2014 SALGA REFERENCE GUIDE Feel confident that someone is always on your side.
CHOOSING A PRODUCT ACCORDING TO YOUR LIFESTYLE NEEDS: I need quality care where I control my benefits Bonitas offers you unlimited hospitalisation as well as a savings account where you choose how to manage and spend your benefits I need quality care that also covers my day-to-day expenses Bonitas offers tried and tested products that take care of you and your family whether it s in or out of hospital I only need a hospital plan Bonitas offers an uncomplicated hospital plan that gives you peace of mind because you know the essentials are covered I need to ensure that I have no co-payments Bonitas gives you access to a professional network of medical experts that covers your needs at no extra cost to you
WHY BONITAS? At Bonitas we don t promise, we do. From the moment we opened our doors over 31 years ago, we have worked hard at bringing affordable healthcare to everyone, and adding value to their lives. We know that part of getting better means you need to be able to focus on the things that matter and not worry about whether you re covered or if your medical bills will be paid in full. GOVERNANCE Bonitas Medical Fund is registered as a Medical Scheme in terms of the Medical Schemes Act. The Scheme complies with all aspects of the Medical Schemes Act. Trustees are elected by members. Trustees act in the best interest of the Scheme and its members. Benefits are approved by the Council for Medical Schemes. WE SUPPORT YOU BY OFFERING REAL BENEFITS THAT MATTER: 2. 1. On-site consultants 7. 6. Largest GP Network An unlimited number of trips on international medical cover Specialist Network 3. 8. 4. Prescribed Minimum Benefit (PMBs) covered at private hospitals 9. Healthy Solvency HIV tests and flu vaccines on all options 5. Basket of supplementary benefits paid from risk 10. Pharmacy Direct provides courier delivery of chronic medication nationally 11. Traditional options cover dentistry and optometry from risk World Class Managed Care programmes and Clinically Approved (VCT) Programmes. FINANCIALLY SOUND AND RELIABLE AA- GLOBAL CREDIT RATING RESERVES OF OVER R2.7 BILLION 35.5 % SOLVENCY MARGIN 13.7 % ADMINISTRATION COST OF GROSS CONTRIBUTION INCOME Financially sound and reliable, Bonitas has an AA-Global Credit Rating reserve of over R2.7 billion, a solvency margin of 35.5% and administration costs of only 13.7% of gross contribution income. Making your life easier, our advanced support network translates our philosophy of designed to support your life into reality for you. Intelligently innovative, lucidly simple and easy to understand, our forward-thinking product options and exceptional service match what you look for in a scheme. Key indicators such as solvency ratio, average beneficiary age, pensioner ratio and claims ratio are known to provide a dependable indication of a medical scheme's long-term viability, financial stability and value for money.
BONITAS KEY INDICATORS This is the financial side of our business. Simply put, it gives you the information you need to reassure yourself that we re in good shape today and into the future. KEY INDICATORS Solvency Ratio Average Beneficiary Age Pensioner Ratio Non-Healthcare Expenses per Beneficiary Per Month Non-Healthcare Expenses as a % of Risk Contribution Income Non-Healthcare Expenses as a % of Gross Contribution Income Principal Member Beneficiaries BONITAS 35.5% 31.4 5.1% R144 14% 13.7% 295 211 651 518 OPEN SCHEME AVERAGE 29.1% 33.2 8.2% R164 15.6% 13.6% - - The table sets out the key indicators for Bonitas compared to the open scheme average based on the latest annual report (updated) from the Council for Medical Schemes SOLVENCY RATIO 35.5 % SOLVENCY RATIO Bonitas solvency rate is one of the highest in the country overtaking the prescribed minimum solvency ratio of 25% which not only ensures the scheme has the ability to meet its financial commitments; it is also the most reliable indication of its financial dependability and ability to pay claims. SIZE OF THE MEDICAL SCHEME 295 211 PRINCIPAL MEMBERS 651 518 BENEFICIARIES In the medical scheme industry, there is safety in numbers. The larger the scheme's membership base, the better its ability to spread the risk of high claims. With over 295 211 principal members and 651 518 beneficiaries covered, Bonitas is well-equipped to ensure that size really does count. NON-HEALTHCARE EXPENSE RATIOS Expense ratios are an important indicator of whether a scheme offers value for money or not. Inevitably medical schemes have expenses (such as administration fees and broker commission) and the higher these non-healthcare costs, the less there is available to pay claims. Schemes with higher than average expense ratios generally don t offer good value for money. AVERAGE BENEFICIARY AGE 31.4 yrs PENSIONER RATIO 5.1 % Choosing a medical scheme with a relatively young beneficiary age and low pensioner ratio ensures you get value for money. This is because as people age, their medical costs rise and this tends to increase contributions. DRASTICALLY LOWER THAN THE VAST MAJORITY OF OPEN SCHEMES IN THE INDUSTRY, BONITAS AVERAGE BENEFICIARY AGE IS 31.4 YEARS AND OUR PENSIONER RATIO IS 5.1%.
