronic conditions
Additional benefits for maternity and children, including access to 24/7 paediatric telephonic advice, including weekends and public holidays
WHY BONITAS?
*According to Global Credit Rating (GCR) report 2015
WH
Y BON
ITAS?
Page 3 All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
IMPO
RTAN
T IN
FORM
ATIO
N
PREFERRED PROVIDERS AND DESIGNATED SERVICE PROVIDERS
We negotiate rates with preferred providers and Designated Service Providers to ensure that they do not charge you more than the agreed rate. This will ensure that your benefits last as long as possible and give you more value for money.
Please note: Where you are required to use a Designated Service Provider and you do not do so, a significant co-payment will apply. You can call us on 0860 002 108 or log in to www.bonitas.co.za to view the list of preferred providers and Designated Service Providers.
UNDERSTANDING THE BONITAS RATE
The Bonitas Rate is the rate at which we reimburse healthcare providers.
Where we pay 100% of the Bonitas Rate and your healthcare provider charges more than this, you will have to pay the outstanding amount. For example, if you visit a healthcare provider that charges 200% of the medical aid rate and you receive a bill of R1 000, we will only pay R500.
If you visit a healthcare provider that charges the Bonitas Rate, we will pay the bill in full (provided that you have benefits available).
On some options we pay more than 100% of the Bonitas Rate.
IMPORTANT INFORMATION
PROVIDERS ON THE NETWORK WILL BE PAID IN FULL
We encourage all our members to use providers on our network, as this will ensure that providers are paid in full (provided that you have benefits available).
DEPENDANTS
An adult dependant is any dependant on your medical aid who is 21 years or older.
A child dependant is any dependant on your medical aid who is under 21 years.
If your child is a student and is registered on your medical aid, child rates will apply up to and including the last day of the month in which he/she turns 24 years old. We will require valid proof of registration from a recognised tertiary institution for child rates to apply to a student.
UNDERWRITING
Late-joiner penalties and waiting periods may apply to your membership. This is a requirement of the Medical Schemes Act 131 of 1998.
A late-joiner penalty applies to members over 35 years of age or older, who have had a break in medical aid membership for more than 3 months from 1 April 2001. Late-joiner penalties will result in your premium being increased. This is based on a specific calculation considering the number of years you have not been a member of a medical aid.
A general waiting period lasts 3 months. During this period you and your dependants are not entitled to claim any benefits, except, Prescribed Minimum Benefits in some circumstances.
A condition-specific waiting period lasts 12 months. During this period you and your dependants are not entitled to claim benefits related to a specific condition.
PRORATION OF BENEFITS
If you join Bonitas during the year, benefits will automatically be prorated. This means that you will only have access to a percentage of your benefits, based on the month you join us, until the next benefit year begins. For example, if you join in June, you will have access to six months’ worth of benefits, which is 50% of the total benefits.
Page 4All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
BONCOMPREHENSIVE
Main member
Adult dependant
Child dependant
R5 254 R4 956 R1 069
Your 4th and subsequent children will be covered free of charge.
This first-class savings plan offers ample savings, an above threshold benefit and extensive hospital cover.
Unlimited cover up to 300% in hospital Cancer benefit of R556 700 including benefit for specialised drugs
No network restrictions or co-payments on CT scans and MRIs Comprehensive preventative care benefits
Rich savings and above threshold benefits Annual wellness screening and R2 100 for Wellness Extender
Extensive cover for 62 chronic conditions Extensive maternity benefits including private ward
Specialised dentistry and refractive surgery Cover for childhood vaccines and infant paediatric and childhood illness benefits
BON
COM
PREHEN
SIVE
Page 5 All claims are paid at the Bonitas Rate, unless otherwise stated. All benefi ts and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefi ts are subject to approval from the Council for Medical Schemes.
IN-HOSPITAL BENEFITS Cover for major medical events that result in a benefi ciary being admitted into hospital.
Pre-authorisation is required.
We negotiate extensively with hospitals to ensure the best possible value for our members. Members have access to all private hospitals. A co-payment will apply to admissions at specifi c hospitals. Please call us on 0860 002 108 or log in to www.bonitas.co.za for a list of these hospitals.
GP consultations Unlimited, covered at 300% of the Bonitas Rate
Specialist consultations Unlimited, covered at 300% of the Bonitas Rate
Blood tests and other laboratory tests Unlimited, covered at 100% of the Bonitas Rate
X-rays and ultrasounds Unlimited, covered at 100% of the Bonitas Rate
MRIs and CT scans(specialised radiology)
Unlimited
Pre-authorisation required
Paramedical/Allied medical professionals(such as physiotherapists, occupational therapists, dieticians and biokineticists)
Unlimited, covered at 100% of the Bonitas Rate
Your therapist must get a referral from the doctor treating you in hospital
Internal prosthesisR49 600 per family
Pre-authorisation required
External prosthesisR49 600 per family
Pre-authorisation required
Internal nerve stimulators R149 100 per family
Cochlear implantsR250 000 per family
You must use a preferred supplier
Mental health hospitalisation
R42 200 per family
No cover for physiotherapy for mental health admissions
You must use a Designated Service Provider
Take-home medicine R490 per benefi ciary, per hospital stay
Physical rehabilitationR44 650 per family
Pre-authorisation required
Alternatives to hospital(hospice, step-down facilities)
R14 900 per family
Pre-authorisation required
Cancer treatment
R556 700 per family
Pre-authorisation required
R220 900 of this can be used for specialised drugs (including biological drugs)
Non-cancer specialised drugs(including biological drugs)
R176 700 per family
Managed Care protocols apply
Organ transplantsUnlimited
Pre-authorisation required
Kidney dialysis
Unlimited
You must use a preferred provider
Pre-authorisation required
HIV/AIDS Unlimited, if you register on the HIV/AIDS programme
BON
COM
PREH
ENSI
VE
Page 6All claims are paid at the Bonitas Rate, unless otherwise stated. All benefi ts and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefi ts are subject to approval from the Council for Medical Schemes.
OUT-OF-HOSPITAL BENEFITSThese benefi ts provide cover for consultations with your GP or specialist, acute medicine, x-rays, blood tests and other out-of-hospital medical expenses.
Once your savings for the year are fi nished, you will need to pay for day-to-day medical expenses out of your own pocket until you have paid the full self-payment gap. You will then reach the threshold level and have access to your above threshold benefi t. Please submit all claims you have paid while in the self-payment gap to us, so that we can keep a record. Not all claims accumulate to the threshold level.
Please note: You must get a GP referral for specialist consultations (excluding consultations with oncologists and ophthalmologists; maternity consultations and consultations with paediatricians for children under age 2).
GP consultations Paid from available savings and/or above threshold benefi t
Specialist consultations
Paid from available savings and/or above threshold benefi t
You must get a referral from your GP
Blood tests and other laboratory tests Paid from available savings and/or above threshold benefi t
X-rays and ultrasounds Paid from available savings and/or above threshold benefi t
MRIs and CT scans(specialised radiology)
R28 200 per family
Pre-authorisation required
Acute medicine Paid from available savings and/or above threshold benefi t
Over-the-counter medicine Paid from available savings and/or above threshold benefi t
Paramedical/Allied medical professionals(such as physiotherapists, occupational therapists, dieticians and biokineticists)
Paid from available savings and/or above threshold benefi t
Mental health consultations
R14 300 per family
In and out-of-hospital consultations (included in the mental health hospitalisation benefi t)
No cover for educational psychologists for benefi ciaries older than 21 years
Refractive surgeryR18 700 per family
Pre-authorisation required
General medical appliances(such as wheelchairs and crutches)
R7 550 per family
Stoma care and CPAP machines may exceed the general medical appliances limit by R5 550 per family
Foot orthotics paid from available savings
You must use a preferred supplier
Hearing aids
R23 200 per family, once every 2 years (based on the date of your previous claim) 10% co-payment applies
You must use a preferred supplier
Optometry
Limited to R2 880, once every 2 years (based on the date of your previous claim) per benefi ciary
Paid from available savings and/or above threshold benefi t
Basic dentistry Paid from available savings and/or above threshold benefi t
Consultations Once per benefi ciary, every 6 months
X-rays: Intra-oral Managed Care protocols apply
X-rays: Extra-oral
1 per benefi ciary, every 3 years
Additional benefi ts may be considered where specialised dental treatment is required
Mainmember
Adultdependant
Childdependant
Savings R11 892 R11 220 R 2 424
Self-payment gap R 3 600 R 2 980 R 1 370
Threshold level R15 492 R14 200 R 3 794
Above threshold benefi t Unlimited Unlimited Unlimited
BON
COM
PREHEN
SIVE
Page 7 All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
Oral hygiene
Once per beneficiary, every 6 months
Fissure sealants are only covered for children under 16 years
Fluoride treatments are only covered for children from age 5 and younger than 16 years
Fillings
Benefit for fillings is granted once per tooth, in 365 days
Benefit for re-treatment of a tooth is subject to Managed Care protocols
A treatment plan and x-rays may be required for multiple fillings
Root canal therapy and extractions Managed Care protocols apply
Plastic dentures and associated laboratory costs
1 set of plastic dentures (an upper and a lower) per beneficiary, once every 4 years
Specialised dentistry Paid from available savings and/or above threshold benefit
Partial metal frame dentures and associated laboratory costs
2 partial frames (an upper and a lower) per beneficiary, once every 5 years
Managed Care protocols apply
Crowns, bridges and associated laboratory costs
3 crowns per family, per year
Benefit for crowns will be granted once per tooth, every 5 years
A treatment plan and x-rays may be requested
Pre-authorisation required
Implants and associated laboratory costs
2 implants per beneficiary, once every 5 years
Cost of implant components is limited to R2 350 per implant
Managed Care protocols apply
Pre-authorisation required
Orthodontics and associated laboratory costs
Orthodontic treatment is granted once per beneficiary, per lifetime
Pre-authorisation cases will be clinically assessed by using an orthodontic needs analysis
Benefit allocation is subject to the outcome of the needs analysis and funding can be granted up to 100% of the Bonitas Dental Tariff
Benefit for orthodontic treatment will be granted where function is impaired (not granted for cosmetic reasons)
Only 1 family member may begin orthodontic treatment in a calendar year
Benefit for fixed comprehensive treatment is limited to beneficiaries from age 9 and younger than 18 years
Managed Care protocols apply
Pre-authorisation required
Periodontics
Benefit is limited to conservative, non-surgical therapy only and will only be applied to members who are registered on the Periodontal Programme
Managed Care protocols apply
Pre-authorisation required
Maxillo-facial surgery and oral pathology
Surgery in the dental chair Managed Care protocols apply
Hospitalisation (general anaesthetic)
General anaesthetic is only available to children under the age of 5 for extensive dental treatment
General anaesthetic benefit is available for the removal of impacted teeth
Managed Care protocols apply
Pre-authorisation required
Laughing gas in dental rooms Managed Care protocols apply
BON
COM
PREH
ENSI
VE
Page 8All claims are paid at the Bonitas Rate, unless otherwise stated. All benefi ts and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefi ts are subject to approval from the Council for Medical Schemes.
IV conscious sedation in rooms
Limited to extensive dental treatment
Managed Care protocols apply
Pre-authorisation required
Scheme exclusions Please see page 52
CHRONIC BENEFITSBonComprehensive off ers extensive cover for the 62 chronic conditions listed below. This is limited to R12 450 per benefi ciary and R24 800 per family on the applicable formulary. Pre-authorisation is required. If you use medicine that is not listed on the formulary, you will have to pay a 40% co-payment.
You can get your medicine from any pharmacy.
Once the amount above is fi nished, you will still be covered for the 27 Prescribed Minimum Benefi ts, listed below.
Prescribed Minimum Benefi ts covered
1. Addison’s Disease 10. Crohn’s Disease 19. Hyperlipidaemia
2. Asthma 11. Diabetes Insipidus 20. Hypertension
3. Bipolar Mood Disorder 12. Diabetes Type 1 21. Hypothyroidism
4. Bronchiectasis 13. Diabetes Type 2 22. Multiple Sclerosis
5. Cardiac Failure 14. Dysrhythmias 23. Parkinson’s Disease
6. Cardiomyopathy 15. Epilepsy 24. Rheumatoid Arthritis
7. Chronic Obstructive Pulmonary Disease
16. Glaucoma 25. Schizophrenia
8. Chronic Renal Disease 17. Haemophilia 26. Systemic Lupus Erythematosus
9. Coronary Artery Disease
18. HIV/AIDS 27. Ulcerative Colitis
Additional conditions covered
28. Acne 40. Depression 52. Osteoporosis
29. Allergic Rhinitis 41. Eczema 53. Paget's Disease
30. Alzheimer’s Disease (early onset)
42. Gastro-Oesophageal Refl ux Disease (GORD)
54. Panic Disorder
31. Ankylosing Spondylitis 43. Generalised Anxiety Disorder
55. Pemphigus
32. Anorexia Nervosa 44. Gout 56. Polyarteritis Nodosa
33. Attention Defi cit Disorder (in children aged 5-18)
45. Huntington's Disease 57. Post-Traumatic Stress Disorder
34. Barrett's Oesophagus 46. Hyperthyroidism 58. Pulmonary Interstitial Fibrosis
35. Behcet's Disease 47. Hypoparathyroidism 59. Psoriatic Arthritis
36. Bulimia Nervosa 48. Myaesthenia Gravis 60. Systemic Sclerosis
37. Cystic Fibrosis 49. Narcolepsy 61. Tourette's Syndrome
38. Dermatitis 50. Neuropathies 62. Zollinger-Ellison Syndrome
39. Dermatomyositis 51. Obsessive Compulsive Disorder
BON
COM
PREHEN
SIVE
Page 9 All claims are paid at the Bonitas Rate, unless otherwise stated. All benefi ts and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefi ts are subject to approval from the Council for Medical Schemes.
SUPPLEMENTARY BENEFITSWe believe in giving you more value. These additional benefi ts will not aff ect your other benefi t limits or savings.
