Bonitas 2013

Bonitas Benefit Structure and Options 2013

Major Medical Benefits

Major medical benefits cover medical expenses in hospital and major medical events. Hospital accounts are covered in full as per the negotiated rates between Bonitas and the major hospital groups. Hospital admission is subject to pre-authorisation by Hospital Benefit Management, except in the case of emergencies.
StandardPrimaryBonComprehensiveBonSaveBonEssential

Overall Annual Limit

UnlimitedR1 000 000
per family
per annum
UnlimitedUnlimitedUnlimited

Reimbursement Rate¹

100% Bonitas Rate100% Bonitas Rate300% Bonitas Rate150% Bonitas Rate100% Bonitas Rate

Provider

Any hospitalAny hospitalAny hospitalAny hospitalAny hospital

Chronic Benefits

Chronic Benefits covers medicine for conditions that require medication on an ongoing basis. Subject to pre-authorisation by Chronic Medicine Management.
StandardPrimaryBonComprehensiveBonSaveBonEssential

Limit

R7 000 per beneficiary;
R14 000 per family;
(42 conditions)
Prescribed Minimum Benefits only at Designated Service Provider (26 conditions) R10 000 per beneficiary;
R20 000 per family;
(53 conditions)
Prescribed Minimum; Benefits only at Designated Service Provider
(26 conditions)
Prescribed Minimum; Benefits only at Designated Service Provider
(26 conditions)

Formulary list¹

Comprehensive formulary in benefit. Restrictive Formulary when benefits are exceeded for PMB's only Restrictive Formulary Comprehensive Formulary; in benefit. Restrictive Formulary when benefits are exceeded for PMB's only Restrictive Formulary Restrictive Formulary

Provider

Any Pharmacy or Dispensing GP up to limit. PMB's unlimited at DSP thereafter Pharmacy Direct Comprehensive Formulary; in benefit. Restrictive Formulary when benefits are exceeded for PMB's only Pharmacy Direct Restrictive Formulary

Out of Hospital Benefits

Out of hospital benefits cover day to day medical expenses incurred out of hospital.
StandardPrimaryBonComprehensiveBonSaveBonEssential
Out of hospital care is coordinated through your general practitioner (GP). Visiting a contracted GP on the Bonitas GP Network ensures that you will not be charged anything in excess of the Bonitas Tariff. Acute medication, radiology and pathology etc. prescribed by your doctor is available from your Day to Day Benefit. Specialist consultations are also payable from this benefit if referred by your GP. Visiting a contracted specialist on the Bonitas Specialist Network ensures that you would not be charged co-payments in benefit.A savings account enables members to self-insure and manage their own out of hospital expenses. Unspent savings are carried forward with interest. An insured threshold benefit provides additional peace of mind for high out of hospital expenses.A savings account enables member to manage their out of hospital medical expenses. Unspent savings are carried forward with interest. Visiting a contracted specialist on the Bonitas Specialist Network ensures that you would not be charged co-payments in benefit. A hospital plan with cover for PMB conditions only. Visiting a contracted specialist on the Bonitas Specialist Network ensures that you would not be charged co-payments in benefit.

Supplementary Benefits

Additional benefits, medical expenses incurred in or out of hospital. All of the following benefits are paid from risk, subject to benefit limits.
StandardPrimaryBonComprehensiveBonSaveBonEssential
Maternity Care
Immune deficiency *
Mental Health Benefits
Specialised Radiology
Medical Transportation **
Endoscopies
Cochlea Implants
Internal Nerve Stimulator
Prostheses ***
HIV test and Flu vaccine
Infant Paediatric Benefit
Childhood Illness Benefit
General Appliances
Maternity Care
Immune deficiency *
Mental Health Benefits
Specialised Radiology
Medical Transportation **
Endoscopies
Prostheses ***
HIV test and Flu vaccine
Infant Paediatric Benefit
Childhood Illness Benefit
General Appliances
Maternity Care
Immune deficiency *
Mental Health Benefits
Specialised Radiology
Medical Transportation **
Endoscopies
Cochlea Implants
Internal Nerve Stimulator
Prostheses ***
HIV test and Flu vaccine
Infant Paediatric Benefit
Childhood Illness Benefit
General Appliances
Refractive Surgery
Maternity Care
Immune deficiency *
Mental Health Benefits
Specialised Radiology
Medical Transportation **
Endoscopies
Prostheses ***
HIV test and Flu vaccine
Infant Paediatric Benefit
Childhood Illness Benefit
General Appliances
Maternity Care
Immune deficiency *
Mental Health Benefits
Medical Transportation **
Endoscopies
Prostheses ***
HIV test and Flu vaccine
Infant Paediatric Benefit
Childhood Illness Benefit
* Immune deficiency related to HIV infection
** Emergency Medical Transportation
*** Prostheses Internal and External

Contributions

ContributionsStandardPrimaryBonComprehensiveBonSaveBonEssential
TraditionalTraditionalNew GenerationNew GenerationNew Generation
Main Member (M)R 1,973R 1,274R 3,346R 1,406R 979
Adult(A)R 1,707R 997R 3,156R 1,089R 749
Child(C)R 577R 406R 681R 422R 287
M+AR 3,680R 2,271R 6,502R 2,495R 1,728
M+A+CR 4,257R 2,677R 7,183R 2,917R 2,015
M+A+C+CR 4,834R 3,083R 7,864R 3,339R 2,302
M+A+C+C+C R 5,411R 3,489R 8,545R 3,761R 2,589

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