I need quality care where I control my benefits Bonitas offers you unlimited hospitalisation as well as a savings account where you chose how to manage and spend your benefits. BonComprehensive Flexible quality cover for all needs. R3 607 Main Member* Elite medical plan with surgical procedures and consultation paid at 300% of the Bonitas rate. Unlimited hospitalisation at any hospital. Cover for 53 chronic conditions. Unlimited medication and consultations in threshold. Infant paediatric, childhood illness, Centre for Diabetes and Endocrinology (CDE) and supplementary benefits covered from risk. BonClassic Flexible quality care with extra chronic cover. R2 513 Main Member* Comes with a savings account facility which covers acute medication, Pharmacy Advice Therapy (PAT) and GP and specialist consultations. Covers 63 chronic conditions, dentistry, optometry and cochlear implants. Unlimited hospitalisation at 100% of Bonitas rates and supplementary benefits paid from risk. BonSave Flexible quality care with extra day-to-day cover. R1 558 Main Member* A host of day-to-day benefits, paid from savings account. Unlimited hospitalisation at 150% Bonitas rate. Medication for the 26 Prescribed Minimum Benefits are provided through Pharmacy Direct, basic dentistry, infant paediatric, childhood illness and supplementary benefits paid from risk. MAJOR MEDICAL BENEFITS BONCOMPREHENSIVE BONCLASSIC BONSAVE OAL Unlimited Unlimited Unlimited REIMBURSEMENT RATE Surgical procedures and consultations at 300% of Bonitas Rate 100% Bonitas Rate 150% Bonitas Rate PROVIDER Any hospital Any hospital Any hospital GPs & SPECIALISTS, PATHOLOGY & RADIOLOGY, PARAMEDICAL SERVICES Unlimited Unlimited Unlimited ONCOLOGY - CHEMO & RADIATION R475 000 per family R315 000 per family R264 500 per family ONCOLOGY - BIOLOGICAL DRUGS INCLUDED IN THE ONCOLOGY LIMIT R200 000 (10% co-payment) per family No benefit No benefit ORGAN TRANSPLANTS Unlimited Pre-authorisation Unlimited RENAL DIALYSIS Unlimited Pre-authorisation PMBs only MEDICATION TO TAKE OUT R420 per beneficiary, per admission R360 per beneficiary, per admission R290 per beneficiary, per admission PHYSICAL REHABILITATION R38 000 per family R38 000 per family R38 000 per family ALTERNATIVE TO HOSPITALISATION R12 700 per family R12 700 per family R12 700 per family
CHRONIC BENEFITS CHRONIC 53 chronic conditions. comprehensive formulary R10 600 per beneficiary, R21 150 per family Restrictive formulary when benefits are exceeded for PMBs at DSP. 40% co-payment apply at non-dsp 63 chronic conditions. comprehensive formulary R8 700 per beneficiary, R18 000 per family. Restrictive formulary. 40% co-payment apply at non-dsp 26 PMBs, restrictive formulary at DSP, 40% co-payment apply at non-dsp OUT OF HOSPITAL BENEFITS SAVINGS THRESHOLD MEMBER SELF-FUNDING GAP SAVINGS SAVINGS MEMBER R6 492 R7 400 R908 R3 024 R3 180 MEMBER +A R12 624 R14 100 R1 476 R5 616 R5 640 MEMBER +A+C R13 944 R16 050 R2 106 R6 360 R6 600 MEMBER +A+2C R15 264 R18 000 R2 736 R7 104 R7 560 MEMBER +A+3C R16 584 R19 950 R3 366 R7 848 R8 520 GP CONSULTATIONS Subject to savings and/or threshold, 25% co-payment in threshold Subject to savings Subject to savings, once savings exhausted 3 visits per beneficiary, up to a maximum of 6 visits per family SPECIALIST CONSULTATIONS Subject to savings and/or threshold, 25% co-payment in threshold Subject to savings Subject to savings RADIOLOGY Subject to savings and/or threshold R2 400 p.b. or R 3 700 p.f Subject to savings PATHOLOGY Subject to savings and/or threshold R2 400 p.b. or R 5 300 p.f Subject to savings PARAMEDICAL SERVICES Subject to savings and/or threshold. 