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 21⁄2 yearsAccess to telephone helpline for 24/7 medical advice, including weekends and holidays
Infant paediatric benefi t
Children under 1 year 3 consultations with a paediatrician
Children between ages 1 and 2 2 consultations with a paediatrician
Childhood illness benefi t
Children between ages 2 and 12 2 GP consultations
Preventative care
General health1 HIV test per benefi ciary
1 fl u vaccine per benefi ciary
Cardiac health 1 full lipogram every 5 years, for members aged 20 and over
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
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
1 prostate screening antigen test for men between ages 55 and 69, who are considered to be at high risk for prostate cancer
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 65 and over
Wellness benefi ts
Wellness screening
1 wellness screening per benefi ciary at a participating pharmacy, biokineticist or a Bonitas wellness day
Wellness screening includes the following tests:• Blood pressure• Glucose• Cholesterol• Body mass index• Waist-to-hip ratio
Wellness Extender
R2 100 per family
Each benefi ciary must complete a wellness screening and register for this benefi t. You may then choose from the following additional benefi ts:• GP consultation(s)• Biokineticist consultation(s)• Dietician consultation(s)• Physiotherapy consultation(s)• A programme to stop smoking
All claims are paid at the Bonitas Rate
BON
COM
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VE
Page 10All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
BONCLASSICThis generous savings option offers a wide range of medical benefits, in and out of hospital.
Main member
Adult dependant
Child dependant
R3 648 R3 132 R 900Your 4th and subsequent children will be covered free of charge.
Unlimited cover up to 100% in hospital Separate benefits for physiotherapy, blood and laboratory tests and paramedical services
Network specialists paid in full in hospital Cover for 48 chronic conditions
No co-payments for CT scans and MRIs Benefit for non-cancer specialised drugs (including biological drugs)
Generous savings and additional benefits for optometry Generous preventative care and maternity benefits
Cover for basic and specialised dentistry including orthodontics Annual wellness screening and R1 450 for Wellness Extender
BON
CLASSIC
Page 11 All claims are paid at the Bonitas Rate, unless otherwise stated. All benefi ts and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefi ts are subject to approval from the Council for Medical Schemes.
IN-HOSPITAL BENEFITSCover for major medical events that result in a benefi ciary being admitted into hospital.
Pre-authorisation is required.
We negotiate extensively with hospitals to ensure the best possible value for our members. Members have access to all private hospitals. A co-payment will apply to admissions at specifi c hospitals. Please call us on 0860 002 108 or log in to www.bonitas.co.za for a list of these hospitals.
GP consultations Unlimited, covered at 100% of the Bonitas Rate
Specialist consultations
Unlimited, network specialists covered in full
Unlimited, non-network specialists paid at 100% of the Bonitas Rate
Blood tests and other laboratory tests Unlimited, covered at 100% of the Bonitas Rate
X-rays and ultrasounds Unlimited, covered at 100% of the Bonitas Rate
MRIs and CT scans(specialised radiology)
R26 100 per family, in and out of hospital
Pre-authorisation required
Paramedical/Allied medicalprofessionals(such as physiotherapists, occupational therapists, dieticians and biokineticists)
Unlimited, covered at 100% of the Bonitas Rate
Your therapist must get a referral from the doctor treating you in hospital
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
Spinal surgery
You will have to pay a R5 300 co-payment if you do not go for an assessment through the back and neck rehabilitation programme
Cochlear implantsR250 000 per family
You must use a preferred supplier
Mental health hospitalisation
R37 100 per family
No cover for physiotherapy for mental health admissions
You must use a Designated Service Provider
Take-home medicine R420 per benefi ciary, per hospital stay
Physical rehabilitationR44 650 per family
Pre-authorisation required
Alternatives to hospital (hospice, step-down facilities)
R14 900 per family
Pre-authorisation required
Cancer treatment
R369 500 per family
You must use a preferred provider
Pre-authorisation required
Non-cancer specialised drugs (including biological drugs)
R110 400 per family
10% co-payment applies
Managed Care protocols apply
Pre-authorisation required
Organ transplants
Unlimited, covered at 100% of the Bonitas Rate
Pre-authorisation required
Kidney dialysisUnlimited, at a preferred provider
Pre-authorisation required
HIV/AIDS Unlimited, if you register on the HIV/AIDS programme
BON
CLAS
SIC
Page 12All claims are paid at the Bonitas Rate, unless otherwise stated. All benefi ts and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefi ts are subject to approval from the Council for Medical Schemes.
OUT-OF-HOSPITAL BENEFITS These benefi ts provide cover for consultations with your GP or specialist, acute medicine, x-rays, blood tests and other out-of-hospital medical expenses.
GP consultations Paid from available savings
Specialist consultationsPaid from available savings
You must get a referral from your GP
Blood tests and other laboratory testsR2 800 per benefi ciary
R6 200 per family
X-rays and ultrasoundsR2 800 per benefi ciary
R4 340 per family
MRIs and CT scans(specialised radiology)
R26 100 per family, in and out of hospital
Pre-authorisation required
Acute medicine Paid from available savings
Over-the-counter medicine Paid from available savings
Paramedical/Allied medical professionals(such as physiotherapists, occupational therapists, dieticians and biokineticists)
Main member onlyR2 670
Main member + 1 dependantR4 090
Main member + 2 dependantsR4 720
Main member + 3 dependantsR5 040
Main member + 4 or more dependantsR5 400
Physical therapyR1 380 per benefi ciary
R2 800 per family
Mental health consultations
R14 300 per family
In and out-of-hospital consultations (included in the mental health hospitalisation benefi t)
No cover for educational psychologists for benefi ciaries older than 21 years
General medical appliances(such as wheelchairs and crutches)
R7 000 per family
Foot orthotics paid from available savings
Hearing aids
R15 200 per family, once every 3 years (based on the date of your previous claim)
10% co-payment applies
You must use a preferred supplier
Optometry
R5 300 per family, once every 2 years (based on the date of your previous claim)
Each benefi ciary can choose glasses or contact lenses
Eye tests
1 per benefi ciary, once every 2 years at a network provider, at network rates
OR
R350 per benefi ciary, at a non-network provider
Single vision lenses (Clear) or
100% towards the cost of lenses at network rates
R150 per lens, per benefi ciary, out of network
Bifocal lenses (Clear) or
100% towards the cost of lenses at network rates
R325 per lens, per benefi ciary, out of network
Multifocal lenses (Clear)
100% towards the cost of lenses at network rates
R700 per lens, per benefi ciary, out of network
Frames R740 per benefi ciary, once every 2 years
Mainmember
Adultdependant
Childdependant
Savings R6 192 R5 316 R1 524
BON
CLASSIC
Page 13 All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
Contact lenses R1 790 per beneficiary, included in family limit
Basic dentistryR4 200 per family, per year
Covered at the Bonitas Dental Tariff
Consultations 2 annual check-ups per beneficiary (once every 6 months)
X-rays: Intra-oral Managed Care protocols apply
X-rays: Extra-oral
1 per beneficiary, every 3 years
Additional benefits may be considered if specialised dental treatment is required
Oral hygiene
2 annual scale and polish treatments per beneficiary (once every 6 months)
Fissure sealants are only covered for children under 16 years
Fluoride treatments are only covered for children from age 5 and younger than 16 years
Fillings
Benefit for fillings is granted once per tooth, in 365 days
Benefit for re-treatment of a tooth is subject to Managed Care protocols
A treatment plan and x-rays may be required for multiple fillings
Root canal therapy and extractions Managed Care protocols apply
Plastic dentures and associated laboratory costs
1 set of plastic dentures (an upper and a lower) per beneficiary, once every 4 years
Managed Care protocols apply
Specialised dentistryR5 050 per family, per year
Covered at the Bonitas Dental Tariff
Partial metal frame dentures and associated laboratory costs
2 partial frames (an upper and a lower) per beneficiary, once every 5 years
Managed Care protocols apply
Crowns, bridges and associated laboratory costs
1 crown per family, per year
Benefit for crowns will be granted once per tooth, every 5 years
A treatment plan and x-rays may be requested
You must use a provider on the DENIS network
Pre-authorisation required
Implants and associated laboratory costs
No benefit
Orthodontics and associated laboratory costs
Orthodontic treatment is granted once per beneficiary, per lifetime
Pre-authorisation cases will be clinically assessed by using an orthodontic needs analysis
Benefit allocation is subject to the outcome of the needs analysis and funding can be granted up to 100% of the Bonitas Dental Tariff
Benefit for orthodontic treatment will be granted where function is impaired (not granted for cosmetic reasons)
Only 1 family member may begin orthodontic treatment in a calendar year
Benefit for fixed comprehensive treatment is limited to beneficiaries from age 9 and younger than 18 years
Managed Care protocols apply
Pre-authorisation required
Periodontics
Benefit is limited to conservative, non-surgical therapy only and will only be applied to members who are registered on the Periodontal Programme
Managed Care protocols apply
Pre-authorisation required
BON
CLAS
SIC
Page 14All claims are paid at the Bonitas Rate, unless otherwise stated. All benefi ts and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefi ts are subject to approval from the Council for Medical Schemes.
Maxillo-facial surgery and oral pathology
Surgery in the dental chair Managed Care protocols apply
Hospitalisation(general anaesthetic)
A co-payment of R3 000 per hospital admission and admission protocols apply
General anaesthetic is only available to children under the age of 5 for extensive dental treatment
General anaesthetic benefi t is available for the removal of impacted teeth
Managed Care protocols apply
Pre-authorisation required
Laughing gas in dental rooms Managed Care protocols apply
IV conscious sedation in rooms
Limited to extensive dental treatment
Managed Care protocols apply
Pre-authorisation required
Scheme exclusions Please see page 52
CHRONIC BENEFITSBonClassic off ers generous cover for 48 chronic conditions. Cover is limited to R10 200 per benefi ciary and R21 100 per family on the applicable formulary. If you choose to use medicine that is not on the formulary, you will have to pay a 40% co-payment.
Pre-authorisation is required. You can get your medicine from any pharmacy on our network.
Once the amount above is fi nished, you will still be covered for the 27 Prescribed Minimum Benefi ts, listed below, from our Designated Service Provider. If you do not use the Designated Service Provider, you will have to pay a 40% co-payment.
Prescribed Minimum Benefi ts covered
1. Addison’s Disease 10. Crohn’s Disease 19. Hyperlipidaemia
2. Asthma 11. Diabetes Insipidus 20. Hypertension
3. Bipolar Mood Disorder 12. Diabetes Type 1 21. Hypothyroidism
4. Bronchiectasis 13. Diabetes Type 2 22. Multiple Sclerosis
5. Cardiac Failure 14. Dysrhythmias 23. Parkinson’s Disease
6. Cardiomyopathy 15. Epilepsy 24. Rheumatoid Arthritis
7. Chronic Obstructive Pulmonary Disease
16. Glaucoma 25. Schizophrenia
8. Chronic Renal Disease 17. Haemophilia 26. Systemic Lupus Erythematosus
9. Coronary Artery Disease
18. HIV/AIDS 27. Ulcerative Colitis
Additional conditions covered
28. Alzheimer’s Disease (early onset)
35. Gastro-Oesophageal Refl ux Disease (GORD)
42. Panic Disorder
29. Ankylosing Spondylitis
36. Generalised Anxiety Disorder
43. Polyarteritis Nodosa
30. Attention Defi cit Disorder (in children aged 5-18)
37. Gout 44. Pulmonary Interstitial Fibrosis
31. Barrett's Oesophagus 38. Hypoparathyroidism 45. Post-Traumatic Stress Disorder
32. Benign Prostatic Hypertrophy
39. Obsessive Compulsive Disorder
46. Scleroderma
33. Depression 40. Osteoporosis 47. Tourette's Syndrome
34. Eczema 41. Paget's Disease 48. Zollinger-Ellison Syndrome
BON
CLASSIC
Page 15 All claims are paid at the Bonitas Rate, unless otherwise stated. All benefi ts and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefi ts are subject to approval from the Council for Medical Schemes.
SUPPLEMENTARY BENEFITSWe believe in giving you more value. These additional benefi ts will not aff ect your other benefi t limits and savings.
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 21⁄2 yearsAccess to telephone helpline for 24/7 medical advice, including weekends and holidays
Preventative care
General health1 HIV test per benefi ciary
1 fl u vaccine per benefi ciary
Cardiac health 1 full lipogram every 5 years, for members aged 20 and over
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
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 65 and over
Wellness benefi ts
Wellness screening
1 wellness screening per benefi ciary at a participating pharmacy, biokineticist or a Bonitas wellness day
Wellness screening includes the following tests:• Blood pressure• Glucose• Cholesterol• Body mass index• Waist-to-hip ratio
Wellness Extender
R1 450 per family
Each benefi ciary must complete a wellness screening and register for this benefi t. You may then choose from the following additional benefi ts:• GP consultation(s)• Biokineticist consultation(s)• Dietician consultation(s)• Physiotherapy consultation(s)• A programme to stop smoking
All claims are paid at the Bonitas Rate
BON
CLAS
SIC
Page 16All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
BONCOMPLETE
Main member
Adult dependant
Child dependant
R2 923 R2 340 R 794
This savings option offers generous savings, an above threshold benefit and rich hospital cover.
Your 4th and subsequent children will be covered free of charge.
Unlimited cover up to 100% in hospital Additional benefit for basic dentistry
Network specialists paid in full in hospital Cover for 31 chronic conditions
Additional benefit for take-home medicine after hospital stay Childhood illness, infant paediatric and maternity benefits
No co-payments for CT scans and MRIs Generous preventative care benefits
Savings and above threshold benefits Annual wellness screening and R1 450 for Wellness Extender
BON
COM
PLETE
Page 17 All claims are paid at the Bonitas Rate, unless otherwise stated. All benefi ts and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefi ts are subject to approval from the Council for Medical Schemes.
IN-HOSPITAL BENEFITSCover for major medical events that result in a benefi ciary being admitted into hospital.
Pre-authorisation is required.
We negotiate extensively with hospitals to ensure the best possible value for our members. Members have access to all private hospitals. A co-payment will apply to admissions at specifi c hospitals. Please call us on 0860 002 108 or log in to www.bonitas.co.za for a list of these hospitals.
