2019 Full-Bonitas Brochure

PRODUCT
BROCHURE
WHY CHOOSE BONITAS
Affordable, quality healthcare for you and your Largest GP network and a specialist network
family to give you more value for money
A wide range of plans including savings, Access to quality service providers and
traditional, income based and hospital plans healthcare professionals so you get the best
care
Preventative care and wellness benefits in

Cover for up to 60 chronic conditions and free
addition to savings and day-to-day benefits so
medicine delivery
you get more value
Complete care and support for families including Benefits for dentistry and optometry in
additional benefits for maternity, consultations addition to your savings and day-to-day
with a paediatrician and 24/7 baby advice line benefits
Managed Care programmes to help you Free cover for your fourth and subsequent
manage chronic conditions including cancer, children so you only pay for a maximum of
mental health, HIV/AIDS and diabetes three children
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 Fund Rules, the Fund Rules will prevail. The Fund Rules are available on request. Benefits are subject to approval from the
Council for Medical Schemes
INDEX
How to choose the right plan page 3 INCOME BASED OPTION
Our plans page 4 BonCap page 60
How our plans work page 5 HOSPITAL OPTIONS
Overview of our plans page 7 Hospital Standard page 65
BonEssential page 69
SAVINGS OPTIONS
BonEssential Select page 73
BonComprehensive page 9
BonClassic page 14
What you need to know page 77
BonComplete page 20
Find a service provider page 78
BonSave page 26
BonFit page 31
TRADITIONAL OPTIONS
Standard page 36
Standard Select page 42
Primary page 48
Primary Select page 54
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. Page 2
HOW TO CHOOSE THE RIGHT PLAN
Choosing the medical aid plan that fits your needs can be tricky. Make things simpler by following these steps.
1
Analyse your healthcare needs
2
Check how much cover you require
Completing a quick personal healthcare needs analysis will help you determine
what level of cover you need. If you’re going to have dependants on your plan,
you’ll need to check that their needs are covered too. Consider how much you and
your dependants have spent on medical expenses for the last year to help guide If you find that you hardly claim or have had a few
you. medical expenses, then you will need a lower level of
cover.
Ask yourself:
If, however, you have had a large number of medical
How often do you and your Do you or your dependants need to visit expenses then you will require a higher level of cover.
dependants visit the doctor? a specialist?
Do you and your dependants Do you and your dependants need extra
require medicine often? cover for cancer, renal dialysis, HIV or any
other condition?
3 4
Get expert advice
Decide if you want to use a network
Some plans require you to use a specific GP

and hospital network or a selection of If you're still unsure as to which plan to choose, you
preferred providers. This helps to keep your can visit www.bonitas.co.za and use the Plan Finder
costs as low as possible. and Plan Comparison tools.
You can also speak to a broker or financial advisor

for assistance.
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.
OUR PLANS
BONCOMPREHENSIVE STANDARD BONCAP HOSPITAL STANDARD
This first-class savings plan offers ample This traditional option offers rich This income based entry-level plan offers This hospital plan offers extensive
savings, an above threshold benefit and day-to-day benefits and comprehensive basic day-to-day benefits and hospital hospital benefits with some
extensive hospital cover. hospital cover. cover using a network of doctors, value-added benefits.
providers and hospitals.
BONCLASSIC STANDARD SELECT BONESSENTIAL

This generous savings option offers a This traditional option uses a quality This hospital plan offers comprehensive
wide range of medical benefits, in and provider network to offer rich day-to-day hospital benefits with some value-added
out of hospital. benefits and hospital cover. benefits.
BONCOMPLETE PRIMARY BONESSENTIAL SELECT

This savings option offers generous This traditional option offers simple This hospital plan uses a quality provider
savings, an above threshold benefit and day-to-day benefits and hospital cover. network to offer comprehensive hospital
rich hospital cover. benefits with some value-added benefits.
BONSAVE PRIMARY SELECT

This savings option offers sufficient This traditional option uses a quality
savings to use as you choose for medical provider network to offer simple
expenses and extensive hospital cover. day-to-day benefits and hospital cover.
BONFIT
This savings plan offers basic cover for
day-to-day medical needs and essential
hospital cover.
HOW OUR PLANS WORK
SAVINGS OPTIONS TRADITIONAL OPTIONS
Above threshold
benefits*
OUT-OF-HOSPITAL ADDITIONAL OUT-OF-HOSPITAL ADDITIONAL

Day-to-day medical expenses BENEFITS Day-to-day medical BENEFITS
Carry over each year expenses
Self-payment
gap*
*BONCOMPREHENSIVE
STANDARD
BONCLASSIC
STANDARD SELECT
*BONCOMPLETE
PRIMARY
BONSAVE
PRIMARY SELECT
BONFIT
MANAGED CARE MANAGED CARE
IN-HOSPITAL CHRONIC IN-HOSPITAL CHRONIC

Network & Non-network BENEFITS Network & Non-network BENEFITS
Up to 60 conditions Up to 45 conditions
including PMBs including PMBs
FROM R2 027 FROM R1 904
INCOME BASED OPTION HOSPITAL OPTIONS
OUT-OF-HOSPITAL ADDITIONAL
Day-to-day medical BENEFITS
expenses HOSPITAL STANDARD
BONESSENTIAL
IN-HOSPITAL BONESSENTIAL SELECT ADDITIONAL
Network & Non-network BENEFITS
BONCAP
MANAGED CARE
MANAGED CARE
CHRONIC CHRONIC
IN-HOSPITAL BENEFITS
Network BENEFITS
27 PMBs 27 PMBs
FROM R1 009 FROM R1 477
OVERVIEW OF OUR PLANS
OVERVIEW OF OUR PLANS