25% co-payment in threshold M0 = R2 300, M1 = R3 500, M2 = R4 050, M3 = R4 300, M4 = R4 600 Subject to savings OPTOMETRY Subject to savings and/or threshold, limited to R2 450 per beneficiary. 25% co-payment in threshold R5 260 per family, per annum. Eye examination 100% of cost. Frames/lens add-ons R700 p,b. Single vision lens R185 per lens, p.b. Bifocal lens R430 per lens, p.b. Multi-focal lenses R750 per lens, p.b. Contact lens R1 635 p.b. Subject to savings ACUTE MEDICATIONS AND PAT Subject to savings and/or threshold, 100% of Bonitas rate accrue to threshold, 25% co-payment in threshold. Subject to savings Subject to savings BASIC DENTISTRY Subject to savings and/or threshold. 25% co-payment in threshold. Covered according to DENIS Clinical Protocols and Bonitas Dental Tariff R3 600 p.f.p.a. Covered according to DENIS Clinical Protocols and Bonitas Dental Tariff Covered according to DENIS Clinical Protocols and Bonitas Dental Tariff SPECIALISED DENTISTRY Subject to savings and/or threshold. 25% co-payment in threshold. Covered according to DENIS Clinical Protocols and Bonitas Dental Tariff R4 300 p.f.p.a. Covered according to DENIS Clinical Protocols and Bonitas Dental Tariff No benefit SUPPLEMENTARY BENEFITS MATERNITY CARE 12 ante-natal consultations, 2 x 2D scans, 4 post-natal consultations with a midwife. Ante-natal classes R1 000 and post confinement in a private ward Ante-natal classes R980, 12 ante-natal consultations, 2 x 2D scans, 4 post-natal consultations with a midwife Ante-natal classes R950, 6 ante-natal consultations, 2 x 2D scans, 4 post-natal consultations with a midwife
REFRACTIVE SURGERY R15 900 per family No benefit No benefit HIV Unlimited subject to Aid for AIDS registration PMBs subject to Aid for AIDS registration R24 800 per beneficiary subject to Aid for AIDS registration MENTAL HEALTH R36 000 per family, sub-limit of R12 000 in and out of hospital consultations R31 700 per family, sub-limit of R12 400 in and out of hospital consultations R24 800 per family, sub-limit of R12 150 in and out of hospital consultations SPECIALISED RADIOLOGY R24 000 per family, subject to pre-authorisation R22 200 joint limit for in and out of hospital R17 000 per family, subject to pre-authorisation AMBULANCE - EMERGENCY ER24 ER24 ER24 ENDOSCOPIES IN DOCTORS ROOMS* Unlimited Unlimited Unlimited PROSTHESES INTERNAL R42 300 per family R42 000 per family PMBs only PROSTHESES EXTERNAL R42 300 per family Included in internal prosthesis PMBs only COCHLEAR IMPLANTS R158 000 per family R158 000 per family No benefit INTERNAL NERVE STIMULATORS R127 000 per family No benefit No benefit HIV TESTS & FLU VACCINES 1 each per beneficiary, per annum 1 each per beneficiary, per annum 1 per each beneficiary, per annum INFANT PAEDIATRIC BENEFIT 3 consultations before the age of 1 year. 2 consultations between the ages of 1 and 2 years No benefit 2 consultations before the age of 1 year. 1 consultation between the ages of 1 and 2 years CHILDHOOD ILLNESS BENEFIT 2 GP consultations between the ages of 2 and 12 years No benefit 1 GP consultation between the ages of 2 and 12 years WOMEN S HEALTH 1 mammogram every 3 years for females aged 50 to 74 years. 