GP consultations Unlimited, covered at 100% of the Bonitas Rate
Specialist consultations
Unlimited, network specialists covered in full
Unlimited, non-network specialists paid at 100% of the Bonitas Rate
Blood tests and other laboratory tests Unlimited, covered at 100% of the Bonitas Rate
X-rays and ultrasounds Unlimited, covered at 100% of the Bonitas Rate
MRIs and CT scans(specialised radiology)
R21 000 per family, in and out of hospital
Pre-authorisation required
Paramedical/Allied medicalprofessionals(such as physiotherapists, occupational therapists, dieticians and biokineticists)
Unlimited, covered at 100% of the Bonitas Rate
Your therapist must get a referral from the doctor treating you in hospital
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
Spinal surgery
You will have to pay a R5 300 co-payment if you do not go for an assessment through the back and neck rehabilitation programme
Mental health hospitalisation
R29 000 per family
No cover for physiotherapy for mental health admissions
You must use a Designated Service Provider
Take-home medicine R370 per benefi ciary, per hospital stay
Physical rehabilitationR44 650 per family
Pre-authorisation required
Alternatives to hospital (hospice, step-down facilities)
R14 900 per family
Pre-authorisation required
Cancer treatment
R310 150 per family
You must use a preferred provider
Pre-authorisation required
Organ transplantsUnlimited
Pre-authorisation required
Kidney dialysisUnlimited, at a preferred provider
Pre-authorisation required
HIV/AIDS Unlimited, if you register on the HIV/AIDS programme
BON
COM
PLET
E
Page 18All claims are paid at the Bonitas Rate, unless otherwise stated. All benefi ts and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefi ts are subject to approval from the Council for Medical Schemes.
OUT-OF-HOSPITAL BENEFITS
These benefi ts provide cover for consultations with your GP or specialist, acute medicine, x-rays, blood tests and other out of hospital medical expenses.
Once your savings for the year are fi nished, you will need to pay for day-to-day medical expenses out of your own pocket until you have paid the full self-payment gap. You will then reach the threshold level and have access to your above threshold benefi t. Please submit all claims you have paid while in the self-payment gap to us, so that we can keep a record. Not all claims accumulate to the threshold level.
Please note: You must get a GP referral for specialist consultations (excluding consultations with oncologists and ophthalmologists; maternity consultations and consultations with paediatricians for children under age 2).
GP consultations Paid from available savings and/or above threshold benefi t
Specialist consultations
Paid from available savings and/or above threshold benefi t
You must get a referral from your GP
Blood tests and other laboratory tests Paid from available savings and/or above threshold benefi t
X-rays and ultrasounds Paid from available savings and/or above threshold benefi t
MRIs and CT scans(specialised radiology)
R21 000 per family, in and out of hospital
Pre-authorisation required
Acute medicine Paid from available savings and/or above threshold benefi t
Over-the-counter medicine Paid from available savings and/or above threshold benefi t
Paramedical/Allied medical professionals(such as physiotherapists, occupational therapists, dieticians and biokineticists)
Paid from available savings and/or above threshold benefi t
Mainmember
Adultdependant
Childdependant
Savings R5 256 R4 200 R1 428
Self-payment gap R1 568 R1 326 R 336
Threshold level R6 824 R5 526 R1 764
Above threshold benefi t R4 150 R2 450 R1 060
Mental health consultations
R14 300 per family
In and out of hospital consultations (included in the mental health hospitalisation benefi t)
No cover for educational psychologists for benefi ciaries older than 21 years
General medical appliances(such as wheelchairs and crutches)
Paid from available savings and/or above threshold benefi t
Foot orthotics paid from available savings
You must use a preferred supplier
Hearing aids
Paid from available savings and/or above threshold benefi t
Available once every 2 years (based on the date of your previous claim)
You must use a preferred supplier
OptometryPaid from available savings and/or above threshold benefi t, once every 2 years (based on the date of your previous claim)
Basic dentistry Covered at the Bonitas Dental Tariff
Consultations 2 annual check-ups per benefi ciary (once every 6 months)
X-rays: Intra-oral Managed Care protocols apply
X-rays: Extra-oral
1 per benefi ciary, every 3 years
Additional benefi ts may be considered if specialised dental treatment is required
Oral hygiene
2 annual scale and polish treatments per benefi ciary (once every 6 months)
Fissure sealants are only covered for children under 16 years
Fluoride treatments are only covered for children from age 5 and younger than 16 years
BON
COM
PLETE
Page 19 All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
Fillings
Benefit for fillings is granted once per tooth, in 365 days
Benefit for re-treatment of a tooth is subject to Managed Care protocols
A treatment plan and x-rays may be required for multiple fillings
Root canal therapy and extractions Managed Care protocols apply
Plastic dentures and associated laboratory costs
1 set of plastic dentures (an upper and a lower) per beneficiary, once every 4 years
Specialised dentistry Covered at the Bonitas Dental Tariff
Partial metal frame dentures and associated laboratory costs
1 partial frame (an upper or a lower) per beneficiary, once every 5 years
Managed Care protocols apply
Crowns, bridges and associated laboratory costs
1 crown per family, per year
Benefit for crowns will be granted once per tooth, every 5 years
A treatment plan and x-rays may be requested
You must use a provider on the DENIS network
Pre-authorisation required
Implants and associated laboratory costs
No benefit
Orthodontics and associated laboratory costs
Orthodontic treatment is granted once per beneficiary, per lifetime
Pre-authorisation cases will be clinically assessed by using an orthodontic needs analysis
Benefit allocation is subject to the outcome of the needs analysis and funding can be granted up to 65% of the Bonitas Dental Tariff
Benefit for orthodontic treatment will be granted where function is impaired (not granted for cosmetic reasons)
Only 1 family member may begin orthodontic treatment in a calendar year
Benefit for fixed comprehensive treatment is limited to beneficiaries from age 9 and younger than 18 years
Managed Care protocols apply
Pre-authorisation required
Periodontics
Benefit is limited to conservative, non-surgical therapy only and will only be applied to members who are registered on the Periodontal Programme
Managed Care protocols apply
Pre-authorisation required
Maxillo-facial surgery and oral pathology
Surgery in the dental chair Managed Care protocols apply
Hospitalisation(general anaesthetic)
A co-payment of R3 000 per hospital admission and admission protocols apply
General anaesthetic is only available to children under the age of 5 for extensive dental treatment
General anaesthetic benefit is available for the removal of impacted teeth
Managed Care protocols apply
Pre-authorisation required
BON
COM
PLET
E
Page 20All claims are paid at the Bonitas Rate, unless otherwise stated. All benefi ts and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefi ts are subject to approval from the Council for Medical Schemes.
Laughing gas in dental rooms Managed Care protocols apply
IV conscious sedation in rooms
Limited to extensive dental treatment
Managed Care protocols apply
Pre-authorisation required
Scheme exclusions Please see page 52
CHRONIC BENEFITSBonComplete off ers cover for 31 chronic conditions, using the applicable formulary.Pre-authorisation is required.
You must use our Designated Service Provider to get your medicine. If you do not use the Designated Service Provider or if you use medicine that is not on the formulary, you will have to pay a 40% co-payment.
Prescribed Minimum Benefi ts covered
1. Addison’s Disease 10. Crohn’s Disease 19. Hyperlipidaemia
2. Asthma 11. Diabetes Insipidus 20. Hypertension
3. Bipolar Mood Disorder 12. Diabetes Type 1 21. Hypothyroidism
4. Bronchiectasis 13. Diabetes Type 2 22. Multiple Sclerosis
5. Cardiac Failure 14. Dysrhythmias 23. Parkinson’s Disease
6. Cardiomyopathy 15. Epilepsy 24. Rheumatoid Arthritis
7. Chronic Obstructive Pulmonary Disease
16. Glaucoma 25. Schizophrenia
8. Chronic Renal Disease 17. Haemophilia 26. Systemic Lupus Erythematosus
9. Coronary Artery Disease
18. HIV/AIDS 27. Ulcerative Colitis
Additional conditions covered for children
28. Acne 30. Allergic Dermatitis / Eczema
31. Attention Defi cit Disorder(in children aged 5-18)
29. Allergic Rhinitis
SUPPLEMENTARY BENEFITSWe believe in giving you more value. These additional benefi ts will not aff ect your other benefi t limits or savings.
Maternity care
Per pregnancy
6 antenatal consultations with a gynaecologist, GP or midwife
R1 100 for antenatal classes
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 21⁄2 yearsAccess to telephone helpline for 24/7 medical advice, including weekends and holidays
Infant paediatric benefi t
Children under 1 year 2 consultations with a paediatrician
Children between ages 1 and 2 1 consultation with a paediatrician
Childhood illness benefi t
Children between ages 2 and 12 1 GP consultation
Preventative care
General health1 HIV test per benefi ciary
1 fl u vaccine per benefi ciary
Cardiac health 1 full lipogram every 5 years, for members aged 20 and over
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
BON
COM
PLETE
Page 21 All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
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
Wellness benefits
Wellness screening
1 wellness screening per beneficiary at a participating pharmacy, biokineticist or a Bonitas wellness day
Wellness screening includes the following tests:• Blood pressure• Glucose• Cholesterol• Body mass index• Waist-to-hip ratio
Wellness Extender
R1 450 per family
Each beneficiary must complete a wellness screening and register for this benefit. You may then choose from the following additional benefits:• GP consultation(s)• Biokineticist consultation(s)• Dietician consultation(s)• Physiotherapy consultation(s)• A programme to stop smoking
All claims are paid at the Bonitas Rate
BON
COM
PLET
E
Page 22All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
BONSAVEThis savings option offers sufficient savings to use as you choose for medical expenses and extensive hospital cover.
Main member
Adult dependant
Child dependant
R2 135 R1 654 R 640 Your 4th and subsequent children will be covered free of charge.
Unlimited cover up to 150% in hospital Savings plus additional benefit for basic dentistry
Specialists paid at 150% in hospital Cover for up to 6 additional GP consultations after savings are finished
No co-payments for CT scans and MRIs 27 PMB chronic conditions covered
Reasonable co-payments for certain in-hospital procedures Childhood illness, infant paediatric and maternity benefits
Additional benefit for take-home medicine after hospital stay Annual wellness screening and R1 050 for Wellness Extender
BON
SAVE
Page 23 All claims are paid at the Bonitas Rate, unless otherwise stated. All benefi ts and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefi ts are subject to approval from the Council for Medical Schemes.
IN-HOSPITAL BENEFITSCover for major medical events that result in a benefi ciary being admitted into hospital.
Pre-authorisation is required.
We negotiate extensively with hospitals to ensure the best possible value for our members. Members have access to all private hospitals. A co-payment will apply to admissions at specifi c hospitals. Please call us on 0860 002 108 or log in to www.bonitas.co.za for a list of these hospitals.
GP consultations Unlimited, covered at 150% of the Bonitas Rate
Specialist consultations Unlimited, covered at 150% of the Bonitas Rate
Blood tests and other laboratory tests Unlimited, covered at 100% of the Bonitas Rate
X-rays and ultrasounds Unlimited, covered at 100% of the Bonitas Rate
MRIs and CT scans(specialised radiology)
R21 000 per family, in and out of hospital
Pre-authorisation required
Paramedical/Allied medical professionals(such as physiotherapists, occupational therapists, dieticians and biokineticists)
Unlimited, covered at 100% of the Bonitas Rate
Your therapist must get a referral from the doctor treating you in hospital
Internal and external prostheses
PMB only
Managed Care protocols apply
Pre-authorisation required
You must use a preferred supplier
Mental health hospitalisation
R29 000 per family
No cover for physiotherapy for mental health admissions
You must use a Designated Service Provider
Take-home medicine R340 per benefi ciary, per hospital stay
Physical rehabilitationR44 650 per family
Pre-authorisation required
Alternatives to hospital(hospice, step-down facilities)
R14 900 per family
Pre-authorisation required
Cancer treatment
R310 150 per family
You must use a preferred provider
Pre-authorisation required
Organ transplantsUnlimited
Pre-authorisation required
Kidney dialysis
Unlimited
You must use the Designated Service Provider
Pre-authorisation required
HIV/AIDS Unlimited, if you register on the HIV/AIDS programme
BON
SAVE
Page 24All claims are paid at the Bonitas Rate, unless otherwise stated. All benefi ts and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefi ts are subject to approval from the Council for Medical Schemes.
A co-payment will apply to the following procedures in hospital
R1 300 co-payment R3 300 co-payment R6 500 co-payment
1. Colonoscopy 1. Arthroscopy 1. Back Surgery including Spinal Fusion
2. Conservative Back Treatment
2. Diagnostic Laparoscopy
2. Joint Replacements
3. Cystoscopy 3. Laparoscopic Hysterectomy
3. Laparoscopic Pyeloplasty
4. Facet Joint Injections 4. Laparoscopic Appendectomy
4. Laparoscopic Radical Prostatectomy
5. Flexible Sigmoidoscopy 5. Percutaneous Radiofrequency Ablations (Percutaneous Rhizotomies)
5. Nissen Fundoplication (Refl ux Surgery)
6. Functional Nasal Surgery
7. Gastroscopy
8. Hysteroscopy (not Endometrial Ablation)
9. Myringotomy
10. Tonsillectomy and Adenoidectomy
11. Umbilical Hernia Repair
12. Varicose Vein Surgery
OUT-OF-HOSPITAL BENEFITSThese benefi ts provide cover for consultations with your GP or specialist, acute medicine, x-rays, blood tests and other out-of-hospital medical expenses.
GP consultations Paid from available savings
Specialist consultationsPaid from available savings
You must get a referral from your GP
Acute medicine and over-the-counter medicine
Paid from available savings
X-rays and ultrasounds Paid from available savings
MRIs and CT scans(specialised radiology)
R21 000 per family, in and out of hospital
Pre-authorisation required
Blood tests and other laboratory tests Paid from available savings
Mental health consultations
R14 300 per family
In and out-of-hospital consultations (included in the mental health hospitalisation benefi t)
No cover for educational psychologists for benefi ciaries older than 21 years
Paramedical/Allied medical professionals(such as physiotherapists, occupational therapists, dieticians and biokineticists)
Paid from available savings
General medical appliances(such as wheelchairs and crutches)
R6 200 per family
Stoma care and CPAP machines may exceed the general medical appliances limit by R5 900 per family
Foot orthotics paid from available savings
You must use a preferred supplier
Optometry Paid from available savings
Basic dentistry Covered at the Bonitas Dental Tariff
Consultations 2 annual check-ups per benefi ciary (once every 6 months)
X-rays: Intra-oral Managed Care protocols apply
Mainmember
Adultdependant
Childdependant
Savings R4 104 R3 180 R1 236
BON
SAVE
Page 25 All claims are paid at the Bonitas Rate, unless otherwise stated. All benefi ts and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefi ts are subject to approval from the Council for Medical Schemes.
