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Untitled Document
There's nothing standard about our Standard option . It provides comprehensive hospital cover as well as generous day-to-day benefits. The Standard option means you can make full use of our GP Network where you need not be out of pocket because you won't be asked to make a co-payment. Our Standard option also has unlimited overall
annual benefits and additional chronic medicine benefits. ESTIMATE
OF WHAT IT WILL COST | | | | | BonSave 2012 | Contributions | Principal Member | Adult Dependant | Child Dependant | | Total | R1 795 | R1 553 | R 525 | |
| | | | | Major Medical Unlimited 100% Bonitas Rate |
| | | | | | | | | Chronic Medication
42 Chronic Conditions
R6 900 per beneficiary
R 13 800 per family |
| | | | | | | | | Out of Hospital
GP Network PLUS
Day to Day Benefits
Basic & Advanced Dentistry, Optometry | | | | | | | | | | Supplementary
Additional benefits in or out of hospital | | | | | |
| | | | | | | Download 2012 Brochure
Major medical expenses are covered at 100% of Bonitas tariff. This benefit includes major medical events. All hospital admissions, oncology treatment and renal dialysis require pre-authorisation by Hospital Benefit Management except in case of emergencies. | Overall Annual Limit - Unlimited | | Benefits payable at 100% of the Bonitas rate | | Sub-limits applicable: | | GP & Specialist Consultants | Unlimited | | Pathology | Unlimited | | Radiology (Specialised & General) | Unlimited | | Paramedical Services(Allied Medical Professions) e .g. speech therapy, occupational therapy, dietetics | Unlimited |
| Oncology |
R250 000 per family |
| Organ Transplants | Unlimited | | Chronic Renal Dialysis | Unlimited | | Maxillo Facial Surgery | Unlimited, excluding orthognatic surgery | | Medication to take out (TTO) | R 320 per beneficiary, per admission | | Physical Rehabilitation | R34 000 per family | | Download 2012 Brochure
Covers medication for conditions that require medication on an ongoing basis. Limited to R6 900 per beneficiary and R 13800 per family, at any pharmacy or dispensing GP, subject to pre-authorisation . Once limit has been exceeded, PMB's are unlimited at DSP subject to restrictive formulary. Only 42 chronic conditions covered plus applicable chronic DTP's. Download 2012 Brochure
Covers day to day medical expenses e.g. GP & specialist conSUltations, acute medication, pathology, radiology, paramedical services (Allied Medical Professions), optometry, dentistry etc.
| GP Benefit |
| A benefit has been created specifically for out of hospital general practitioner consultations empowering the GP to become your co-ordinator of care. By making use of a GP in the network you are not only guaranteed that the doctor will charge the Bonitas rate, but the benefit available is more generous. A SUb-limit applies to non-network visits, this limit is included in the GP benefit limit allowing you the flexibility to see any doctor when you are away from home. To find a network doctor near you call 0860002108. |
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GP Benefit |
In Network |
Non Network
Benefit included in the Network benefit |
| Member |
R3 000 |
R1 000 |
| Member +1 |
R4 500 |
R1 500 |
| Member +2 |
R4 900 |
R1 650 |
| Member +3 |
R5 200 |
R1 750 |
| Member +4 + |
R5 600 |
R1 870 |
| The Bonitas GP Network is the scheme's Designated Service Provider for the provision of Prescribed Minimum Benefits. A co-payment of 40% will thus apply for out of network visits once limits are exhausted. |
| Day to day Benefit |
| The day to day benefit is the pool of benefits from which your GP can presc ribe the appropriate care to improve your health. This benefit covers acute medication, out of hospital radiology, pathology, paramedical services (dietetics, occupational therapy, speech therapy, social workers, audiology, physiotherapy and others) and includes specialist consultations which will only be payable on referral by your GP. |
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| Day to Day Benefit |
| Member |
R3 100 |
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| Member +1 |
R4 700 |
| Member +2 |
R5 100 |
| Memeber +3 |
R5 500 |
| Member +4 + |
R5 900 |
| Specialist Consultations |
| Specialist referral management will require all beneficiaries to obtain a referral from a GP to consult with a specialist. The following exceptions apply: |
| Gynaecologist |
Female beneficiaries, 1 visit per annum without referral. |
| Paediatricians |
No referral required for beneficiaries under age 2. |
| Oncologist & Ophthalmologists |
No referral required |