1 pap smear every 3 years for females aged 21 to 65 years No benefit No benefit CARDIAC HEALTH 1 full lipogram per beneficiary No benefit No benefit ELDERLY HEALTH 1 Pneumoccocal vaccination above age 65 years 1 Faecal Occult blood test p.b.p.a between the age 50 to 75 years 1 Bone Densitometry Screening test for females above the age of 65 years No benefit No benefit CHILDREN S HEALTH 1 TSH test for infants below 1 month of age Immunisation for children up to age 12 years, as specified in the Extended Programme on Immunisation (EPI) No benefit No benefit APPLIANCES GENERAL APPLIANCES R6 800 per family R6 300 per family R5 600 per family WHEELCHAIRS & LARGE ORTHOPAEDIC APPLIANCES Included in General Appliances benefit Included in General Appliances limit Included in General Appliances benefit STOMA PRODUCTS AND CPAP* SUBJECT TO PRE-AUTHORISATION May exceed General Appliances by R4 750 Included in General Appliances benefit May exceed General Appliances by R5 000 HEARING AIDS R21 000 Biennial per family R13 800 per family (1 Jan 2013-31 Dec 2015) No benefit OXYGEN : HOME VENTILATION Unlimited subject to pre-authorisation by HBM Included in General Appliances benefit Unlimited subject to pre-authorisation by HBM *REFER TO THE CONTRIBUTION TABLE IN THIS DOCUMENT
*CONTRIBUTIONS MAIN MEMBER ADULT DEPENDANT CHILD DEPENDANT BONCOMPREHENSIVE Risk contribution R3 066 Savings contribution R541 Total contribution R3 607 Risk contribution R2 891 Savings contribution R511 Total contribution R3 402 Risk contribution Savings contribution Total contribution R624 R110 R734 BONCLASSIC Risk contribution R2 261 Savings contribution R252 Total contribution R2 513 Risk contribution R1 942 Savings contribution R216 Total contribution R2 158 Risk contribution Savings contribution Total contribution R558 R62 R620 STANDARD R2 186 R1 891 R639 BONSAVE Risk contribution R1 293 Savings contribution R265 Total contribution R1 558 Risk contribution R1 002 Savings contribution R205 Total contribution R1 207 Risk contribution Savings contribution Total contribution R388 R80 R468 PRIMARY R1 412 R1 105 R450 BONESSENTIAL R1 085 R830 R318 *BONCAP contributions (CALCULATED ON PENSIONABLE INCOME) INCOME BAND MAIN MEMBER ADULT DEPENDANT CHILD DEPENDANT 0 to R5 700 R615.00 R583.00 R290.00 R5 701 to R9 300 R748.00 R707.00 R342.00 R9 301 to R12 700 R1 219.00 R1 086.00 R462.00 R12 701+ R1 496.00 R1 332.00 R567.00 Bonitas-Medical-Fund @BonitasMedical 0860 002 108 bonitas.co.za
I need quality care that also covers my day-to-day Bonitas offers tried and tested products that take care of you and your family whether it s in or out of hospital. Standard Quality care for the whole family. R2 186 Main Member* Comprehensive hospital cover with generous day-to-day benefits. Covers 42 chronic conditions. Unlimited annual benefits and hospitalisation at 100% Bonitas rate. Centre for Diabetes and Endocrinology (CDE) and Supplementary benefits paid from risk. Primary Quality care when needed the most. R1 412 Main Member* All major medical expenses at 100% of our rate. Substantial GP and day-to-day benefits while supplementary benefits are all paid from risk. Medication for the 26 Prescribed Minimum Benefits are provided through Pharmacy Direct. MAJOR MEDICAL BENEFITS STANDARD PRIMARY OAL Unlimited Unlimited REIMBURSEMENT RATE 100% Bonitas Rate 100% Bonitas Rate PROVIDER Any hospital Any hospital GPs & SPECIALISTS, PATHOLOGY & RADIOLOGY, PARAMEDICAL SERVICES Unlimited Unlimited ONCOLOGY - CHEMO & RADIATION R264 500 per family R127 000 per family ORGAN TRANSPLANTS Unlimited PMBs, covered as per state protocol RENAL DIALYSIS Unlimited PMBs, covered as per state protocol MEDICATION TO TAKE OUT R360 per beneficiary, per admission R290 per beneficiary, per admission PHYSICAL REHABILITATION R38 000 per family R38 000 per family ALTERNATIVE TO HOSPITALISATION R12 700 per family R12 700 per family CHRONIC BENEFITS CHRONIC 42 chronic conditions R7 400 p.b. or R14 800 p.f. Comprehensive formulary in benefit limit Restrictive formulary when benefits are exceeded 26 PMBs restrictive formulary at DSP, 40% co-payment apply at non-dsp