X-rays: Extra-oral
1 per benefi ciary, every 3 years
Additional benefi ts may be considered if specialised dental treatment is required
Oral hygiene
2 annual scale and polish treatments per benefi ciary (once every 6 months)
Fissure sealants are only covered for children under 16 years
Fluoride treatments are only covered for children from age 5 and younger than 16 years
Fillings
Benefi t for fi llings is granted once per tooth, in 365 days
Benefi t for re-treatment of a tooth is subject to Managed Care protocols
A treatment plan and x-rays may be required for multiple fi llings
Root canal therapy and extractions
Benefi t for root canal includes all teeth except primary teeth and permanent molars
Managed Care protocols apply
Plastic dentures and associated laboratory costs
1 set of plastic dentures (an upper and a lower) per benefi ciary, once every 4 years
Specialised dentistry No benefi t
Maxillo-facial surgery and oral pathology
Surgery in the dental chair Managed Care protocols apply
Hospitalisation(general anaesthetic)
A co-payment of R3 000 per hospital admission and admission protocols apply
General anaesthetic is only available to children under the age of 5 for extensive dental treatment
General anaesthetic benefi t is available for the removal of impacted teeth
Managed Care protocols apply
Pre-authorisation required
Laughing gas in dental rooms Managed Care protocols apply
IV conscious sedation in rooms
Limited to extensive dental treatment
Managed Care protocols apply
Pre-authorisation required
Scheme exclusions Please see page 52
CHRONIC BENEFITSBonSave ensures that you are covered for the 27 Prescribed Minimum Benefi ts listed below on the applicable formulary. Pre-authorisation is required. If you do not use our Designated Service Provider or if you use medicine that is not on the formulary, you will have to pay a 40% co-payment.
Prescribed Minimum Benefi ts covered
1. Addison’s Disease 10. Crohn’s Disease 19. Hyperlipidaemia
2. Asthma 11. Diabetes Insipidus 20. Hypertension
3. Bipolar Mood Disorder 12. Diabetes Type 1 21. Hypothyroidism
4. Bronchiectasis 13. Diabetes Type 2 22. Multiple Sclerosis
5. Cardiac Failure 14. Dysrhythmias 23. Parkinson’s Disease
6. Cardiomyopathy 15. Epilepsy 24. Rheumatoid Arthritis
7. Chronic Obstructive Pulmonary Disease
16. Glaucoma 25. Schizophrenia
8. Chronic Renal Disease 17. Haemophilia 26. Systemic Lupus Erythematosus
9. Coronary Artery Disease
18. HIV/AIDS 27. Ulcerative Colitis
BON
SAVE
Page 26All claims are paid at the Bonitas Rate, unless otherwise stated. All benefi ts and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefi ts are subject to approval from the Council for Medical Schemes.
SUPPLEMENTARY BENEFITSWe believe in giving you more value. These additional benefi ts will not aff ect your other benefi t limits or savings.
Additional GP consultations
If you use all your savings for the year, your family will still get a maximum of 6 GP consultations (limited to 3 per benefi ciary) paid at the Bonitas Rate
Maternity care
Per pregnancy
6 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 21⁄2 yearsAccess to telephone helpline for 24/7 medical advice, including weekends and holidays
Infant paediatric benefi t
Children under 1 year 2 consultations with a paediatrician
Children between ages 1 and 2 1 consultation with a paediatrician
Childhood illness benefi t
Children between ages 2 and 12 1 GP consultation
Preventative care
General health1 HIV test per benefi ciary
1 fl u vaccine per benefi ciary
Women’s health 1 pap smear every 3 years, for women between ages 21 and 65
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
Wellness benefi ts
Wellness screening
1 wellness screening per benefi ciary at a participating pharmacy, biokineticist or a Bonitas wellness day
Wellness screening includes the following tests:• Blood pressure• Glucose• Cholesterol• Body mass index• Waist-to-hip ratio
Wellness Extender
R1 050 per family
Each benefi ciary must complete a wellness screening and register for this benefi t. You may then choose from the following additional benefi ts:• GP consultation(s)• Biokineticist consultation(s)• Dietician consultation(s)• Physiotherapy consultation(s)• A programme to stop smoking
All claims are paid at the Bonitas Rate
BON
SAVE
Page 27 All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
BONFITThis savings plan offers basic cover for day-to-day medical needs and essential hospital cover.
Main member
Adult dependant
Child dependant
R1 789 R1 385 R 535 Your 4th and subsequent children will be covered free of charge.
Unlimited cover up to 100% at hospitals on the BonFit network Basic savings for day-to-day medical expenses
Network specialists paid in full in hospital 27 PMB chronic conditions covered
No co-payments for CT scans and MRIs Childhood illness, infant paediatric and maternity benefits
Reasonable co-payments for certain in-hospital procedures Basic preventative care benefits
Additional benefit for take-home medicine after hospital stay Annual wellness screening and R1 050 for Wellness Extender
BON
FIT
Page 28All claims are paid at the Bonitas Rate, unless otherwise stated. All benefi ts and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefi ts are subject to approval from the Council for Medical Schemes.
IN-HOSPITAL BENEFITSCover for major medical events that result in a benefi ciary being admitted into hospital. You must use a hospital on the BonFit network or you will have to pay a 30% co-payment.
Pre-authorisation is required.
GP consultations Unlimited, covered at 100% of the Bonitas Rate
Specialist consultations
Unlimited, network specialists coveredin full
Unlimited, non-network specialists paid at 100% of the Bonitas Rate
Blood tests and other laboratory tests Unlimited, covered at 100% of the Bonitas Rate
X-rays and ultrasounds Unlimited, covered at 100% of the Bonitas Rate
MRIs and CT scans(specialised radiology)
Unlimited
Pre-authorisation required
Paramedical/Allied medical professionals (such as physiotherapists, occupational therapists, dieticians and biokineticists)
Unlimited, covered at 100% of the Bonitas Rate
Your therapist must get a referral from the doctor treating you in hospital
Internal and external prostheses
PMB only
Managed Care protocols apply
Pre-authorisation required
You must use a preferred supplier
Mental health hospitalisation
R29 000 per family
No cover for physiotherapy for mental health admissions
You must use a Designated Service Provider
Take-home medicine R340 per benefi ciary, per hospital stay
Physical rehabilitationR44 650 per family
Pre-authorisation required
Alternatives to hospital (hospice, step-down facilities)
R14 900 per family
Pre-authorisation required
Cancer treatment
R310 150 per family
You must use a preferred provider
Pre-authorisation required
Organ transplantsUnlimited
Pre-authorisation required
Kidney dialysis
Unlimited
Pre-authorisation required
You must use the Designated Service Provider
HIV/AIDS Unlimited, if you register on the HIV/AIDS programme
A co-payment will apply to the following procedures in hospital
R1 300 co-payment R3 300 co-payment R6 500 co-payment
1. Colonoscopy 1. Arthroscopy 1. Back Surgery including Spinal Fusion
2. Conservative Back Treatment
2. Diagnostic Laparoscopy
2. Joint Replacements
3. Cystoscopy 3. Laparoscopic Hysterectomy
3. Laparoscopic Pyeloplasty
4. Facet Joint Injections 4. Laparoscopic Appendectomy
4. Laparoscopic Radical Prostatectomy
5. Flexible Sigmoidoscopy 5. Percutaneous Radiofrequency Ablations (Percutaneous Rhizotomies)
5. Nissen Fundoplication (Refl ux Surgery)
6. Functional Nasal Surgery
7. Gastroscopy
8. Hysteroscopy (not Endometrial Ablation)
9. Myringotomy
10. Tonsillectomy and Adenoidectomy
11. Umbilical Hernia Repair
12. Varicose Vein Surgery
BON
FIT
Page 29 All claims are paid at the Bonitas Rate, unless otherwise stated. All benefi ts and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefi ts are subject to approval from the Council for Medical Schemes.
OUT-OF-HOSPITAL BENEFITSThese benefi ts provide cover for consultations with your GP or specialist, acute medicine, x-rays, blood tests and other out-of-hospital medical expenses.
GP consultations Paid from available savings
Specialist consultationsPaid from available savings
You must get a referral from your GP
Blood tests and other laboratory tests Paid from available savings
X-rays and ultrasounds Paid from available savings
MRIs and CT scans(specialised radiology)
Paid from available savings
Pre-authorisation required
Acute medicine Paid from available savings
Over-the-counter medicine Paid from available savings
Paramedical/Allied medical professionals (such as physiotherapists, occupational therapists, dieticians and biokineticists)
Paid from available savings
Mental health consultations
PMB consultations only
In and out-of-hospital consultations (included in the mental health hospitalisation benefi t)
No cover for educational psychologists for benefi ciaries older than 21 years
General medical appliances Paid from available savings
Optometry Paid from available savings
Basic dentistryPaid from available savings
Managed Care protocols apply
Consultations Paid from available savings
X-rays: Intra-oral Paid from available savings
X-rays: Extra-oral Paid from available savings
Oral hygiene Paid from available savings
Fillings Paid from available savings
Root canal therapy and extractions Paid from available savings
Plastic dentures and associated laboratory costs
Paid from available savings
Surgery in the dental chairManaged Care protocols apply
Pre-authorisation required
Hospitalisation(general anaesthetic)
A co-payment of R3 000 per hospital admission and admission protocols apply
General anaesthetic is only available to children under the age of 5 years for extensive dental treatment
General anaesthetic benefi ts are available for the removal of impacted teeth
BonFit hospital network applies
Managed Care protocols apply
Pre-authorisation required
Laughing gas in dental rooms Managed Care protocols apply
IV conscious sedation in rooms
Limited to extensive dental treatment
Managed Care protocols apply
Pre-authorisation required
Specialised dentistry No benefi t
Scheme exclusions Please see page 52
Mainmember
Adultdependant
Childdependant
Savings R3 228 R2 496 R 960
BON
FIT
Page 30All claims are paid at the Bonitas Rate, unless otherwise stated. All benefi ts and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefi ts are subject to approval from the Council for Medical Schemes.
CHRONIC BENEFITSBonFit ensures that you are covered for the 27 Prescribed Minimum Benefi ts listed below on the applicable formulary. Pre-authorisation is required. If you do not use our Designated Service Provider or if you use medicine that is not on the formulary, you will have to pay a 40% co-payment.
Prescribed Minimum Benefi ts covered
1. Addison’s Disease 10. Crohn’s Disease 19. Hyperlipidaemia
2. Asthma 11. Diabetes Insipidus 20. Hypertension
3. Bipolar Mood Disorder 12. Diabetes Type 1 21. Hypothyroidism
4. Bronchiectasis 13. Diabetes Type 2 22. Multiple Sclerosis
5. Cardiac Failure 14. Dysrhythmias 23. Parkinson’s Disease
6. Cardiomyopathy 15. Epilepsy 24. Rheumatoid Arthritis
7. Chronic Obstructive Pulmonary Disease
16. Glaucoma 25. Schizophrenia
8. Chronic Renal Disease 17. Haemophilia 26. Systemic Lupus Erythematosus
9. Coronary Artery Disease
18. HIV/AIDS 27. Ulcerative Colitis
SUPPLEMENTARY BENEFITSWe believe in giving you more value. These additional benefi ts will not aff ect your other benefi t limits or savings.
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 21⁄2 yearsAccess to telephone helpline for 24/7 medical advice, including weekends and holidays
Infant paediatric benefi t
Children under 1 year 2 consultations with a paediatrician
Children between ages 1 and 2 1 consultation with a paediatrician
Childhood illness benefi t
Children between ages 2 and 12 1 GP consultation
Preventative care
General health1 HIV test per benefi ciary
1 fl u vaccine per benefi ciary
Women’s health 1 pap smear every 3 years, for women between ages 21 and 65
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
Wellness benefi ts
Wellness screening
1 wellness screening per benefi ciary at a participating pharmacy, biokineticist or a Bonitas wellness day
Wellness screening includes the following tests:• Blood pressure• Glucose• Cholesterol• Body mass index• Waist-to-hip ratio
Wellness Extender
R1 050 per family
Each benefi ciary must complete a wellness screening and register for this benefi t. You may then choose from the following additional benefi ts:• GP consultation(s)• Biokineticist consultation(s)• Dietician consultation(s)• Physiotherapy consultation(s)• A programme to stop smoking
All claims are paid at the Bonitas Rate
BON
FIT
Page 31 All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
This traditional option offers rich day-to-day benefits and comprehensive hospital cover.
Main member
Adult dependant
Child dependant
R2 998 R2 600 R 880
STANDARD
Your 4th and subsequent children will be covered free of charge.
Unlimited cover up to 100% in hospital Rich day-to-day benefits plus optometry benefit
Network specialists paid in full in hospital Cover for basic and specialised dentistry including orthodontics
Additional benefit for take-home medicine after hospital stay Cover for 44 chronic conditions
No co-payments for CT scans and MRIs Childhood illness, infant paediatric and maternity benefits
Separate benefit for GP consultations Annual wellness screening and R1 450 for Wellness Extender
STAN
DARD
Page 32All claims are paid at the Bonitas Rate, unless otherwise stated. All benefi ts and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefi ts are subject to approval from the Council for Medical Schemes.
IN-HOSPITAL BENEFITS Cover for major medical events that result in a benefi ciary being admitted into hospital.
Pre-authorisation is required.
We negotiate extensively with hospitals to ensure the best possible value for our members. Members have access to all private hospitals. A co-payment will apply to admissions at specifi c hospitals. Please call us on 0860 002 108 or log in to www.bonitas.co.za for a list of these hospitals.