BonComprehensive BonClassic BonComplete BonSave BonFit
In-hospital benefits
Unlimited hospital cover ✓ ✓ ✓ ✓ ✓
Bonitas Rate for hospital cover* 300% 100% 100% 150% 100%
Hospital network applies x x x x ✓
Prostheses ✓ ✓ ✓ ✓ x
Cancer treatment ✓ ✓ ✓ ✓ ✓
Mental health ✓ ✓ ✓ ✓ ✓
Out-of-hospital benefits
Day-to-day/GP consultations/Savings ✓ ✓ ✓ ✓ ✓
Chronic conditions covered 60 47 31 27 27
Specialist consultations ✓ ✓ ✓ ✓ ✓
Blood and lab tests ✓ ✓ ✓ ✓ ✓
Specialised radiology (CT scans, MRIs) with no co-payments ✓ ✓ ✓ ✓ ✓
X-rays ✓ ✓ ✓ ✓ ✓
Basic dentistry ✓ ✓ ✓ ✓ ✓
Specialised dentistry ✓ ✓ ✓ x x
Optometry ✓ ✓ ✓ ✓ ✓
Mental health consultations ✓ ✓ ✓ ✓ ✓
Additional benefits
Contraceptives ✓ ✓ ✓ ✓ ✓
Maternity benefits ✓ ✓ ✓ ✓ ✓
24/7 baby advice line for children under 3 ✓ ✓ ✓ ✓ ✓
Childhood immunisations ✓ ✓ ✓ ✓ ✓
Separate benefit for paediatric consultations ✓ x ✓ ✓ ✓
Wellness benefits ✓ ✓ ✓ ✓ ✓
Preventative care ✓ ✓ ✓ ✓ ✓
International travel benefit ✓ ✓ ✓ ✓ ✓
* Please note: Network specialists will be covered in full at the Bonitas Rate.
** Contributions for BonCap are income based. Income will be verified once a year.
Standard Standard Select Primary Primary Select BonCap** Hospital Standard BonEssential BonEssential Select
✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
100% 100% 100% 100% 100% 100% 100% 100%
x ✓ x ✓ ✓ x x ✓
✓ ✓ ✓ ✓ x ✓ x x
✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
✓ ✓ ✓ ✓ ✓ x x x
45 45 27 27 27 27 27 27
✓ ✓ ✓ ✓ ✓ x x x
✓ ✓ ✓ ✓ ✓ x x x
✓ ✓ ✓ ✓ ✓ ✓ x x
✓ ✓ ✓ ✓ ✓ x x x
✓ ✓ ✓ ✓ ✓ x x x
✓ ✓ x x x x x x
✓ ✓ ✓ ✓ ✓ x x x
✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
✓ ✓ ✓ ✓ x x x x
✓ ✓ ✓ ✓ x ✓ x x
✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
✓ ✓ ✓ ✓ x ✓ ✓ ✓
BONCOMPREHENSIVE This first-class savings plan offers ample savings, an above threshold benefit and extensive
hospital cover.
What you get
R1 220
Rich savings and
R
unlimited above
R threshold benefit antenatal classes
Plus benefits for:

Hearing aids, mental health
Preventative care:
R27 550 Unlimited
specialist consultations &
HIV test & flu vaccine chronic benefit per family treatment at 300% of the
and MRIs & CT scans
Bonitas Rate
60 chronic conditions covered
3 Paediatric consultations
per child 0-1 years
Full lipogram
R618 500
Mammogram Managed care cancer benefit per family
R1 580 2 GP consultations per

child aged 2 – 12 years
Pap smear programmes
- R245 400 can be used for
specialised drugs
for contraceptives Childhood immunisations to help you manage a range of
No co-payment for scans
Pneumococcal vaccine conditions including:
Newborn hearing screening Unlimited blood tests, scans &
✓ Cancer
Prostate screening x-rays at 100% of the Bonitas Rate
✓ Mental health
Bone density screening ✓ HIV/AIDS R277 700
cochlear implants per family
Product rules, limits, terms and ✓ Diabetes
conditions apply.
Cover for refractive eye
✓
12
Back and neck pain
maternity Wellness screening + surgery
consultations
R2 540
✓ Hip and knee replacements
Unlimited
2 x2D scans terminal care benefit
wellness extender for extra
1 amniocentesis consultations and treatment
Main member Adult dependant Child dependant You only pay for a maximum of three
children. Full-time students pay child
What you pay
R6 438 R6 072 R1 310
RR rates up to age 24 years.
OUT-OF-HOSPITAL BENEFITS R8 390 per family
General medical appliances
These benefits provide cover for consultations with your GP or specialist, acute medicine, x-rays, An additional R6 160 per family will apply should Stoma Care and
(such as wheelchairs and
blood tests and other out-of-hospital medical expenses. CPAP machines exceed the general medical appliances limit
crutches)
You must use a preferred supplier
Main member Adult dependant Child dependant R25 780 per family, once every 2 years (based on the date of your
previous claim)
Savings R14 568 R13 740 R2 964 Hearing aids
10% co-payment applies
Self-payment gap R4 000 R3 310 R1 520 You must use a preferred supplier
Above threshold benefit Unlimited Unlimited Unlimited
Once your savings for the year are finished, you will need to pay for day-to-day medical expenses
ADDITIONAL BENEFITS
BONCOMPREHENSIVE
yourself until you have paid the full self-payment gap. You will then have access to your above
threshold benefit. Please submit all claims you have paid towards the self-payment gap to us, so We believe in giving you more value. The following benefits are in addition to your savings and other
that we can let you know when you have access to your above threshold benefit. benefits.
GP consultations Paid from available savings or above threshold benefit