| Specialist referral by a GP is also required for Prescribed Minimum Benefit Conditions. |
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| In addition to the day to day benefit the following is also provided: |
| Basic Dentistry |
Subject to clinical protocols and Bonitas Dental Tariff (BOT) |
| Advanced Dentistry |
Subject to clinical protocols and Bonitas Dental Tariff (BOT) |
| Optometry |
2-year benefit from anniversary of claiming, per beneficiary |
| Optometric examination |
Maximum R380 at network provider, or R250 at a non-network provider. |
| Frames & prescription lenses/add-ons |
R600 per beneficiary |
| Clear Single Vision |
R 130 per lens or |
| Clear Aquity Flat-Top Bifocal |
R 290 per lens or |
| Clear Aquity Multifocal |
R 530 per lens or |
| Contact lenses |
R 1 260 per beneficiary |
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Savings Benefit
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Per Month
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Per Annum
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| Principal Member |
R 457 |
R5 484 |
| Adult Dependant |
R 431 |
R5 172 |
| Child Dependant |
R 93 |
R1 116 |
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Threshold Benefit
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Threshold
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Self-Funding Gap
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| Principal Member |
R7 000 |
R1 516 |
| Adult Dependant |
R6 400 |
R1 228 |
| Child Dependant |
R1 850 |
R 734 |
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Acute Medication& Pharmacy Advised Therapy
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Subject to savings and / or threshold
The following limits apply:
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| Member |
R 8 000 |
| Member +1 |
R 9 500 |
| Member +2 |
R11 000 |
| Member +3+ |
R13 000 |
| (80% of the Bonitas rate accrues to threshold; 20% co-payment in threshold) |
| GP and Specialists Consultations |
Subject to savings and/or threshold, 20% co-payment in threshold |
| General Radiology |
Subject to savings and/or threshold |
| Pathology |
Subject to savings and/or threshold |
| Paramedical Services/ Auxiliary Services
(Allied Medical Professions) e.g.speech therapy, occupational therapy, audiology, dietetics |
Subject to savings and/or threshold, limited to R5 500 per family and 20% co-payment in threshold |
| Optometry |
Subject to savings and/or threshold, limited to R2 250 per beneficiary and 20% co-payment in threshold |
| In addition: Dental Benefits |
| Basic Dentistry |
Subject to savings and/or threshold. 20% co-payment in threshold. Covered according to DEN S clinical protocols and Bonitas Dental Tariff (BDT) |
| Advanced Dentistry |
Subject to savings and/or threshold. 20% co-payment in threshold. Covered according to DEN S clinical protocols and Bonitas Dental Tariff (BDT) |
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Download 2012 Brochure
Additional benefits, medical expenses incurred in or out of hospital Maternity Care per event
(ante- and postnatal) | Unlimited hospitalisation, subject to pre-authorisation. R800 for ante-natal classes. 12 ante-natal conSUltations, 2 X 2D scans and 4 post-natal consultations with midwife | | Immune deficiency related to HIV infection | R22 500 per beneficiary Subject to Aid for AIDS (AFA) registration and clinical protocols | | Mental Health Benefits | R28 000 per family, subject to pre-authorisation includes a sub-limit of R 11 000 for consultations in & out of hospital. | | Specialised Radiology (out of hospital) | R18 000 per family, subject to pre-authorisation | | Emergency Transportation | Unlimited, subject to Netcare 911 | | Endoscopies in practitioners’ rooms | Unlimited, subject to preauthorisation | | Prostheses Internal and External | R30 500 per family, subject to pre-authorisation |
| HIV test and Flu vaccine | Free, 1 per beneficiary per annum |
| Infant Paediatric Benefit (out of hospital paid from Risk) |
2 consultations before the age of one. 1 consultation before the age of two per beneficiary per annum. |
| Appliances | | | General appliances | R5 600 per family | | Wheelchairs & large orthopaedic appliances | Included in the general appliance limit | | Stoma products & CPAP machines | May exceed general appliance limit by R4 500 |
| Hearing aids |
R12 300 per family, biennial benefit (Jan 2012 - Dec 2013) |
| Oxygen: Home ventilation | Unlimited, subject to pre-authorisation by Hospital Management | Download 2012 Brochure
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