GP consultations Unlimited, covered at 100% of the Bonitas Rate
Specialist consultations
Unlimited, network specialists covered in full
Unlimited, non-network specialists paid at 100% of the Bonitas Rate
Blood and other laboratory tests Unlimited, covered at 100% of the Bonitas Rate
X-rays and ultrasounds Unlimited, covered at 100% of the Bonitas Rate
MRIs and CT scans(specialised radiology)
R23 500 per family, in and out of hospital
Pre-authorisation required
Paramedical/Allied medical professionals (such as physiotherapists, occupational therapists, dieticians and biokineticists)
Unlimited, covered at 100% of the Bonitas Rate
Your therapist must get a referral from the doctor treating you in hospital
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
Spinal surgery
You will have to pay a R5 300 co-payment if you do not go for an assessment through the back and neck rehabilitation programme
Internal nerve stimulators R149 100 per family
Cochlear implantsR250 000 per family
You must use a preferred supplier
Mental health hospitalisation
R36 550 per family
No cover for physiotherapy for mental health admissions
You must use a Designated Service Provider
Take-home medicine R420 per benefi ciary, per hospital stay
Physical rehabilitationR44 650 per family
Pre-authorisation required
Alternatives to hospital(hospice, step-down facilities)
R14 900 per family
Pre-authorisation required
Cancer treatment
R310 150 per family
You must use a preferred provider
Pre-authorisation required
Organ transplantsUnlimited
Pre-authorisation required
Kidney dialysisUnlimited, at a preferred provider
Pre-authorisation required
HIV/AIDS Unlimited, if you register on the HIV/AIDS programme
STANDARD
Page 33 All claims are paid at the Bonitas Rate, unless otherwise stated. All benefi ts and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefi ts are subject to approval from the Council for Medical Schemes.
OUT-OF-HOSPITAL BENEFITSOut-of-hospital claims will be paid from available day-to-day benefi ts. There is a separate benefi t for GP consultations.
GP consultationsIf you do not use a GP on our network, your benefi t for GP consultations will be limited to the non-network GP consultation benefi t. This is shown in the table below.
Main member only R3 750 (R1 220 of this can be used for non-network GP consultations)
Main member + 1 dependant R5 500 (R1 880 of this can be used for non-network GP consultations)
Main member + 2 dependants R6 100 (R2 050 of this can be used for non-network GP consultations)
Main member + 3 dependants R6 400 (R2 150 of this can be used for non-network GP consultations)
Main member + 4 or more dependants R6 950 (R2 320 of this can be used for non-network GP consultations)
Day-to-day benefi tsThese benefi ts provide cover for consultations with your specialist, acute medicine, x-rays, blood tests and other out-of-hospital medical expenses.
Please note: You must get a GP referral for specialist consultations (excluding consultations with oncologists and ophthalmologists; maternity consultations and consultations with paediatricians for children under age 2).
Main member only R 5 232
Main member + 1 dependant R 7 970
Main member + 2 dependants R 9 214
Main member + 3 dependants R10 062
Main member + 4 or more dependants R10 966
Specialist consultationsPaid from available day-to-day benefi ts
You must get a referral from your GP
Blood tests and other laboratory tests Paid from available day-to-day benefi ts
X-rays and ultrasounds Paid from available day-to-day benefi ts
MRIs and CT scans(specialised radiology)
R23 500 per family, in and out of hospital
Pre-authorisation required
Acute medicine Paid from available day-to-day benefi ts
Over-the-counter medicine
R700 per benefi ciary
R2 121 per family
Paid from available day-to-day benefi ts
Paramedical/Allied medical professionals(such as physiotherapists, occupational therapists, dieticians and biokineticists)
Paid from available day-to-day benefi ts
Mental health consultations
R14 300 per family
In and out-of-hospital consultations (included in the mental health hospitalisation benefi t)
No cover for educational psychologists for benefi ciaries older than 21 years
General medical appliances(such as wheelchairs and crutches)
R6 900 per family
Stoma care products and CPAP machines may exceed the general medical appliances limit by R5 900 per family
No benefi t for foot orthotics
You must use a preferred supplier
Hearing aids
R14 400 per family, once every 2 years (based on the date of your previous claim)
20% co-payment applies
You must use a preferred supplier
Optometry
R5 550 per family, once every 2 years (based on the date of your previous claim) Each benefi ciary can choose glasses or contact lenses
Eye tests
1 per benefi ciary, once every 2 years at a network provider, at network rates
OR
R350 per benefi ciary, once every 2 years at a non-network provider
STAN
DARD
Page 34All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
Single vision lenses (Clear) or
100% towards the cost of lenses at network rates
R150 per lens, per beneficiary, out of network
Bifocal lenses (Clear) or
100% towards the cost of lenses at network rates
R325 per lens, per beneficiary, out of network
Multifocal lenses (Clear)
100% towards the cost of lenses at network rates
R700 per lens, per beneficiary, out of network
Frames R850 per beneficiary, once every 2 years
Contact lenses R1 850 per beneficiary (included in the family limit)
Basic dentistry Covered at the Bonitas Dental Tariff
Consultations 2 annual check-ups per beneficiary (once every 6 months)
X-rays: Intra-oral Managed Care protocols apply
X-rays: Extra-oral
1 per beneficiary, every 3 years
Additional benefit may be considered if specialist dental treatment planning/follow up is required
Oral hygiene
2 annual scale and polish treatments per beneficiary (once every 6 months)
Fissure sealants are only covered for children under 16 years
Fluoride treatments are only covered for children from age 5 and younger than 16 years
Fillings
Benefit for fillings is granted once per tooth, in 365 days
Benefit for re-treatment of a tooth is subject to Managed Care protocols
A treatment plan and x-rays may be required for multiple fillings
Root canal and extractions Managed Care protocols apply
Plastic dentures and associated laboratory costs
1 set of plastic dentures (an upper and a lower) per beneficiary, once every 4 years
Specialised dentistry Covered at the Bonitas Dental Tariff
Partial metal frame dentures and associated laboratory costs
1 partial frame (an upper or lower) per beneficiary, once every 5 years
Managed Care protocols apply
Crowns, bridges and associated laboratory costs
1 crown per family, per year
Benefit for crowns will be granted once per tooth, every 5 years
A treatment plan and x-rays may be requested
You must use a provider on the DENIS network
Pre-authorisation required
Implants and associated laboratory costs
No benefit
Orthodontics and associated laboratory costs
Orthodontic treatment is granted once per beneficiary, per lifetime
Pre-authorisation cases will be clinically assessed by using an orthodontic needs analysis
Benefit allocation is subject to the outcome of the needs analysis and funding can be granted up to 80% of the Bonitas Dental Tariff
Benefit for orthodontic treatment will be granted where function is impaired (not granted for cosmetic reasons)
Only 1 family member may begin orthodontic treatment in a calendar year
Benefit for fixed comprehensive treatment is limited to beneficiaries from age 9 and younger than 18 years
Managed Care protocols apply
Pre-authorisation required
STANDARD
Page 35 All claims are paid at the Bonitas Rate, unless otherwise stated. All benefi ts and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefi ts are subject to approval from the Council for Medical Schemes.
Periodontics
Benefi t is limited to conservative, non-surgical therapy only and will only be applied to members who are registered on the Periodontal Programme
Managed Care protocols apply
Pre-authorisation required
Maxillo-facial surgery and oral pathology
Surgery in the dental chair Managed Care protocols apply
Hospitalisation(general anaesthetic)
A co-payment of R3 000 per hospital admission and admission protocols apply
General anaesthetic is only available to children under the age of 5 for extensive dental treatment
General anaesthetic benefi t is available for the removal of impacted teeth
Managed Care protocols apply
Pre-authorisation required
Laughing gas in dental rooms Managed Care protocols apply
IV conscious sedation in rooms
Limited to extensive dental treatment
Managed Care protocols apply
Pre-authorisation required
Scheme exclusions Please see page 52
CHRONIC BENEFITSThe Standard Option off ers cover for 44 chronic conditions. Cover is limited to R8 650 per benefi ciary and R17 350 per family on the applicable formulary. Pre-authorisation is required. If you choose to use medicine that is not on the formulary, you will have to pay a 40% co-payment. You can get your medicine from any pharmacy on our network.
Once the amount above is fi nished, you will still be covered for the 27 Prescribed Minimum Benefi ts, listed below, through the Designated Service Provider. If you do not use the Designated Service Provider, you will have to pay a 40% co-payment.
Prescribed Minimum Benefi ts covered
1. Addison’s Disease 10. Crohn’s Disease 19. Hyperlipidaemia
2. Asthma 11. Diabetes Insipidus 20. Hypertension
3. Bipolar Mood Disorder 12. Diabetes Type 1 21. Hypothyroidism
4. Bronchiectasis 13. Diabetes Type 2 22. Multiple Sclerosis
5. Cardiac Failure 14. Dysrhythmias 23. Parkinson’s Disease
6. Cardiomyopathy 15. Epilepsy 24. Rheumatoid Arthritis
7. Chronic Obstructive Pulmonary Disease
16. Glaucoma 25. Schizophrenia
8. Chronic Renal Disease 17. Haemophilia 26. Systemic Lupus Erythematosus
9. Coronary Artery Disease
18. HIV/AIDS 27. Ulcerative Colitis
Additional conditions covered
28. Acne 34. Dermatitis 40. Obsessive Compulsive Disorder
29. Allergic Rhinitis 35. Depression 41. Panic Disorder
30. Ankylosing Spondylitis
36. Eczema 42. Post-Traumatic Stress Disorder
31. Attention Defi cit Disorder(in children aged 5-18)
37. Gastro-Oesophageal Refl ux Disease(GORD)
43. Tourette’s Syndrome
32. Barrett’s Oesophagus 38. Gout 44. Zollinger-Ellison Syndrome
33. Behcet’s Disease 39. Narcolepsy
STAN
DARD
Page 36All claims are paid at the Bonitas Rate, unless otherwise stated. All benefi ts and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefi ts are subject to approval from the Council for Medical Schemes.
SUPPLEMENTARY BENEFITS
We believe in giving you more value. These additional benefi ts will not aff ect your other benefi t limits.
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 21⁄2 yearsAccess to telephone helpline for 24/7 medical advice, including weekends and holidays
Infant paediatric benefi t
Children under 1 year 2 consultations with a paediatrician
Children between ages 1 and 2 2 consultations with a paediatrician
Childhood illness benefi t
Children between ages 2 and 12 2 GP consultations
Childhood illness benefi t
General health1 HIV test per benefi ciary
1 fl u vaccine per benefi ciary
Cardiac health 1 full lipogram every 5 years, for members aged 20 and over
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
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
Wellness benefi ts
Wellness screening
1 wellness screening per benefi ciary at a participating pharmacy, biokineticist or a Bonitas wellness day
Wellness screening includes the following tests:• Blood pressure• Glucose• Cholesterol• Body mass index• Waist-to-hip ratio
Wellness Extender
R1 450 per family
Each benefi ciary must complete a wellness screening and register for this benefi t. You may then choose from the following additional benefi ts:• GP consultation(s)• Biokineticist consultation(s)• Dietician consultation(s)• Physiotherapy consultation(s)• A programme to stop smoking
All claims are paid at the Bonitas Rate
STANDARD
Page 37 All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
STANDARD SELECT
Main member
Adult dependant
Child dependant
R2 597 R2 247 R 760
This traditional option uses a quality provider network to offer rich day-to-day benefits and hospital cover.
Your 4th and subsequent children will be covered free of charge.
Unlimited cover up to 100% at hospitals on the Standard Select network Rich day-to-day benefits plus optometry benefit
Network specialists paid in full in hospital Cover for basic and specialised dentistry including orthodontics
Additional benefit for take-home medicine after hospital stay Cover for 44 chronic conditions
No co-payments for CT scans and MRIs Childhood illness, infant paediatric and maternity benefits
Separate benefit for GP consultations Annual wellness screening and R1 450 for Wellness Extender
STAN
DARD
SEL
ECT
Page 38All claims are paid at the Bonitas Rate, unless otherwise stated. All benefi ts and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefi ts are subject to approval from the Council for Medical Schemes.
IN-HOSPITAL BENEFITS Cover for major medical events that result in a benefi ciary being admitted into hospital. Please note: You must use a hospital on the Standard Select network or you will have to pay a 30% co-payment.
Pre-authorisation is required.
GP consultations Unlimited, covered at 100% of the Bonitas Rate
Specialist consultations
Unlimited, network specialists covered in full
Unlimited, non-network specialists paid at 100% of the Bonitas Rate
Blood tests and other laboratory tests Unlimited, covered at 100% of the Bonitas Rate
X-rays and ultrasounds Unlimited, covered at 100% of the Bonitas Rate
MRIs and CT scans(specialised radiology)
R23 500 per family, in and out of hospital
Pre-authorisation required
Paramedical/Allied medical professionals(such as physiotherapists, occupational therapists, dieticians and biokineticists)
Unlimited, covered at 100% of the Bonitas Rate
Your therapist must get a referral from the doctor treating you in hospital
Internal and external prostheses
R39 800 per family
You must use a Designated Service Provider for hip and knee replacements
Managed Care protocols apply
Pre-authorisation required
You must use a preferred supplier
Spinal surgery
You will have to pay a R5 300 co-payment if you do not go for an assessment through the back and neck rehabilitation programme
Internal nerve stimulators R149 100 per family
Cochlear implantsR250 000 per family
You must use a preferred supplier
Mental health hospitalisation
R36 550 per family
No cover for physiotherapy for mental health admissions
You must use a Designated Service Provider
Take-home medicine R420 per benefi ciary, per hospital stay
Physical rehabilitationR44 650 per family
Pre-authorisation required
Alternatives to hospital(hospice, step-down facilities)
R14 900 per family
Pre-authorisation required
Cancer treatment
R310 150 per family
You must use a preferred provider
Pre-authorisation required
Organ transplantsUnlimited
Pre-authorisation required
Kidney dialysis
Unlimited
You must use the Designated Service Provider
Pre-authorisation required
HIV/AIDS Unlimited, if you register on the HIV/AIDS programme
STANDARD
SELECT
Page 39 All claims are paid at the Bonitas Rate, unless otherwise stated. All benefi ts and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefi ts are subject to approval from the Council for Medical Schemes.
OUT-OF-HOSPITAL BENEFITSOut-of-hospital claims will be paid from available day-to-day benefi ts. There is a separate benefi t for GP consultations.
GP consultationsYou must choose 1 GP on our network for each benefi ciary. This is your nominated GP for the year. If you do not use your nominated GP, your benefi t will be limited to the non-nominated GP consultation benefi t as indicated in the table below.