Contraceptives
Paid from available savings or above threshold benefit
Specialist consultations For women aged up to 50 R1 580 per family
You must get a referral from your GP
Blood tests and other Maternity care
laboratory tests
12 antenatal consultations with a gynaecologist, GP or midwife
Acute medicine Paid from available savings or above threshold benefit
2 2D ultrasound scans
Over-the-counter medicine Paid from available savings or above threshold benefit
R1 220 for antenatal classes
Paramedical/Allied medical
professionals 1 amniocentesis
Per pregnancy
(such as physiotherapists, Paid from available savings or above threshold benefit Private ward after delivery
occupational therapists,
dieticians and biokineticists) 4 consultations with a midwife after delivery
Paid from available savings or above threshold benefit A Bonitas baby bag (you must register for this after obtaining
Specialised dentistry pre-authorisation for the delivery)
Pre-authorisation required
Paid from available savings or above threshold benefit Childcare
Basic dentistry
Pre-authorisation required for plastic dentures Hearing screening For newborns, in or out-of-hospital
Optometry Congenital hypothyroidism
Limited to R3 020 per beneficiary For infants under 1 month old
screening
Foot orthotics Paid from available savings
Babyline 24/7 helpline for medical advice for children under 3 years
3 consultations per child under 1 year
The following are paid from your unlimited overall annual Paediatrician consultations
2 consultations per child between ages 1 and 2
benefit (and not from your savings, so you get more value for money):
GP consultations 2 consultations per child between ages 2 and 12
R31 330 per family, in and out-of-hospital According to Expanded Programme on Immunisation in South
MRIs and CT scans Immunisations
(specialised radiology)
Africa
Preventative care
R15 890 per family
In and out-of-hospital consultations (included in the mental 1 HIV test per beneficiary
General health
Mental health consultations health hospitalisation benefit) 1 flu vaccine per beneficiary
Cover for educational psychologists for beneficiaries up to the
Cardiac health 1 full lipogram every 5 years, for members aged 20 and over
age of 21 years
1 mammogram every 2 years, for women over 40 CHRONIC BENEFITS
Women’s health
1 pap smear every 3 years, for women between ages 21 and 65 BonComprehensive offers extensive cover for the 60 chronic conditions listed below. Your chronic
1 prostate screening antigen test for men between ages 45 and medicine benefit is R13 830 per beneficiary and R27 550 per family on the applicable formulary.
Men’s health If you choose to use medicine that is not on the formulary, you will have to pay a 40% co-payment.
69, who are considered to be at high risk for prostate cancer
Once the amount above is finished, you will still be covered for the 27 Prescribed Minimum Benefits,
1 pneumococcal vaccine every 5 years, for members aged listed below. You can get your medicine from any pharmacy. Pre-authorisation is required.
65 and over
1 stool test for colon cancer, for members between ages Prescribed Minimum Benefits covered
Elderly health
50 and 75
1 bone density screening every 5 years, for women aged 1. Addison’s Disease 10. Crohn’s Disease 19. Hyperlipidaemia
65 and over and men aged 70 and over
2. Asthma 11. Diabetes Insipidus 20. Hypertension
BONCOMPREHENSIVE
Wellness benefits 3. Bipolar Mood Disorder 12. Diabetes Type 1 21. Hypothyroidism
1 wellness screening per beneficiary at a participating pharmacy, 4. Bronchiectasis 13. Diabetes Type 2 22. Multiple Sclerosis
biokineticist or a Bonitas wellness day
5. Cardiac Failure 14. Dysrhythmias 23. Parkinson’s Disease
Wellness screening includes the following tests:
6. Cardiomyopathy 15. Epilepsy 24. Rheumatoid Arthritis
Wellness screening • Blood pressure
• Glucose 7. Chronic Obstructive 16. Glaucoma 25. Schizophrenia
• Cholesterol Pulmonary Disease
• Body mass index 8. Chronic Renal Disease 17. Haemophilia 26. Systemic Lupus
• Waist-to-hip ratio Erythematosus
R2 540 per family which can be used for consultations and 9. Coronary Artery Disease 18. HIV/AIDS 27. Ulcerative Colitis
treatment with:
• GP
• Biokineticist Additional conditions covered
• Dietician
• Physiotherapist, or 28. Acne 39. Dermatomyositis 50. Obsessive Compulsive
Wellness extender Disorder
• A programme to stop smoking
Each adult beneficiary must complete a wellness screening to 29. Allergic Rhinitis 40. Depression 51. Osteoporosis
access the wellness extender 30. Alzheimer’s Disease 41. Eczema 52. Paget’s Disease
(early onset)
Child dependants can access the wellness extender once an adult
beneficiary has completed a wellness screening 31. Ankylosing Spondylitis 42. Gastro-Oesophageal 53. Panic Disorder
Reflux Disease
International travel benefit
(GORD)
R5 million per beneficiary 32. Anorexia Nervosa 43. Generalised Anxiety 54. Polyarteritis Nodosa
Per trip R10 million per family Disorder
(up to 90 days) Including cover for mandatory vaccines 33. Attention Deficit 44. Gout 55. Post-Traumatic Stress
Disorder Disorder
You must register for this benefit (in children aged 5-18)
34. Barrett’s Oesophagus 45. Huntington’s Disease 56. Pulmonary Interstitial