OUT OF HOSPITAL BENEFITS GP CONSULTATIONS IN NETWORK OUT OF NETWORK SUB-LIMIT INCLUDED IN NETWORK BENEFIT IN NETWORK OUT OF NETWORK SUB-LIMIT INCLUDED IN NETWORK BENEFIT MEMBER R3 200 R1 050 R1 500 R500 MEMBER +A R4 700 R1 600 R2 850 R950 MEMBER +A+C R5 200 R1 750 R3 300 R1 100 MEMBER +A+2C R5 500 R1 850 R3 600 R1 200 MEMBER +A+3C R5 900 R2 000 R4 000 R1 350 DAY TO DAY LIMIT MEMBER R3 600 R1 600 MEMBER +A R5 500 R2 900 MEMBER +A+C R5 900 R3 400 MEMBER +A+2C R6 400 R3 700 MEMBER +A+3C R6 950 R4 000 ACUTE MEDICATION AND PAT PAT sub-limit of R620 p.b. and R1 900 per family. All are subject to day to day benefit PAT sub-limit of R380 p.b. and R1 100 per family All are subject to day to day benefit SPECIALISTS, RADIOLOGY, PATHOLOGY, PARAMEDICAL SERVICES Subject to day to day benefit Subject to day to day benefit OPTOMETRY 2-year benefit 2-year benefit OPTOMETRIC EXAMINATION 100% of cost at network provider, or R295 at a non-network provider 100% of cost at network provider, or R295 at a non-network provider FRAMES & PRESCRIPTION LENSES/ADD-ONS R800 per beneficiary R300 per beneficiary at a network provider CLEAR SINGLE VISION R150 per lens or R150 per lens or CLEAR AQUITY FLAT-TOP BIFOCAL R325 per lens or R325 per lens or CLEAR AQUITY MULTIFOCAL (UP TO BIFOCAL LIMIT) R600 per lens or R600 per lens or CONTACT LENSES R1 550 per beneficiary R750 per beneficiary CONSERVATIVE DENTISTRY Benefits are subject to DENIS clinical protocols. Covered at the BDT* (Bonitas Dental Tariff) Benefits are subject to DENIS clinical protocols. Covered at the BDT* (Bonitas Dental Tariff) SPECIALISED DENTISTRY Benefits are subject to DENIS clinical protocols. Covered at the BDT* (Bonitas Dental Tariff) No benefit SUPPLEMENTARY BENEFITS MATERNITY CARE Ante-natal classes R950, 12 ante-natal consultations, 2 x 2D scans, 4 post-natal consultations with a midwife 6 ante-natal consultations, 2 x 2D scans, 4 post-natal consultations with a midwife HIV R24 900 per beneficiary subject to Aid for AIDS R19 000 per beneficiary subject to Aid for AIDS registration
MENTAL HEALTH R31 200 per family, sub-limit of R12 200 in and out of hospital consultations R12 200 per family, sub-limit of R7 400 in and out of hospital consultations. SPECIALISED RADIOLOGY R20 100 per family, subject to pre-authorisation out of hospital. No limit in hospital R9 500 per family (joint limit in and out of hospital) AMBULANCE - EMERGENCY ER24 ER24 ENDOSCOPIES IN DOCTORS ROOMS* Unlimited Unlimited PROSTHESES INTERNAL AND EXTERNAL R33 900 per family PMBs only COCHLEAR IMPLANTS R158 000 per family No benefit INTERNAL NERVE STIMULATORS R127 000 per family No benefit HIV TESTS & FLU VACCINES 1 each per beneficiary, per annum 1 each per beneficiary, per annum INFANT PAEDIATRIC BENEFIT 2 consultations before the age of 1 year. 1 consultation between the ages of 1 and 2 years per beneficiary per annum 1 consultations before the age of 1 year. 1 consultation between the ages of 1 and 2 years per beneficiary per annum CHILDHOOD ILLNESS BENEFIT 2 GP consultations between the ages of 2 and 12 years 1 GP consultation between the ages of 2 and 12 years APPLIANCES GENERAL APPLIANCES R6 200 per family R5 550 per family WHEELCHAIRS & LARGE ORTHAPAEDIC APPLIANCES Included in General Appliances limit Included in General Appliances limit STOMA PRODUCTS AND CPAP* May exceed General Appliances by R5 000 May exceed General Appliances by R5 000 HEARING AIDS R13 000 biennial per family R7 400 biennial per family OXYGEN HOME VENTILATION Unlimited. Subject to Hospital Benefit Management Unlimited. Subject to Hospital Benefit Management *REFER TO THE CONTRIBUTION TABLE IN THIS DOCUMENT
Only the best care is good enough.