Main member only R3 750 (R1 220 of this can be used for non-nominated GP consultations)
Main member + 1 dependant R5 500 (R1 880 of this can be used for non-nominated GP consultations)
Main member + 2 dependants R6 100 (R2 050 of this can be used for non-nominated GP consultations)
Main member + 3 dependants R6 400 (R2 150 of this can be used for non-nominated GP consultations)
Main member + 4 or more dependants R6 950 (R2 320 of this can be used for non-nominated GP consultations)
Day-to-day benefi ts
These benefi ts provide cover for consultations with your specialist, acute medicine, x-rays, blood tests and other out-of-hospital medical expenses.
Please note: You must get a GP referral for specialist consultations (excluding consultations with oncologists and ophthalmologists; maternity consultations and consultations with paediatricians for children under age 2).
Main member only R 5 232
Main member + 1 dependant R 7 970
Main member + 2 dependants R 9 2 1 4
Main member + 3 dependants R10 062
Main member + 4 or more dependants R10 966
Specialist consultationsPaid from available day-to-day benefi ts
You must get a referral from your GP
Blood tests and other laboratory tests Paid from available day-to-day benefi ts
X-rays and ultrasounds Paid from available day-to-day benefi ts
MRIs and CT scans(specialised radiology)
R23 500 per family, in and out of hospital Pre-authorisation required
Acute medicine Paid from available day-to-day benefi ts
Over-the-counter medicine
R700 per benefi ciary
R2 121 per family
Paid from available day-to-day benefi ts
Paramedical/Allied medical professionals(such as physiotherapists, occupational therapists, dieticians and biokineticists)
Paid from available day-to-day benefi ts
Mental health consultations
R14 300 per family
In and out-of-hospital consultations (included in the mental health hospitalisation benefi t)
No cover for educational psychologists for benefi ciaries older than 21 years
General medical appliances(such as wheelchairs and crutches)
R6 900 per family
Stoma care products and CPAP machines may exceed the general medical appliances limit by R5 900 per family
No benefi t for foot orthotics
You must use a preferred supplier
Hearing aids
R14 400 per family, once every 2 years (based on the date of your previous claim)
20% co-payment
You must use a preferred supplier
Optometry
R5 550 per family, once every 2 years (based on the date of your previous claim)
Each benefi ciary can choose glasses or contact lenses
Eye tests
1 per benefi ciary, once every 2 years at a network provider at network rates
OR
R350 per benefi ciary, once every 2 years at a non-network provider
STAN
DARD
SEL
ECT
Page 40All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
Single vision lenses (Clear) or
100% towards the cost of lenses at network rates
R150 per lens, per beneficiary, out of network
Bifocal lenses (Clear) or
100% towards the cost of lenses at network rates
R325 per lens, per beneficiary, out of network
Multifocal lenses (Clear)
100% towards the cost of lenses at network rates
R700 per lens, per beneficiary, out of network
Frames R850 per beneficiary, once every 2 years
Contact lenses R1 850 per beneficiary, included in the family limit
Basic dentistry Covered at the Bonitas Dental Tariff
Consultations 2 annual check-ups per beneficiary (once every 6 months)
X-rays: Intra-oral Managed Care protocols apply
X-rays: Extra-oral
1 per beneficiary, every 3 years
Additional benefits may be considered if specialised dental treatment is required
Oral hygiene
2 annual scale and polish treatments per beneficiary (once every 6 months)
Fissure sealants are only covered for children under 16 years
Fluoride treatments are only covered for children from age 5 and younger than 16 years
Fillings
Benefit for fillings is granted once per tooth, in 365 days
Benefit for re-treatment of a tooth is subject to Managed Care protocols
A treatment plan and x-rays may be required for multiple fillings
Root canal therapy and extractions Managed Care protocols apply
Plastic dentures and associated laboratory costs
1 set of plastic dentures (an upper and a lower) per beneficiary, once every 4 years
Specialised dentistry Covered at the Bonitas Dental Tariff
Partial metal frame dentures and associated laboratory costs
1 partial frame (an upper or a lower) per beneficiary, once every 5 years
Managed Care protocols apply
Crowns, bridges and associated laboratory costs
1 crown per family, per year
You must use a provider on the DENIS network and pre-authorise this procedure
Benefit for crowns will be granted once per tooth, every 5 years
A treatment plan and x-rays may be requested
Implants and associated laboratory costs
No benefit
Orthodontics and associated laboratory costs
Orthodontic treatment is granted once per beneficiary, per lifetime
Pre-authorisation cases will be clinically assessed by using an orthodontic needs analysis
Benefit allocation is subject to the outcome of the needs analysis and funding can be granted up to 80% of the Bonitas Dental Tariff
Benefit for orthodontic treatment will be granted where function is impaired (not granted for cosmetic reasons)
Only 1 family member may begin orthodontic treatment in a calendar year
Benefit for fixed comprehensive treatment is limited to beneficiaries from age 9 and younger than 18 years
Managed Care protocols apply
Pre-authorisation required
STANDARD
SELECT
Page 41 All claims are paid at the Bonitas Rate, unless otherwise stated. All benefi ts and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefi ts are subject to approval from the Council for Medical Schemes.
Periodontics
Benefi t is limited to conservative, non-surgical therapy only and will only be applied to members who are registered on the Periodontal Programme
Managed Care protocols apply
Pre-authorisation required
Maxillo-facial surgery and oral pathology
Surgery in the dental chair Managed Care protocols apply
Hospitalisation(general anaesthetic)
A co-payment of R3 000 per hospital admission and admission protocols apply
General anaesthetic is only available to children under the age of 5 for extensive dental treatment
General anaesthetic benefi t is available for the removal of impacted teeth
Standard Select hospital network applies
Managed Care protocols apply
Pre-authorisation required
Laughing gas in dental rooms Managed Care protocols apply
IV conscious sedation in rooms
Limited to extensive dental treatment
Managed Care protocols apply
Pre-authorisation required
Scheme exclusions Please see page 52
CHRONIC BENEFITSStandard Select off ers cover for 44 chronic conditions. Cover is limited to R8 650 per benefi ciary and R17 350 per family using the applicable formulary. Pre-authorisation is required. If you do not get your medicine from our Designated Service Provider or if you use medicine that is not listed on the formulary, you will have to pay a 40% co-payment.
Once the amount above is fi nished, you will still be covered for the 27 Prescribed Minimum Benefi ts, listed below.
Prescribed Minimum Benefi ts covered
1. Addison’s Disease 10. Crohn’s Disease 19. Hyperlipidaemia
2. Asthma 11. Diabetes Insipidus 20. Hypertension
3. Bipolar Mood Disorder 12. Diabetes Type 1 21. Hypothyroidism
4. Bronchiectasis 13. Diabetes Type 2 22. Multiple Sclerosis
5. Cardiac Failure 14. Dysrhythmias 23. Parkinson’s Disease
6. Cardiomyopathy 15. Epilepsy 24. Rheumatoid Arthritis
7. Chronic Obstructive Pulmonary Disease
16. Glaucoma 25. Schizophrenia
8. Chronic Renal Disease 17. Haemophilia 26. Systemic Lupus Erythematosus
9. Coronary Artery Disease
18. HIV/AIDS 27. Ulcerative Colitis
Additional conditions covered
28. Acne 34. Dermatitis 40. Obsessive Compulsive Disorder
29. Allergic Rhinitis 35. Depression 41. Panic Disorder
30. Ankylosing Spondylitis
36. Eczema 42. Post-Traumatic Stress Disorder
31. Attention Defi cit Disorder(in children aged 5-18)
37. Gastro-Oesophageal Refl ux Disease(GORD)
43. Tourette’s Syndrome
32. Barrett’s Oesophagus 38. Gout 44. Zollinger-Ellison Syndrome
33. Behcet’s Disease 39. Narcolepsy
STAN
DARD
SEL
ECT
Page 42All claims are paid at the Bonitas Rate, unless otherwise stated. All benefi ts and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefi ts are subject to approval from the Council for Medical Schemes.
SUPPLEMENTARY BENEFITSWe believe in giving you more value. These additional benefi ts will not aff ect your other benefi t limits.
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 21⁄2 yearsAccess to telephone helpline for 24/7 medical advice, including weekends and holidays
Infant paediatric benefi t
Children under 1 year 2 consultations with a paediatrician
Children between ages 1 and 2 2 consultations with a paediatrician
Childhood illness benefi t
Children between ages 2 and 12 2 GP consultations
Preventative care
General health1 HIV test per benefi ciary
1 fl u vaccine per benefi ciary
Cardiac health 1 full lipogram every 5 years, for members aged 20 and over
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
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
Wellness benefi ts
Wellness screening
1 wellness screening per benefi ciary at a participating pharmacy, biokineticist or a Bonitas wellness day
Wellness screening includes the following tests:• Blood pressure• Glucose• Cholesterol• Body mass index• Waist-to-hip ratio
Wellness Extender
R1 450 per family
Each benefi ciary must complete a wellness screening and register for this benefi t. You may then choose from the following additional benefi ts:• GP consultation(s)• Biokineticist consultation(s)• Dietician consultation(s)• Physiotherapy consultation(s)• A programme to stop smoking
All claims are paid at the Bonitas Rate STANDARD
SELECT
Page 43 All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
PRIMARYThis traditional option offers simple day-to-day benefits and hospital cover.
Main member
Adult dependant
Child dependant
R1 924 R1 505 R 613Your 4th and subsequent children will be covered free of charge.
Unlimited cover up to 100% in hospital Separate benefit for GP consultations
Network specialists paid in full in hospital Rich day-to-day benefits plus basic dentistry and optometry benefits
Additional benefit for take-home medicine after hospital stay 27 PMB chronic conditions covered
Reasonable co-payments for certain in-hospital procedures Childhood illness, infant paediatric and maternity benefits
No co-payments for CT scans and MRIs Annual wellness screening and R1 050 for Wellness Extender
PRIM
ARY
Page 44All claims are paid at the Bonitas Rate, unless otherwise stated. All benefi ts and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefi ts are subject to approval from the Council for Medical Schemes.
IN-HOSPITAL BENEFITSCover for major medical events that result in a benefi ciary being admitted into hospital.
Pre-authorisation is required.
We negotiate extensively with hospitals to ensure the best possible value for our members. Members have access to all private hospitals. A co-payment will apply to admissions at specifi c hospitals. Please call us on 0860 002 108 or log in to www.bonitas.co.za for a list of these hospitals.
GP consultations Unlimited, covered at 100% of the Bonitas Rate
Specialist consultations
Unlimited, network specialists covered in full
Unlimited, non-network specialists paid at 100% of the Bonitas Rate
Blood tests and other laboratory tests Unlimited, covered at 100% of the Bonitas Rate
X-rays and ultrasounds Unlimited, covered at 100% of the Bonitas Rate
MRIs and CT scans(specialised radiology)
R11 700 per family, in and out of hospital
Pre-authorisation required
Paramedical/Allied medical professionals(such as physiotherapists, occupational therapists, dieticians and biokineticists)
Unlimited, covered at 100% of the Bonitas Rate
Your therapist must get a referral from the doctor treating you in hospital
Internal and external prostheses
PMB only
Managed Care protocols apply
Pre-authorisation required
You must use a preferred supplier
Mental health hospitalisation
R14 250 per family
No cover for physiotherapy for mental health admissions
You must use a Designated Service Provider
Take-home medicine R340 per benefi ciary, per hospital stay
Physical rehabilitationR44 650 per family
Pre-authorisation required
Alternatives to hospital(hospice, step-down facilities)
R14 900 per family
Pre-authorisation required
Cancer treatment
R149 000 per family
You must use a preferred provider
Pre-authorisation required
Organ transplantsPMB only
Pre-authorisation required
Kidney dialysis
PMB only
You must use the Designated Service Provider
Pre-authorisation required
HIV/AIDS Unlimited, if you register on the HIV/AIDS programme
PRIMARY
Page 45 All claims are paid at the Bonitas Rate, unless otherwise stated. All benefi ts and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefi ts are subject to approval from the Council for Medical Schemes.
A co-payment will apply to the following procedures in hospital
R1 300 co-payment R3 300 co-payment R6 500 co-payment
1. Colonoscopy 1. Arthroscopy 1. Back Surgery including Spinal Fusion
2. Conservative Back Treatment
2. Diagnostic Laparoscopy
2. Joint Replacements
3. Cystoscopy 3. Laparoscopic Hysterectomy
3. Laparoscopic Pyeloplasty
4. Facet Joint Injections 4. Laparoscopic Appendectomy
4. Laparoscopic Radical Prostatectomy
5. Flexible Sigmoidoscopy 5. Percutaneous Radiofrequency Ablations
(Percutaneous Rhizotomies)
5. Nissen Fundoplication (Refl ux Surgery)
6. Functional Nasal Surgery
7. Gastroscopy
8. Hysteroscopy (not Endometrial Ablation)
9. Myringotomy
10. Tonsillectomy and Adenoidectomy
11. Umbilical Hernia Repair
12. Varicose Vein Surgery
OUT-OF-HOSPITAL BENEFITS
Out-of-hospital claims will be paid from available day-to-day benefi ts. There is a separate benefi t for GP consultations.
GP consultationsIf you do not use a GP on our network, your benefi t for GP consultations will be limited to the non-network GP consultation benefi t. This is shown in the table below.
Main member only R1 800 (R580 of this may be used for non-network GP consultations)
Main member + 1 dependant R3 300 (R1 100 of this may be used fornon-network GP consultations)
Main member + 2 dependants R3 900 (R1 250 of this may be used fornon-network GP consultations)
Main member + 3 dependants R4 200 (R1 400 of this may be used for non-network GP consultations)
Main member + 4 or more dependants R4 750 (R1 650 of this may be used for non-network GP consultations)
Day-to-day benefi ts
These benefi ts provide cover for consultations with your specialist, acute medicine, x-rays, blood tests and other out-of-hospital medical expenses.
Please note: You must get a GP referral for specialist consultations (excluding consultations with oncologists and ophthalmologists; maternity consultations and consultations with paediatricians for children under age 2).