Fibrosis
35. Behcet’s Disease 46. Hyperthyroidism 57. Psoriatic Arthritis
36. Bulimia Nervosa 47. Myaesthenia Gravis 58. Systemic Sclerosis
37. Cystic Fibrosis 48. Narcolepsy 59. Tourette’s Syndrome
38. Dermatitis 49. Neuropathies 60. Zollinger-Ellison
Syndrome
MANAGED CARE PROGRAMMES Provides you with appropriate treatment and tools to live a
normal life
We offer a range of managed care programmes to support you and help put you on the path to
good health. These programmes empower you to manage your condition effectively in the most Covers medicine to treat HIV (including drugs to prevent
clinically-proven way, ensuring your benefits last longer. mother-to-child transmission and infection after sexual assault
or needle-stick injury)
You will need to register to join these programmes.
Treatment and prevention of opportunistic infections such as
pneumonia, TB and flu
Helps manage severe back and neck pain
HIV/AIDS Covers regular blood tests to monitor disease progression,
Offers a personalised treatment plan for up to 6 weeks
(Aid for AIDS) response to therapy and to detect possible side-effects of
Includes assistance from doctors, physiotherapists and treatment
biokineticists
Back and neck Offers HIV-related consultations to visit your doctor to monitor
BONCOMPREHENSIVE
(DBC) Gives access to a home care plan to maintain your results your clinical status
long-term
Gives ongoing patient support via a team of trained and
We cover the full cost of the programme so it won’t impact your experienced counsellors
savings or day-to-day benefits Offers access to telephonic support from doctors
Highly effective and low-risk, with an excellent success rate Helps in finding a registered counsellor for emotional support
Puts you first, offering emotional and medical support
Available to pre-identified members who suffer from depression,
Delivers cost-effective care of the highest quality anxiety, post-traumatic stress disorder and alcohol abuse
Liaises with your doctor to ensure your treatment plan is Access to a Care Manager who will work with you, your
Cancer clinically appropriate to meet your needs treating doctor and where appropriate, with other healthcare
(Medscheme and ICON) professionals to assist in improving your condition
Matches the treatment plan to your benefits to ensure you have Mental wellness
the cover you need (Medscheme) Care Manager to assist with setting up appointments with your
doctor, obtain authorisation for healthcare services, understand
Uses the ICON network of oncology specialists
the importance of preventative care and the use of wellness
Access to a social worker for you and your loved ones benefits or resolve queries related to any other health condition
Empowers you to make the right decisions to stay healthy Provides educational material about mental health which
empowers you to manage your condition
Offers a personalised care plan for your specific needs
Provides cover for the tests required for the management of
diabetes as well as other chronic conditions
Diabetes management Helps you track the results of the required tests
(Medscheme)
Offers access to diabetes doctors, dieticians and podiatrists
Helps you better understand your condition through diabetes
education
Gives access to a dedicated Health Coach to answer any
questions you may have
Based on the latest international standardised clinical care
pathways
Hip and knee replacement Uses a multidisciplinary team, dedicated to assist with
(ICPS / JointCare / Major successful recovery
Joints for Life) Doctors evaluate and treat your condition before surgery to give
you the best outcomes
Treatment is covered in full on the ICPS network
IN-HOSPITAL BENEFITS R618 500 per family
This benefit offers cover for major medical events that result in a beneficiary being admitted into R245 400 of this can be used for specialised drugs
Cancer treatment
hospital. We negotiate extensively with private hospitals to ensure the best possible value for our (including biological drugs)
members.
Sublimit of R44 220 per beneficiary for Brachytherapy
Pre-authorisation is required. Non-cancer specialised
drugs R196 200 per family
Specialist consultations/ (including biological drugs)
Unlimited, covered at 300% of the Bonitas Rate
treatment Unlimited
Organ transplants
GP consultations/treatment Unlimited, covered at 100% of the Bonitas Rate Sublimit of R31 500 per beneficiary for corneal grafts
Unlimited
Blood tests and other
BONCOMPREHENSIVE
Unlimited, covered at 100% of the Bonitas Rate Kidney dialysis You must use a Designated Service Provider or a 20%
laboratory tests
co-payment will apply
X-rays and ultrasounds Unlimited, covered at 100% of the Bonitas Rate
Unlimited, if you register on the HIV/AIDS managed care
R31 330 per family, in and out-of-hospital HIV/AIDS
MRIs and CT scans programme
(specialised radiology) Pre-authorisation required
professionals Unlimited, covered at 100% of the Bonitas Rate
(such as physiotherapists, Your therapist must get a referral from the doctor treating you
occupational therapists, in hospital
dieticians and biokineticists)
Internal prosthesis R55 100 per family
R55 100 per family
External prosthesis
Sublimit of R5 250 per breast prosthesis (limited to 2 per year)
Internal nerve stimulators R165 600 per family
Deep brain stimulation
R233 300 per beneficiary
(excluding prosthesis)
R277 700 per family

Cochlear implants
R20 770 per family
Refractive eye surgery
R46 880 per family
Mental health
No cover for physiotherapy for mental health admissions
hospitalisation
You must use a Designated Service Provider
Take-home medicine R545 per beneficiary, per hospital stay
Physical rehabilitation R49 610 per family
Alternatives to hospital
R16 550 per family
(hospice, step-down facilities)
Unlimited
Terminal care Including hospice/private nursing, home oxygen,
pain management, psychologist and social worker support
BONCLASSIC This generous savings option offers a wide range of medical benefits, in and out of hospital.
What you get
R 2 x2D scans
Generous savings
R 1 amniocentesis
Plus benefits for: R1 220 Preventative care:

R23 440 Unlimited
Hearing aids, mental health antenatal classes
consultations & treatment
and MRIs & CT scans HIV test & flu vaccine chronic benefit per family
at 100% of the Bonitas Rate
47 chronic conditions covered
Optometry in addition to
savings once every two years
Full lipogram
R410 400
Basic & specialised
dentistry Pap smear programmes No co-payment for scans
in addition to savings Childhood immunisations to help you manage a range of Unlimited blood tests, scans &
Pneumococcal vaccine conditions including: x-rays at 100% of the Bonitas Rate
Newborn hearing screening
R1 580 R277 700