I only need a hospital plan Bonitas offers an uncomplicated hospital plan that gives you peace of mind because you know the essentials are covered. BonEssential Quality care that covers the essentials. R1 085 Main Member* Solid, affordable and uncomplicated hospital plan. Unlimited hospitalisation at 100% of Bonitas rate. Medication for the 26 Prescribed Minimum Benefits are provided through Pharmacy Direct. Childhood illness and supplementary benefits covered from risk. MAJOR MEDICAL BENEFITS BONESSENTIAL OAL Unlimited REIMBURSEMENT RATE 100% Bonitas Rate PROVIDER Any hospital GPs & SPECIALISTS, PATHOLOGY & RADIOLOGY, PARAMEDICAL SERVICES Unlimited ONCOLOGY - CHEMO & RADIATION R264 500 per family ONCOLOGY - BIOLOGICAL DRUGS INCLUDED IN THE ONCOLOGY LIMIT No benefit ORGAN TRANSPLANTS Unlimited RENAL DIALYSIS PMBs only MEDICATION TO TAKE OUT R290 per beneficiary, per admission PHYSICAL REHABILITATION R38 000 per family ALTERNATIVE TO HOSPITALISATION R12 700 per family I need to ensure that I have no co-payments BonCap Quality care when you need it. Bonitas gives you access to a professional network of medical experts that covers your needs at no extra cost to you. CONTRIBUTIONS AS PER INCOME* All major medical expenses at 100% of Bonitas tariff, with no overall limit. Substantial GP and out of hospital benefits with additional supplementary benefits. Medication for the 26 Prescribed Minimum Benefits are provided through Pharmacy Direct. MAJOR MEDICAL BENEFITS BONCAP OAL Unlimited REIMBURSEMENT RATE 100% BonCap Rate PROVIDER BonCap Network GPs & SPECIALISTS Unlimited PATHOLOGY Limited to R19 500, except for PMBs GENERAL RADIOLOGY Unlimited SURGICAL PROCEDURES Limited to R13 500 per family per annum BLOOD TRANSFUSION Limited to R14 200 per family per annum PHYSIOTHERAPY & OCCUPATIONAL THERAPY ONCOLOGY - CHEMO & RADIOLOGY ORGAN TRANSPLANTS CHRONIC RENAL DIALYSIS PMBs only MAXILLO-FACIAL SURGERY R13 500 per family included in surgical procedures MEDICATION TO TAKE OUT (TTO) R290 per beneficiary, per admission ALTERNATIVE TO HOSPITALISATION Limited to R11 000 per family per annum, pre-authorisation required PHYSICAL REHABILITATION PMBs only
CHRONIC BENEFITS CHRONIC 26 PMBs. BonCap medicine formulary at DSP, 40% co-payment non-dsp OUT OF HOSPITAL BENEFITS GP CONSULTATIONS SPECIALISTS RADIOLOGY PATHOLOGY PARAMEDICAL SERVICES No benefit, except PMBs OPTICAL ACUTE MEDICATIONS AND PAT BASIC DENTISTRY ADVANCED DENTISTRY CHRONIC BENEFITS CHRONIC 26 PMBs. Pharmacy Direct is the DSP for the distribution of chronic medication OUT OF HOSPITAL BENEFITS GP CONSULTATIONS 12 consultations per