Main member only R1 900
Main member + 1 dependant R3 400
Main member + 2 dependants R4 000
Main member + 3 dependants R4 300
Main member + 4 or more dependants R4 650
Specialist consultationsPaid from available day-to-day benefi ts
You must get a referral from your GP
Blood tests and other laboratory tests Paid from available day-to-day benefi ts
X-rays and ultrasounds Paid from available day-to-day benefi ts
MRIs and CT scans(specialised radiology)
R11 700 per family, in and out of hospital
Pre-authorisation required
Acute medicine Paid from available day-to-day benefi ts
PRIM
ARY
Page 46All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
Over-the-counter medicine
R1 290 per family
R440 per beneficiary
Paid from available day-to-day benefits
Paramedical/Allied medical professionals(such as physiotherapists, occupational therapists, dieticians and biokineticists)
Paid from available day-to-day benefits
Mental health consultations
R8 600 per family
In and out-of-hospital consultations (included in the mental health hospitalisation benefit)
No cover for educational psychologists for beneficiaries older than 21 years
General medical appliances(such as wheelchairs and crutches)
R6 200 per family
Stoma care and CPAP machines may exceed the general medical appliances limit by R5 900 per family
No benefit for foot orthotics
You must use a preferred supplier
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
Eye tests
1 per beneficiary, once every 2 years at a network provider at network rates
OR
R350 per beneficiary, once every 2 years at a non-network provider
Single vision lenses (Clear) or
100% towards the cost of lenses at network rates
R150 per lens, per beneficiary, out of network
Bifocal lenses (Clear) or
100% towards the cost of lenses at network rates
R325 per lens, per beneficiary, out of network
Multifocal lenses (Clear)
100% towards the cost of lenses at network rates
R700 per lens, per beneficiary, out of network
Frames R300 per beneficiary, once every 2 years
Contact lenses R1 225 per beneficiary, included in the family limit
Basic dentistry
Covered at the Bonitas Dental Tariff
You must use a provider on the DENIS network
Consultations 2 annual check-ups per beneficiary (once every 6 months)
X-rays: Intra-oral Managed Care protocols apply
X-rays: Extra-oral 1 per beneficiary, every 3 years
Oral hygiene
2 annual scale and polish treatments per beneficiary (once every 6 months)
Fissure sealants are only covered for children under 16 years
Fluoride treatments are only covered for children from age 5 and younger than 16 years
Fillings
Benefit for fillings is granted once per tooth, in 365 days
Benefit for re-treatment of a tooth is subject to Managed Care protocols
A treatment plan and x-rays may be required for multiple fillings
Root canal therapy and extractions
Managed Care protocols apply
Benefit for root canal includes all teeth except primary teeth and permanent molars
Plastic dentures and associated laboratory costs
1 set of plastic dentures (an upper and a lower) per beneficiary, once every 4 years
PRIMARY
Page 47 All claims are paid at the Bonitas Rate, unless otherwise stated. All benefi ts and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefi ts are subject to approval from the Council for Medical Schemes.
Specialised dentistry No benefi t
Maxillo-facial surgery and oral pathology
Surgery in the dental chair Managed Care protocols apply
Hospitalisation(general anaesthetic)
A co-payment of R3 000 per hospital admission and admission protocols apply
General anaesthetic is only available to children under the age of 5 for extensive dental treatment
General anaesthetic benefi t is available for the removal of impacted teeth
Managed Care protocols apply
Pre-authorisation required
Laughing gas in dental rooms Managed Care protocols apply
IV conscious sedation in rooms
Limited to extensive dental treatment
Managed Care protocols apply
Pre-authorisation required
Scheme exclusions Please see page 52
CHRONIC BENEFITSThe Primary Option ensures that you are covered for the 27 Prescribed Minimum Benefi ts listed below on the applicable formulary. Pre-authorisation is required. If you do not use our Designated Service Provider or if you use medicine that is not on the formulary, you will have to pay a 40% co-payment.
Prescribed Minimum Benefi ts covered
1. Addison’s Disease 10. Crohn’s Disease 19. Hyperlipidaemia
2. Asthma 11. Diabetes Insipidus 20. Hypertension
3. Bipolar Mood Disorder 12. Diabetes Type 1 21. Hypothyroidism
4. Bronchiectasis 13. Diabetes Type 2 22. Multiple Sclerosis
5. Cardiac Failure 14. Dysrhythmias 23. Parkinson’s Disease
6. Cardiomyopathy 15. Epilepsy 24. Rheumatoid Arthritis
7. Chronic Obstructive Pulmonary Disease
16. Glaucoma 25. Schizophrenia
8. Chronic Renal Disease 17. Haemophilia 26. Systemic Lupus Erythematosus
9. Coronary Artery Disease
18. HIV/AIDS 27. Ulcerative Colitis
PRIM
ARY
Page 48All claims are paid at the Bonitas Rate, unless otherwise stated. All benefi ts and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefi ts are subject to approval from the Council for Medical Schemes.
PRIMARY
SUPPLEMENTARY BENEFITSWe believe in giving you more value. These additional benefi ts will not aff ect your other benefi t limits.
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 21⁄2 yearsAccess to telephone helpline for 24/7 medical advice, including weekends and holidays
Infant paediatric benefi t
Children under 1 year 1 consultation with a paediatrician
Children between ages 1 and 2 1 consultation with a paediatrician
Childhood illness benefi t
Children between ages 2 and 12 1 GP consultation
Preventative care
General health1 HIV test per benefi ciary
1 fl u vaccine per benefi ciary
Women’s health 1 pap smear every 3 years, for women between ages 21 and 65
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
Wellness benefi ts
Wellness screening
1 wellness screening per benefi ciary at a participating pharmacy, biokineticist or a Bonitas wellness day
Wellness screening includes the following tests:• Blood pressure• Glucose• Cholesterol• Body mass index• Waist-to-hip ratio
Wellness Extender
R1 050 per family
Each benefi ciary must complete a wellness screening and register for this benefi t. You may then choose from the following additional benefi ts:• GP consultation(s)• Biokineticist consultation(s)• Dietician consultation(s)• Physiotherapy consultation(s)• A programme to stop smoking
All claims are paid at the Bonitas Rate
Page 49 All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
BONESSENTIALThis hospital plan offers rich hospital benefits with some value-added benefits.
Main member
Adult dependant
Child dependant
R1 473 R1 127 R 432Your 4th and subsequent children will be covered free of charge.
Unlimited cover up to 100% in hospital 27 PMB chronic conditions covered
Network specialists paid in full in hospital Childhood illness and maternity benefits
Additional benefit for take-home medicine after hospital stay Basic preventative care benefits
Reasonable co-payments for certain in-hospital procedures Annual wellness screening and R750 for Wellness Extender
BON
ESSE
NTI
AL
Page 50All claims are paid at the Bonitas Rate, unless otherwise stated. All benefi ts and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefi ts are subject to approval from the Council for Medical Schemes.
IN-HOSPITAL BENEFITSCover for major medical events that result in a benefi ciary being admitted into hospital. Pre-authorisation is required.
We negotiate extensively with hospitals to ensure the best possible value for our members. Members have access to all private hospitals. A co-payment will apply to admissions at specifi c hospitals. Please call us on 0860 002 108 or log in to www.bonitas.co.za for a list of these hospitals.
GP consultations Unlimited, covered at 100% of the Bonitas Rate
Specialist consultations
Unlimited, network specialists covered in full
Unlimited, non-network specialists paid at 100% of the Bonitas Rate
Blood tests and other laboratory tests Unlimited, covered at 100% of the Bonitas Rate
X-rays and ultrasounds Unlimited, covered at 100% of the Bonitas Rate
MRIs and CT scans(specialised radiology)
Unlimited
Pre-authorisation required
Paramedical/Allied medical professionals(such as physiotherapists, occupational therapists, dieticians and biokineticists)
Unlimited, covered at 100% of the Bonitas Rate
Your therapist must get a referral from the doctor treating you in hospital
Internal and external prostheses
PMB only
Managed Care protocols apply
Pre-authorisation required
You must use a preferred supplier
Mental health hospitalisation
R29 000 per family
Physiotherapy will be excluded for all mental health admissions
You must use a Designated Service Provider
Take-home medicine R340 per benefi ciary, per hospital stay
Physical rehabilitationR44 650 per family
Pre-authorisation required
Alternatives to hospital (hospice, step-down facilities)
R14 900 per family
Pre-authorisation required
Cancer treatment
R310 150 per family,
You must use a preferred provider
Pre-authorisation required
Organ transplants Unlimited, 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
Scheme exclusions Please see page 52
A co-payment will apply to the following procedures in hospital
R1 300 co-payment R3 300 co-payment R6 500 co-payment
1. Colonoscopy 1. Arthroscopy 1. Back Surgery including Spinal Fusion
2. Conservative Back Treatment
2. Diagnostic Laparoscopy
2. Joint Replacements
3. Cystoscopy 3. Laparoscopic Hysterectomy
3. Laparoscopic Pyeloplasty
4. Facet Joint Injections 4. Laparoscopic Appendectomy
4. Laparoscopic Radical Prostatectomy
5. Flexible Sigmoidoscopy 5. Percutaneous Radiofrequency Ablations
(Percutaneous Rhizotomies)
5. Nissen Fundoplication (Refl ux Surgery)
6. Functional Nasal Surgery
7. Gastroscopy
8. Hysteroscopy (not Endometrial Ablation)
9. Myringotomy
10. Tonsillectomy and Adenoidectomy
11. Umbilical Hernia Repair
12. Varicose Vein Surgery
BON
ESSENTIAL
Page 51 All claims are paid at the Bonitas Rate, unless otherwise stated. All benefi ts and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefi ts are subject to approval from the Council for Medical Schemes.
CHRONIC BENEFITSBonEssential ensures that you are covered for the 27 Prescribed Minimum Benefi ts listed below on the applicable formulary. Pre-authorisation is required. If you do not use our Designated Service Provider or if you use medicine that is not on the formulary, you will have to pay a 40% co-payment.
Prescribed Minimum Benefi ts covered
1. Addison’s Disease 10. Crohn’s Disease 19. Hyperlipidaemia
2. Asthma 11. Diabetes Insipidus 20. Hypertension
3. Bipolar Mood Disorder 12. Diabetes Type 1 21. Hypothyroidism
4. Bronchiectasis 13. Diabetes Type 2 22. Multiple Sclerosis
5. Cardiac Failure 14. Dysrhythmias 23. Parkinson’s Disease
6. Cardiomyopathy 15. Epilepsy 24. Rheumatoid Arthritis
7. Chronic Obstructive Pulmonary Disease
16. Glaucoma 25. Schizophrenia
8. Chronic Renal Disease 17. Haemophilia 26. Systemic Lupus Erythematosus
9. Coronary Artery Disease
18. HIV/AIDS 27. Ulcerative Colitis
SUPPLEMENTARY BENEFITSWe believe in giving you more value. These additional benefi ts will not aff ect your other benefi t limits.
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 21⁄2 yearsAccess to telephone helpline for 24/7 medical advice, including weekends and holidays
Childhood illness benefi t
Children between ages 2 and 12 1 GP consultation
Preventative care
General health1 HIV test per benefi ciary
1 fl u vaccine per benefi ciary
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
Wellness benefi ts
Wellness screening
1 wellness screening per benefi ciary at a participating pharmacy, biokineticist or a Bonitas wellness day
Wellness screening includes the following tests:• Blood pressure• Glucose• Cholesterol• Body mass index• Waist-to-hip ratio
Wellness Extender
R750 per family
Each benefi ciary must complete a wellness screening and register for this benefi t. You may then choose from the following additional benefi ts:• GP consultation(s)• Biokineticist consultation(s)• Dietician consultation(s)• Physiotherapy consultation(s)• A programme to stop smoking
All claims are paid at the Bonitas Rate
BON
ESSE
NTI
AL
Page 52All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
EXCLUSIONSAlternative health practitioners• Acupuncture on BonCap• Aromatherapy• Ayurvedics• Herbalists• Homoeopathy on BonCap• Iridology• Naturopathy on BonCap• Osteopathy on BonCap • Phytotherapy on BonCap• Reflexology• Therapeutic massage therapy (masseurs)
Ambulance services• Services not authorised by ER24
Appliances, external accessories and orthotics • Appliances, devices and procedures not scientifically proven or appropriate• Back rests and chair seats• Bandages and dressings (except medicated dressings)• Beds and mattresses, pillows and overlays • Long-term implantable ventricular assist devices and total artificial hearts e.g. Heart
Ware® and Berlin heart• Diagnostic kits, agents and appliances, unless otherwise stated, except for diabetic
accessories• Electric toothbrushes• Humidifiers• Ionisers and air purifiers• Orthopaedic shoes and inserts• Pain relieving machines, e.g. TENS and APS• Stethoscopes and sphygmomanometers (blood pressure monitors) • Portable oxygen cylinders are excluded on all options. Portable oxygen concentrators
will be excluded on all options except BonComprehensive and BonClassic, subject to pre-authorisation and available appliance benefit.