✓ Cancer
Prostate screening
for contraceptives ✓ Mental health
Bone density screening ✓ HIV/AIDS
Product rules, limits, terms and ✓ Diabetes Unlimited
conditions apply. terminal care benefit
✓ Back and neck pain
Wellness screening +
✓ Hip and knee replacements R54 600
R1 750
12
Internal and external prostheses
maternity
wellness extender for extra per family
consultations
consultations and treatment
What you pay
R4 470 R3 838 R1 104
OUT-OF-HOSPITAL BENEFITS 1 per beneficiary, at a network provider, at network rates
These benefits provide cover for consultations with your GP or specialist, acute medicine, x-rays, Eye tests OR
blood tests and other out-of-hospital medical expenses.
R300 per beneficiary, at a non-network provider
Main member Adult dependant Child dependant Single vision lenses (Clear) 100% towards the cost of lenses at network rates
or R175 per lens, per beneficiary, out of network
Savings R7 584 R6 516 R1 872
Bifocal lenses (Clear) 100% towards the cost of lenses at network rates
GP consultations Paid from available savings or R410 per lens, per beneficiary, out of network
Paid from available savings
Specialist consultations 100% towards the cost of lenses at network rates
You must get a referral from your GP Multifocal lenses (Clear)
R710 per lens, per beneficiary, out of network
Acute medicine Paid from available savings
BONCLASSIC
R1 110 per beneficiary at a network provider

Over-the-counter medicine Paid from available savings Frames
R740 per beneficiary at a non-network provider
Foot orthotics Paid from available savings
Contact lenses R1 790 per beneficiary, included in family limit
The following are paid from your unlimited overall annual R4 700 per family, per year
benefit (and not from your savings, so you get more value for money): Basic dentistry
Covered at the Bonitas Dental Tariff
2 annual check-ups per beneficiary
R3 110 per beneficiary Consultations
(once every 6 months)
Blood tests and x-rays
R6 890 per family X-rays: Intra-oral Managed Care protocols apply
MRIs and CT scans R28 990 per family, in and out-of-hospital 1 per beneficiary, every 3 years
(specialised radiology) Pre-authorisation required X-rays: Extra-oral Additional benefits may be considered if specialist dental
Main member only R2 960 treatment is required
professionals Main member + 1 dependant R4 550 2 annual scale and polish treatments per beneficiary
(such as occupational therapists, Main member + 2 dependants R5 240 (once every 6 months)
physiotherapists, biokineticists Main member + 3 dependants R5 600 Oral hygiene Fissure sealants are only covered for children under 16 years
and dieticians)
Main member + 4 or more dependants R6 000 Fluoride treatments are only covered for children from age
R15 890 per family 5 and younger than 16 years
In and out-of-hospital consultations (included in the mental Benefit for fillings is granted once per tooth, in 365 days
Mental health consultations health hospitalisation benefit) Benefit for re-treatment of a tooth is subject to Managed Care
Fillings
Cover for educational psychologists for beneficiaries up to the protocols
age of 21 years
A treatment plan and x-rays may be required for multiple fillings
Root canal therapy and
(such as wheelchairs and R7 780 per family Managed Care protocols apply
extractions
crutches)
1 set of plastic dentures (an upper and a lower) per beneficiary,
R16 880 per family, once every 3 years Plastic dentures and once every 4 years
(based on the date of your previous claim) associated laboratory costs
Hearing aids Managed Care protocols apply
You must use a preferred supplier R5 650 per family, per year
Specialised dentistry
R5 565 per family, once every 2 years (based on the date of your
Optometry previous claim)
Each beneficiary can choose glasses or contact lenses
Partial metal frame 2 partial frames (an upper and a lower) per beneficiary, once Limited to extensive dental treatment
dentures and associated every 5 years IV conscious sedation in
Managed Care protocols apply
laboratory costs rooms
Managed Care protocols apply Pre-authorisation required
1 crown per family, per year
Crowns, bridges and Benefit for crowns will be granted once per tooth, every 5 years
associated laboratory costs A treatment plan and x-rays may be requested ADDITIONAL BENEFITS
Pre-authorisation required We believe in giving you more value. The following benefits are in addition to your savings and other
Orthodontic treatment is granted once per beneficiary, benefits.
per lifetime
Pre-authorisation cases will be clinically assessed by using an Contraceptives
orthodontic needs analysis R1 580 per family
BONCLASSIC
Benefit allocation is subject to the outcome of the needs For women aged up to 50 You must use the Designated Service Provider for
analysis and funding can be granted up to 100% of the Bonitas pharmacy-dispensed contraceptives
Dental Tariff Maternity care
Orthodontics and associated Benefit for orthodontic treatment will be granted where
laboratory costs 12 antenatal consultations with a gynaecologist, GP or midwife
function is impaired (not granted for cosmetic reasons)
Only 1 family member may begin orthodontic treatment in a
calendar year R1 220 for antenatal classes
Benefit for fixed comprehensive treatment is limited to Per pregnancy 1 amniocentesis
beneficiaries from age 9 and younger than 18 years 4 consultations with a midwife after delivery
Managed Care protocols apply A Bonitas baby bag (you must register for this after obtaining
Pre-authorisation required pre-authorisation for the delivery)
Benefit is limited to conservative, non-surgical therapy only Childcare
and will only be applied to members who are registered on the Hearing screening For newborns, in or out-of-hospital
Periodontal Programme
Periodontics Congenital hypothyroidism
Managed Care protocols apply For infants under 1 month old
screening
Pre-authorisation required Babyline 24/7 helpline for medical advice for children under 3 years
Maxillo-facial surgery and oral pathology According to Expanded Programme on Immunisation in South
Immunisations
Surgery in the dental chair Managed Care protocols apply Africa
Preventative care
A co-payment of R3 500 per hospital admission and admission
protocols apply 1 HIV test per beneficiary
General health
General anaesthetic is only available to children under the 1 flu vaccine per beneficiary
age of 5 for extensive dental treatment
Hospitalisation Cardiac health 1 full lipogram every 5 years, for members aged 20 and over
(general anaesthetic) General anaesthetic benefit is available for the removal of
1 mammogram every 2 years, for women over 40
impacted teeth Women’s health
1 pap smear every 3 years, for women between ages 21 and 65
1 prostate screening antigen test for men between ages 45 and
Pre-authorisation required Men’s health
Laughing gas in dental
rooms
1 pneumococcal vaccine every 5 years, for members aged CHRONIC BENEFITS
65 and over BonClassic offers generous cover for the 47 chronic conditions listed below. Your chronic medicine
1 stool test for colon cancer, for members between ages benefit is R11 330 per beneficiary and R23 440 per family on the applicable formulary. If you choose
Elderly health
50 and 75 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. Pre-authorisation is required.
1 bone density screening every 5 years, for women aged
65 and over and men aged 70 and over Once the amount above is finished, you will still be covered for the 27 Prescribed Minimum Benefits,
listed below, through Pharmacy Direct our Designated Service Provider. If you choose not to use
Wellness benefits
Pharmacy Direct, you will have to pay a 40% co-payment.
1 wellness screening per beneficiary at a participating pharmacy,
biokineticist or a Bonitas wellness day Prescribed Minimum Benefits covered
• Blood pressure 1 Addison’s Disease 10. Crohn’s Disease 19. Hyperlipidaemia
Wellness screening
• Glucose
BONCLASSIC