beneficiary per annum subject to the BonCap GP network. Authorisation is required after the 12th visit. PMBs only after the 12th visit, subject to managed care protocols OUT OF NETWORK CONSULTATIONS 1 visit per beneficiary or 2 visits per family to a maximum of R800 and 20% co-payment (except emergencies). No benefit for facility fees ACUTE MEDICATION Subject to the BonCap Acute Medicine Formulary OVER THE COUNTER MEDICATION Limited to R205 per beneficiary, per annum, maximum of R70 per event SPECIALIST CONSULTATIONS 3 visits per beneficiary limited to R2 400 or 5 visits per family limited to R3 550. Subject to referral from a network GP and pre-authorisation OCCUPATIONAL THERAPY & PHYSIOTHERAPY PMBs only on referral from a network GP GENERAL RADIOLOGY List of approved investigations. On referral from a network GP PATHOLOGY List of approved investigations. On referral from a network GP BASIC DENTISTRY Subject to DENIS managed care protocols and approved codes. Covered at Bonitas Dental Tariff SPECIALISED DENTISTRY No benefit OPTOMETRY 2 year benefit from anniversary of claiming per beneficiary per annum. Subject to DSP at PPN network
SUPPLEMENTARY BENEFITS MATERNITY CARE 6 ante-natal consultations, 2 x 2D scans, 4 post-natal consultations with a midwife REFRACTIVE SURGERY No benefit HIV R24 800 per beneficiary subject to Aid for AIDS registration MENTAL HEALTH R24 800 per family subject to pre-authorisation. In hospital only AMBULANCE - EMERGENCY ER24 PROSTHESES INTERNAL PMBs only PROSTHESES EXTERNAL PMBs only HIV TESTS & FLU VACCINES 1 each per beneficiary, per annum CHILDHOOD ILLNESS BENEFIT 1 GP consultation between the ages of 2 and 12 years *REFER TO THE CONTRIBUTION TABLE IN THIS DOCUMENT SUPPLEMENTARY BENEFITS MATERNITY CARE Subject to BonCap GP Network. Neonatal care limited to R35 000 per family IMMUNE DEFICIENCY RELATED TO HIV INFECTION Subject to managed care protocols and registration on the BonCap HIV/AIDS programme MENTAL HEALTH BENEFITS PMBs only. Subject to the BonCap GP network SPECIALISED RADIOLOGY (JOINT LIMIT IN & OUT OF HOSPITAL) R8 900 per family, included in the OAL and subject to pre-authorisation EMERGENCY MEDICAL TRANSPORTATION Subject to ER24 authorisation PROSTHESES INTERNAL (IN HOSPITAL) PMBs only PROSTHESES EXTERNAL No benefit HIV TESTS AND FLU VACCINES 1 each per beneficiary per annum APPLIANCES GENERAL APPLIANCES R4 200 per family WHEELCHAIRS, STOMA PRODUCTS, CPAP *, HEARING AIDS, ETC Joint limit with General Appliances OXYGEN THERAPY & HOME VENTILATION Subject to pre-authorisation by Hospital Benefit Management
Keeping it simple and easy.