Blood, blood equivalents and blood products• Hemopure (bovine blood)
Dentistry • Appointments not kept• Orthodontic treatment for individuals 18 years and older
• Dental procedures or devices which are not regarded by the relevant managed healthcare programme as clinically essential or clinically desirable
• Orthognathic (jaw correction) surgery, other orthodontic related surgery and the associated laboratory costs
• Instruction for oral hygiene• Nutrition and tobacco counselling• Caries susceptibility and microbiological tests• Oral hygiene evaluation• Crown and bridge procedures where there is no extensive tooth structure loss and
associated laboratory costs, electrognathographic recordings, pantographic recordings and other such electronic analyses
• Fissure sealants on patients 16 years and older • Pulp tests and pulp capping (direct and indirect)• Polishing of restorations• Ozone therapy• Metal base to full dentures, including the laboratory costs• The clinical fee of dental repairs, denture tooth replacements and the addition of a soft
base to new dentures (the laboratory fee will be covered at the Bonitas Dental Tariff where Managed Care protocols apply)
• Diagnostic dentures and associated laboratory costs• Provisional crowns, including laboratory costs• Resin bonding for restorations charged as a separate procedure to the restoration• Dental bleaching • Porcelain veneers and inlays/onlays and associated laboratory costs• Pontics on second molars • Laboratory fabricated crowns on primary teeth• Fixed prosthodontics used to repair occlusal wear• Gold foil restorations• Surgical periodontics, which includes gingivectomies, periodontal flap surgery, tissue
grafting and hemisection of a tooth • PerioChip®• Emergency crowns that are not placed for immediate protection in tooth injury and the
associated laboratory costs• Orthodontic re-treatment and the associated laboratory costs• Lingual orthodontics• Implants on wisdom teeth (3rd molars)• Orthodontic treatment for cosmetic reasons and associated laboratory costs• Sinus lifts• Bone augmentations• Bone and other tissue regeneration procedures• Older bars and associated abutments on implants including the laboratory costs• Laboratory costs where the associated dental treatment is not covered • Laboratory costs associated with mouth guards• Snoring appliances• High-impact acrylic• Cost of mineral trioxide• Cost of gold, precious metal, semi-precious metal and platinum foil• Cost of invisible retainer material• Cost of bone regeneration material• Cost of prescribed toothpastes, mouthwashes (e.g Corsodyl) and ointments• Topical application of fluoride in patients 16 years and older
EXCLUSIO
NS
Page 53 All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
• Cost of dental materials in hospital• Fillings to restore teeth damaged due to toothbrush abrasion, attrition, erosion and
fluorosis• Crowns or crown retainers on wisdom teeth (3rd molars)• Crown and bridge procedures for cosmetic reasons and associated laboratory costs• Occlusal rehabilitation and associated laboratory costs• Provisional dentures and associated laboratory costs• Root canal therapy on wisdom teeth and primary (milk) teeth• Enamel microabrasion• Behaviour management• Intramuscular or subcutaneous injection• Special reports and dental testimony including dento-legal fees• Autotransplantation of teeth• Closure of an oral-antral opening (item code 8909) when claimed during the same visit
with impacted teeth (item code 8941, 8943 and 8945)• Hospitalisation (general anaesthetic): where the reason for admission to hospital is
dental fear or anxiety; multiple hospital admissions; where the only reason for admission to hospital is to acquire a sterile facility
• Hospital and anaesthetist claims will not be covered for the following procedures when performed under general anaesthesia: apicectomies, dentectomies, frenectomies, conservative dental treatment (fillings, extractions and root canal therapy) in hospital for adults, professional oral hygiene procedures, implantology and associated surgical procedures and surgical tooth exposure for orthodontic reasons
• Treatment plan completed (currently code 8120)• Procedures that are defined as unusual circumstances and procedures that are defined
as unlisted procedures• Laboratory delivery fees.
Hospitalisation• If application for a pre-authorisation reference (PAR) number for a clinical procedure,
treatment or specialised radiology is not made or is refused, no benefits are payable• Accommodation and services provided in a geriatric hospital, old age home, frail care
facility or similar institution.
InfertilityMedical and surgical treatment, including:• Assisted reproductive technology (ART)• In-vitro fertilisation (IVF)• Gamete Intrafallopian tube transfer (GIFT)• Zygote Intrafallopian tube transfer (ZIFT) • Intracytoplasmic sperm injection (ICS)• Vasovasostomy (reversal of vasectomy).
Maternity• 3D and 4D scans• 2D scans in excess of 2, unless motivated for an appropriate medical condition
• Antenatal classes/exercises except on BonComprehensive, BonClassic, BonSave, Standard, Standard Select and BonComplete.
Medicine and injection material• Anabolic steroids and immunostimulants• Contraceptives - oral, parenteral, foams, IUCDs• Cosmetic preparations, emollients, moisturisers (medicated or otherwise), soaps, scrubs
and other cleansers, sunscreen and suntanning preparations, medicated shampoos and conditioners (except for the treatment of lice, scabies and other microbial infections and coal tar products for the treatment of psoriasis)
• Erectile dysfunction and loss of libido medical treatment• Nutritional supplements, including baby food and special milk preparations, are
authorised by the relevant managed healthcare programme• Maintenance Rituximab (or other monoclonal antibodies) in the first-line setting for
haematological malignancies• Liposomal amphotericin B for fungal infections• Any specialised or new chemotherapeutic drugs that have not convincingly
demonstrated a survival advantage of more than 3 months in advanced or metastatic malignancies, unless pre-authorised
• Trastuzumab (Herceptin) for the treatment of HER2-positive early breast cancer and metastatic cancer on all options except for BonComprehensive
• Carmustine wafers for the treatment of malignant gliomas• Medicines not included in a prescription from a medical practitioner or other healthcare
professional who is legally entitled to prescribe such medicines (except for schedule 0, 1 and 2 medicines supplied by a registered pharmacist)
• Medicines for intestinal flora• Medicines defined as exclusions by the relevant managed healthcare programme• Medicines not approved by the Medicines Control Council, unless Section 21 approval
is obtained and pre-authorised by the relevant managed healthcare programme• Medicines not authorised by the relevant managed healthcare programme• Patent medicines, household remedies and proprietary preparations, and preparations
not otherwise classified• Slimming preparations for obesity• Smoking cessation and anti-smoking preparations, unless authorised as part of the
Wellness Extender benefit, excluded on BonCap• Tonics, evening primrose oil, fish liver oils, multivitamin preparations and/or trace
elements and/or mineral combinations (except for registered products that include haemotonics and those for use by infants and pregnant mothers)
• Biological drugs, except on BonComprehensive and BonClassic, and Beta-Interferon for the treatment of Multiple Sclerosis as per the PMB algorithm
• All benefits for clinical trials and all treatment/admission costs relating to complications of trial drugs, unless pre-authorised by the relevant managed healthcare programme
• Diagnostic agents, unless authorised • Growth hormones, unless pre-authorised• Immunoglobulins and immune stimulants, oral and parenteral, unless pre-authorised • Medicines used specifically to treat alcohol and drug addiction, unless PMB.
EXCL
USI
ON
S
Page 54All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
Mental health• Sleep therapy• Educational psychology visits for adult beneficiaries ( over 21 years of age).
Non-surgical procedures and tests• Epilation – treatment for hair removal• Hyperbaric oxygen therapy except for PMBs• Facet joint injections and percutaneous radiofrequency ablations (percutaneous
rhizotomies) on BonCap.
Optometry• Coloured and other cosmetic effect contact lenses, and contact lens accessories and
solutions• Optical devices which are not regarded by the relevant managed healthcare
programme, as clinically essential or clinically desirable except on BonSave, BonFit, BonClassic and BonComprehensive
• Sunglasses and prescription sunglasses.
Organs, Haemopoietic, Stem cell (bone marrow) transplantation and immunosuppressive medication• Organs and haemopoietic stem cell (bone marrow) donations to any person other than
to a member or dependant of a member on this Fund.
Paramedical Services• Pharmacy services
Pathology and Medical Technology• HIV resistance testing, unless pre-authorised• Gene sequencing.
Physical therapy• X-rays performed by chiropractors• Chiropractor benefits in hospital• Physiotherapy for mental health admissions.
Prostheses internal and external• Cochlear implants on BonComplete, BonEssential, BonSave, BonFit, Primary and
BonCap• Osseo-integrated implants for dental purposes to replace missing teeth, unless
specifically provided for in Annexure B
• Total ankle replacement on BonEssential, BonSave, BonFit, Primary and BonCap • Implantable defibrillators on BonEssential, BonSave, BonFit, Primary and BonCap.
Radiology and radiography• MRI scans ordered by a general practitioner, unless there is no reasonable access to
a specialist• Positron Emission Tomography, except for appropriate diagnosis, staging, the
monitoring of response to treatment and investigation of residual tumour or suspected recurrence (restaging) bone densitometry performed by a general practitioner or specialist not included in the Fund credentialed list
• CT colonography (virtual colonoscopy) for screening• MDCT Coronary Angiography for screening• If application for a pre-authorisation reference number (PAR) for specialised radiology
procedures is not made or is refused, no benefits are payable• All screening that has not been pre-authorised or is not in accordance with the Fund’s
policies and protocols.
Surgical procedures• Abdominoplasties and the repair of divarication of the abdominal muscles• Balloon sinuplasty on BonCap, BonEssential, BonFit, BonSave and Primary• Bilateral gynaecomastia• Blepharoplasties unless causing demonstrated functional visual impairment and
pre-authorised• Breast augmentation• Breast reconstruction - unless mastectomy following cancer and pre-authorised• Breast reductions, (except on BonComprehensive - subject to prior
pre-authorisation and in accordance with the agreed clinical protocol)• All costs for cosmetic surgery performed over and above the codes authorised for
admission• Deep brain stimulation for Parkinson’s and intractable epilepsy on BonCap, BonClassic,
BonComplete, BonEssential, BonFit, BonSave and Primary• Erectile dysfunction surgical procedures• Gender reassignment medical or surgical treatment• Genioplasties as an isolated procedure• Custom-made hip arthroplasty for inflammatory and degenerative joint disease• Keloid surgery except for functional impairment• Laparoscopic unilateral primary inguinal hernia repair on BonCap, BonEssential,
BonSave, BonFit and Primary• Obesity - surgical treatment or bariatric surgery (except on BonComprehensive, in
accordance with the agreed clinical protocol and subject to prior pre-authorisation. Not including post-operative plastic and reconstructive surgery)
• Otoplasties• Pectus excavatum/carinatum• Percutaneous valve replacement, including transcatheter aortic valve implantation and
repairs on BonCap, BonEssential, BonSave, BonFit and Primary• Refractive surgery except on BonComprehensive• Revision of scars except for functional impairment• Rhinoplasties for cosmetic purposes
EXCLUSIO
NS
Page 55 All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
• Robotic surgery, other than for radical prostatectomy where authorised by the managed care organisation; additional costs relating to the use of the robot during such pre-authorised surgery, and including additional fees pertaining to theatre time, disposables and equipment fees remain excluded. Excluded on BonCap.
• Uvulo palatal pharyngoplasty (UPPP and LAUP).
Other• Appointments which a beneficiary fails to keep• Autopsies• Cryo-storage of foetal stem cells and sperm• Holidays for recuperative purposes• Nuclear or radio-active material or waste• Travelling expenses• Veterinary products• Delivery charges or fees.
EXCL
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Page 56All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
HOW TO CLAIMYou must send us your claim within 4 months of receiving treatment or it will not be paid. Send us your claim in one of the following ways.
Post your claim to:Bonitas Claims DepartmentPO Box 74Vereeniging, 1930
OR
Email your claim to claims@bonitas.co.za
OR
Drop off your claim at one of our walk-in centres
Tips to get your medical claims paid quickly
Ensure your bank details are correctClaims refunds are only paid into a bank account by electronic funds transfer (EFT). Please call us on 0860 002 108 if you need to update your banking details.
Please ensure that your claim shows the following:• Your name and initials• Your medical aid number• The treatment date• The name of the patient as shown on your membership card• The amount charged• The tariff• The ICD-10 code (diagnosis code)
Please check that prescriptions for medicine show all your details. Also check that the correct amount of medicine dispensed is shown on the claim. If the pharmacy omits any of these details, we will not be able to process your claim.
Check that your claim has been paidWe pay claims weekly. A statement showing your claims will be sent to you at the end of the month by post or email. You can also log in to www.bonitas.co.za to view the status of your claims.
GET THE BONITAS BABY BAGWe give all pregnant members a beautiful mother and baby bag to congratulate you on the arrival of your bundle of joy. You will need to register for the bag.
Who can receive the baby bag?All members who are pregnant will need to register to receive the mother and baby bag. Registration can only take place after 24 weeks of pregnancy. We require a pre-authorisation number before you can register for the Bonitas baby bag. Call us on 0860 002 108 to get pre-authorisation.
How to registerYou need the following information when you register:• Membership number• Name and surname• Contact details• Delivery address• Alternative delivery address• Date of expected delivery
Then call us on 0860 002 108 or email queries@bonitas.co.za
Please note: In order to ensure that you receive your baby bag, the courier company will be in contact with you to arrange a suitable date and time for delivery.
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Page 57 All claims are paid at the Bonitas Rate, unless otherwise stated. All benefi ts and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefi ts are subject to approval from the Council for Medical Schemes.
SMS‘Find’
to 43899Receive an SMS
with a link
Click on the link andenter your membership
number
Choose the type of doctor you’re
looking for
Select your province,town and suburb
You will receive a listof doctors near you
To have the doctor’sdetails sent to you,
click on ‘SMS me’
FIND A NETWORK PROVIDERThe GP locator allows you to fi nd a doctor on our network to help stretch your benefi ts further and help you get more value for money.
Simply follow the steps below:
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Page 58All claims are paid at the Bonitas Rate, unless otherwise stated. All benefi ts and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefi ts are subject to approval from the Council for Medical Schemes.
HIV/AIDS programme
Aid for AIDSPlease call me: 083 410 9078Call: 0860 100 646Fax: 0800 600 773Email: afa@afadm.co.zawww.aidforaids.co.za
Diabetes programme
Centre for Diabetes and EndocrinologyCall: 011 053 4400Email: members@cdediabetes.co.zawww.cdediabetes.co.za
Back and neck programme
Document Based Care (DBC)Call: 0860 105 104
Hip and knee programme
Improved Clinical Pathway ServicesCall: 011 327 2599Email: admin@icpservices.co.zawww.icpservices.co.za
Chronic medicine
Pharmacy DirectCall: 0860 027 800Fax: 0866 114 000Email: care@pharmacydirect.co.zawww.pharmacydirect.co.za
Optical benefi ts
Iso LesoCall: 0860 10 30 50/60Fax: 011 782 5601www.isoleso.co.za
Dental benefi ts
DENISCall: 0860 336 346Fax: 0866 770 336Email: bonitas@denis.co.zawww.denis.co.za
Emergency assistance
ER24Call: 084 124Email: queriescqc@er24.co.zaEmail: claimsclaims@er24.co.zawww.er24.co.za
FIND A SERVICE PROVIDERWe’ve partnered with several reputable service providers to ensure that our members receive excellent service and more value for money.
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Please note: Product rules, limits, terms and conditions apply. Where there is a discrepancy between the content provided in this brochure, the website and the Scheme Rules, the Scheme Rules will prevail. The Scheme Rules are available on request. Benefits are subject to approval from the Council for Medical Schemes.
Bonitas Medical Fund
@BonitasMedical
0860 002 108
www.bonitas.co.za
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