• Cholesterol
• Body mass index 3. Bipolar Mood Disorder 12. Diabetes Type 1 21. Hypothyroidism
• Waist-to-hip ratio 4. Bronchiectasis 13. Diabetes Type 2 22. Multiple Sclerosis
R1 750 per family which can be used for consultations and 5. Cardiac Failure 14. Dysrhythmias 23. Parkinson’s Disease
treatment with:
• GP
• Biokineticist 7. Chronic Obstructive 16. Glaucoma 25. Schizophrenia
• Dietician Pulmonary Disease
Wellness extender • Physiotherapist, or
8. Chronic Renal Disease 17. Haemophilia 26. Systemic Lupus
Erythematosus
Each adult beneficiary must complete a wellness screening to
access the wellness extender 9. Coronary Artery Disease 18. HIV/AIDS 27. Ulcerative Colitis

beneficiary has completed a wellness screening
Additional conditions covered
International travel benefit 28. Alzheimer’s Disease 35. Gastro-Oesophageal 42. Polyarteritis Nodosa
R5 million per beneficiary (early onset) Reflux Disease (GORD)
R10 million per family 29. Ankylosing Spondylitis 36. Generalised Anxiety 43. Pulmonary Interstitial
Per trip Disorder Fibrosis
(up to 90 days) Including cover for mandatory vaccines
30. Attention Deficit 37. Gout 44. Post-Traumatic Stress
You must register for this benefit Disorder Disorder
(in children aged 5-18)
31. Barrett's Oesophagus 38. Obsessive Compulsive 45. Scleroderma

Disorder
32. Benign Prostatic 39. Osteoporosis 46. Tourette's Syndrome
Hypertrophy
33. Depression 40. Paget's Disease 47. Zollinger-Ellison
Syndrome
34. Eczema 41. Panic Disorder
We offer a range of managed care programmes to support you and help put you on the path to normal life
You will need to register to join these programmes. or needle-stick injury) through Pharmacy Direct, our Designated
Service Provider
Helps manage severe back and neck pain Treatment and prevention of opportunistic infections such as
Offers a personalised treatment plan for up to 6 weeks HIV/AIDS Covers regular blood tests to monitor disease progression,
Includes assistance from doctors, physiotherapists and (Aid for AIDS) response to therapy and to detect possible side-effects of
biokineticists treatment
Back and neck
(DBC) Gives access to a home care plan to maintain your results Offers HIV-related consultations to visit your doctor to monitor
BONCLASSIC
long-term your clinical status
We cover the full cost of the programme so it won’t impact your Gives ongoing patient support via a team of trained and
savings or day-to-day benefits experienced counsellors
Highly effective and low-risk, with an excellent success rate Offers access to telephonic support from doctors
Puts you first, offering emotional and medical support Helps in finding a registered counsellor for emotional support
Delivers cost-effective care of the highest quality Available to pre-identified members who suffer from depression,
Liaises with your doctor to ensure your treatment plan is anxiety, post-traumatic stress disorder and alcohol abuse
Cancer clinically appropriate to meet your needs Access to a Care Manager who will work with you, your
(Medscheme and ICON) Matches the treatment plan to your benefits to ensure you have treating doctor and where appropriate, with other healthcare
the cover you need professionals to assist in improving your condition
Mental wellness
Uses the ICON network of oncology specialists (Medscheme) Care Manager to assist with setting up appointments with your
Access to a social worker for you and your loved ones the importance of preventative care and the use of wellness
Empowers you to make the right decisions to stay healthy benefits or resolve queries related to any other health condition
Offers a personalised care plan for your specific needs Provides educational material about mental health which
(Medscheme)
education
pathways
IN-HOSPITAL BENEFITS Unlimited
Organ transplants
This benefit offers cover for major medical events that result in a beneficiary being admitted into Sublimit of R31 500 per beneficiary for corneal grafts
hospital. We negotiate extensively with private hospitals to ensure the best possible value for our
Unlimited
members.
Kidney dialysis You must use a Designated Service Provider, or a
Pre-authorisation is required.
20% co-payment will apply
Unlimited, if you register on the HIV/AIDS programme
Unlimited, network specialists covered in full at the Bonitas Rate
Specialist consultations/ HIV/AIDS Chronic medicine must be obtained from the Designated Service
treatment Unlimited, non-network specialists paid at 100% of the Bonitas Provider
Rate
GP consultations/treatment Unlimited, covered at 100% of the Bonitas Rate
laboratory tests
BONCLASSIC
MRIs and CT scans R28 990 per family, in and out-of-hospital