SALGA CONTRIBUTIONS M M+S M+S+A M+S+C M+S+2C M+S+3C M+C M+2C M+3C BONCOMPREHENSIVE: 40% R1 442,80 R2 803,60 R4 164,40 R3 097,20 R3 390,80 R3 684,40 R1 736,40 R2 030,00 R2 323,60 Employee 60% R2 164,20 R4 205,40 R6 246,60 R4 645,80 R5 086,20 R5 526,60 R2 604,60 R3 045,00 R3 485,40 Employer TOTAL: R3 607,00 R7 009,00 R10 411,00 R7 743,00 R8 477,00 R9 211,00 R4 341,00 R5 075,00 R5 809,00 BONCLASSIC: 40% R1 005,20 R1 868,40 R2 731,60 R2 116,40 R2 364,40 R2 612,40 R1 253,20 R1 501,20 R1 749,20 Employee 60% R1 507,80 R2 802,60 R4 097,40 R3 174,60 R3 546,60 R3 918,60 R1 879,80 R2 251,80 R2 623,80 Employer TOTAL: R2 513,00 R4 671,00 R6 829,00 R5 291,00 R5 911,00 R6 531,00 R3 133,00 R3 753,00 R4 373,00 STANDARD: 40% R874,40 R1 630,80 R2 387,20 R1 886,40 R2 142,00 R2 397,60 R1 130,00 R1 385,60 R1 641,20 Employee 60% R1 311,60 R2 446,20 R3 580,80 R2 829,60 R3 213,00 R3 596,40 R1 695,00 R2 078,40 R2 461,80 Employer TOTAL: R2 186,00 R4 077,00 R5 968,00 R4 716,00 R5 355,00 R5 994,00 R2 825,00 R3 464,00 R4 103,00 BONSAVE: 40% R623,20 R1 106,00 R1 588,80 R1 293,20 R1 480,40 R1 667,60 R810,40 R997,60 R1 184,80 Employee 60% R934,80 R1 659,00 R2 383,20 R1 939,80 R2 220,60 R2 501,40 R1 215,60 R1 496,40 R1 777,20 Employer TOTAL: R1 558,00 R2 765,00 R3 972,00 R3 233,00 R3 701,00 R4 169,00 R2 026,00 R2 494,00 R2 962,00 PRIMARY: 40% R564,80 R1 006,80 R1 448,80 R1 186,80 R1 366,80 R1 546,80 R744,80 R924,80 R1 104,80 Employee 60% R847,20 R1 510,20 R2 173,20 R1 780,20 R2 050,20 R2 320,20 R1 117,20 R1 387,20 R1 657,20 Employer TOTAL: R1 412,00 R2 517,00 R3 622,00 R2 967,00 R3 417,00 R3 867,00 R1 862,00 R2 312,00 R2 762,00 BONESSENTIAL: 40% R434,00 R766,00 R1 098,00 R893,20 R1 020,40 R1 147,60 R561,20 R688,40 R815,60 Employee 60% R651,00 R1 149,00 R1 647,00 R1 339,80 R1 530,60 R1 721,40 R841,80 R1 032,60 R1 223,40 Employer TOTAL: R1 085,00 R1 915,00 R2 745,00 R2 233,00 R2 551,00 R2 869,00 R1 403,00 R1 721,00 R2 039,00 BONCAP: R0 - R5 700 40% R246,00 R479,00 R712,00 R595,00 R711,00 R827,00 R362,00 R478,00 R594,00 Employee 60% R369,00 R719,00 R1 069,00 R893,00 R1 067,00 R1 241,00 R543,00 R717,00 R891,00 Employer TOTAL: R615,00 R1 198,00 R1 781,00 R1 488,00 R1 778,00 R2 068,00 R905,00 R1 195,00 R1 485,00 BONCAP: R5 701 - R9 300 40% R299,00 R582,00 R865,00 R719,00 R856,00 R992,00 R436,00 R573,00 R710,00 Employee 60% R449,00 R873,00 R1 297,00 R1 078,00 R1 283,00 R1 489,00 R654,00 R859,00 R1 064,00 Employer TOTAL: R748,00 R1 455,00 R2 162,00 R1 797,00 R2 139,00 R2 481,00 R1 090,00 R1 432,00 R1 774,00 BONCAP: R9 301 - R12 700 40% R488,00 R922,00 R1 356,00 R1 107,00 R1 292,00 R1 476,00 R672,00 R857,00 R1 042,00 Employee 60% R731,00 R1 383,00 R2 035,00 R1 660,00 R1 937,00 R2 215,00 R1 009,00 R1 286,00 R1 563,00 Employer TOTAL: R1 219,00 R2 305,00 R3 391,00 R2 767,00 R3 229,00 R3 691,00 R1 681,00 R2 143,00 R2 605,00 BONCAP R12 701+ 40% R598,00 R1 131,00 R1 664,00 R1 358,00 R1 585,00 R1 812,00 R825,00 R1 052,00 R1 279,00 Employee 60% R898,00 R1 697,00 R2 496,00 R2 037,00 R2 377,00 R2 717,00 R1 238,00 R1 578,00 R1 918,00 Employer TOTAL R1 496,00 R2 828,00 R4 160,00 R3 395,00 R3 962,00 R4 529,00 R2 063,00 R2 630,00 R3 197,00