(such as physiotherapists, Your therapist must get a referral from the doctor treating you in
occupational therapists, hospital
R54 600 per family
Internal and external Managed Care protocols apply

prostheses Sublimit of R5 250 per breast prosthesis (limited to 2 per year)
You will have to pay a R6 000 co-payment if you do not go for an
Spinal surgery
assessment through the back and neck programme
You will have to pay a R6 000 co-payment if you do not use the
Hip and knee replacements
preferred provider
R277 700 per family
Cochlear implants
R41 210 per family
Mental health
hospitalisation
R16 550 per family
Unlimited
R410 400 per family
Cancer treatment You must use a preferred provider
BONCOMPLETE This savings option offers generous savings, an above threshold benefit and rich hospital cover.
What you get
Generous savings
R and an above
threshold benefit
R1 220
R antenatal classes
Plus benefits for: Preventative care:

and MRIs & CT scans HIV test & flu vaccine
31 chronic conditions
covered
Unlimited
Chronic medicine delivered
Basic & specialised
dentistry 2 Paediatric consultations
per child 0-1 years
Full lipogram to your doorstep through
Pharmacy Direct R344 500
Mammogram cancer benefit per family
1
in addition to savings
GP consultation per
child aged 2 – 12 years Managed care
Pap smear No co-payment for scans
R1 580
for contraceptives
Childhood immunisations
Pneumococcal vaccine
programmes
to help you manage a range of
Unlimited blood tests, scans &
x-rays at 100% of the Bonitas Rate
Newborn hearing screening conditions including:
Prostate screening
Product rules, limits, terms and
✓
✓
Cancer
HIV/AIDS
R44 210
Internal and external prostheses
conditions apply. per family
✓ Diabetes
✓ Back and neck pain Unlimited

6 maternity
consultations
Wellness screening + ✓ Hip and knee replacements
terminal care benefit
2 x2D scans R1 750

Main member Adult dependant Child dependant You only pay for a maximum of
three children. Full-time students
What you pay
R3 581 R2 868 R973
RR pay child rates up to age 24 years.
OUT-OF-HOSPITAL BENEFITS Bifocal lenses (Clear) 100% towards the cost of clear lenses, limited to R410 per lens,
or per beneficiary
These benefits provide cover for consultations with your GP or specialist, acute medicine, x-rays,
blood tests and other out-of-hospital medical expenses. 100% towards the cost of clear lenses, limited to R710 per lens,
Multifocal lenses (Clear)
per beneficiary
Main member Adult dependant Child dependant Frames R740 per beneficiary
Savings R 6 432 R5 148 R1 752 Contact lenses R1 820 per beneficiary

Self-payment gap R1 740 R1 470 R375
Available once every 2 years (based on the date of your previous
Above threshold benefit R 4 610 R2 720 R1 180 Hearing aids
claim)
Once your savings for the year are finished, you will need to pay for day-to-day medical expenses You must use a preferred supplier
yourself, until you have paid the full self-payment gap. You will then have access to your above
BONCOMPLETE
threshold benefit. Please submit all claims you have paid towards the self-payment gap to us, so
that we can let you know when you have access to your above threshold benefit.
The following are paid from your unlimited overall annual
GP consultations Paid from available savings or above threshold benefit
Basic dentistry Covered at the Bonitas Dental Tariff
Specialist consultations Consultations 2 annual check-ups per beneficiary (once every 6 months)
X-rays: Intra-oral Managed Care protocols apply
laboratory tests 1 per beneficiary, every 3 years
X-rays and ultrasounds Paid from available savings or above threshold benefit X-rays: Extra-oral Additional benefits may be considered if specialist dental
Acute medicine Paid from available savings or above threshold benefit treatment is required
2 annual scale and polish treatments per beneficiary (once every
Over-the-counter medicine Paid from available savings or above threshold benefit
6 months)
professionals Oral hygiene Fissure sealants are only covered for children under 16 years
(such as physiotherapists, Paid from available savings or above threshold benefit Fluoride treatments are only covered for children from age 5 and
occupational therapists, younger than 16 years
Benefit for fillings is granted once per tooth, in 365 days
R15 890 per family
Benefit for re-treatment of a tooth is subject to Managed Care
In and out-of-hospital consultations (included in the mental Fillings
Mental health consultations health hospitalisation benefit) protocols
Cover for educational psychologists for beneficiaries up to the A treatment plan and x-rays may be required for multiple fillings
age of 21 years Root canal therapy and
General medical appliances extractions
(such as wheelchairs and 1 set of plastic dentures (an upper and a lower) per beneficiary,
crutches) You must use a preferred supplier Plastic dentures and once every 4 years
associated laboratory costs
Paid from available savings, once every 2 years (based on the date Pre-authorisation required
Optometry of your previous claim)
Specialised dentistry Covered at the Bonitas Dental Tariff
Each beneficiary can choose glasses or contact lenses
1 partial frame (an upper or a lower) per beneficiary, once every
1 per beneficiary, once every 2 years at a network provider at Partial metal frame 5 years
network rates dentures and associated
Eye tests OR laboratory costs
R300 per beneficiary, once every 2 years at a non-network
provider
Single vision lenses (Clear) 100% towards the cost of clear lenses, limited to R175 per lens,
or per beneficiary
1 crown per family, per year ADDITIONAL BENEFITS
Crowns, bridges and Benefit for crowns will be granted once per tooth, every 5 years We believe in giving you more value. The following benefits are in addition to your savings and other
associated laboratory costs A treatment plan and x-rays may be requested benefits.
Contraceptives
Implants and associated
No benefit
laboratory costs R1 580 per family
Orthodontic treatment is granted once per beneficiary, per For women aged up to 50 You must use the Designated Service Provider for
lifetime pharmacy-dispensed contraceptives
Pre-authorisation cases will be clinically assessed by using an Maternity care
orthodontic needs analysis 6 antenatal consultations with a gynaecologist, GP or midwife
Benefit allocation is subject to the outcome of the needs analysis 2 2D ultrasound scans
BONCOMPLETE
and funding can be granted up to 65% of the Bonitas Dental
Tariff R1 220 for antenatal classes
Orthodontics and associated Benefit for orthodontic treatment will be granted where function Per pregnancy 1 amniocentesis
laboratory costs is impaired (not granted for cosmetic reasons) 4 consultations with a midwife after delivery
Only 1 family member may begin orthodontic treatment in a A Bonitas baby bag (you must register for this after obtaining
calendar year pre-authorisation for the delivery)
Benefit for fixed comprehensive treatment is limited to Childcare
beneficiaries from age 9 and younger than 18 years
Hearing screening For newborns, in or out-of-hospital
Congenital hypothyroidism
For infants under 1 month old
Pre-authorisation required screening
Benefit is limited to conservative, non-surgical therapy only Babyline 24/7 helpline for medical advice for children under 3 years
and will only be applied to members who are registered on the 2 consultations per child under 1 year
Periodontal Programme Paediatric consultations
Periodontics 1 consultation per child between ages 1 and 2
Managed Care protocols apply GP consultations 1 consultation per child between ages 2 and 12
Pre-authorisation required According to Expanded Programme on Immunisation in
Immunisations
Maxillo-facial surgery and oral pathology South Africa
Surgery in the dental chair Managed Care protocols apply Preventative care
A co-payment of R3 500 per hospital admission and admission 1 HIV test per beneficiary
General health
protocols apply 1 flu vaccine per beneficiary
General anaesthetic is only available to children under the age of Cardiac health 1 full lipogram every 5 years, for members aged 20 and over
5 for extensive dental treatment 1 mammogram every 2 years, for women over 40
Hospitalisation Women’s health
(general anaesthetic) General anaesthetic benefit is available for the removal of 1 pap smear every 3 years, for women between ages 21 and 65
impacted teeth
Managed Care protocols apply Men’s health
Pre-authorisation required 1 pneumococcal vaccine every 5 years, for members aged
Laughing gas in dental 65 and over
Managed Care protocols apply Elderly health
rooms 1 stool test for colon cancer, for members between ages
Limited to extensive dental treatment 50 and 75
IV conscious sedation in
rooms
Wellness benefits CHRONIC BENEFITS
1 wellness screening per beneficiary at a participating pharmacy, BonComplete offers cover for 31 chronic conditions, using the applicable formulary.
Wellness screening includes the following tests: Pre-authorisation is required.
• Blood pressure You must use Pharmacy Direct, our Designated Service Provider, to get your medicine. If you choose
Wellness screening
• Glucose not to use Pharmacy Direct or if you choose to use medicine that is not on the formulary, you will
• Cholesterol have to pay a 40% co-payment.
• Body mass index
• Waist-to-hip ratio Prescribed Minimum Benefits covered
R1 750 per family which can be used for consultations and
treatment with: 1. Addison’s Disease 10. Crohn’s Disease 19. Hyperlipidaemia
• GP
• Biokineticist
BONCOMPLETE
• Dietician 3. Bipolar Mood Disorder 12. Diabetes Type 1 21. Hypothyroidism

4. Bronchiectasis 13. Diabetes Type 2 22. Multiple Sclerosis
access the wellness extender 6. Cardiomyopathy 15. Epilepsy 24. Rheumatoid Arthritis
Child dependants can access the wellness extender once an adult 7. Chronic Obstructive 16. Glaucoma 25. Schizophrenia
beneficiary has completed a wellness screening Pulmonary Disease
International travel benefit 8. Chronic Renal Disease 17. Haemophilia 26. Systemic Lupus
R5 million per beneficiary Erythematosus
R10 million per family 9. Coronary Artery Disease 18. HIV/AIDS 27. Ulcerative Colitis
Per trip
Additional conditions covered
You must register for this benefit
28. Acne 30. Allergic Dermatitis/ 31. Attention Deficit
(children up to 21 years) Eczema Disorder
(children up to 21 years) (in children aged 5-18)
29. Allergic Rhinitis

(children up to 21 years)
Service Provider
Back and neck
BONCOMPLETE
Delivers cost-effective care of the highest quality
Liaises with your doctor to ensure your treatment plan is
Cancer clinically appropriate to meet your needs
(Medscheme and ICON) Matches the treatment plan to your benefits to ensure you have
the cover you need
Access to a social worker for you and your loved ones
Empowers you to make the right decisions to stay healthy
(Medscheme)
education
pathways
Organ transplants
This benefit offers cover for major medical events that result in a beneficiary being admitted into Sublimit of R31 500 per beneficiary for corneal grafts
Unlimited
members.
Kidney dialysis You must use a Designated Service Provider, or a 20%
Unlimited, network specialists covered in full at the Bonitas Rate HIV/AIDS
Specialist consultations/ Chronic medicine must be obtained from the Designated Service
treatment Unlimited, non-network specialists paid at 100% of the Provider
Bonitas Rate
BONCOMPLETE

laboratory tests

R44 210 per family

Spinal surgery
preferred provider
R32 210 per family
Mental health
hospitalisation
R16 550 per family
Unlimited
R344 500 per family
BONSAVE This savings option offers savings to use as you choose for medical expenses and extensive
hospital cover.
What you get
R
Savings
R1 220
antenatal classes
Plus benefits for:
Mental health and MRIs & CT
Preventative care:
27 Unlimited
scans chronic conditions
covered specialist consultations &
Basic dentistry HIV test & flu vaccine treatment at 150% of the
in addition to savings Bonitas Rate
Additional GP
consultations
per child 0-1 years
Mammogram
Pap smear
to your doorstep through
Pharmacy Direct
R344 500
when savings are finished
1 GP consultation per
Managed care
programmes
cancer benefit per family
Co-payments apply to 22
R1 580
for contraceptives

Prostate screening to help you manage a range of
conditions including:
elective procedures

Product rules, limits, terms and x-rays at 100% of the Bonitas Rate
✓ Cancer
conditions apply.
✓
✓
HIV/AIDS
Diabetes
R31 500
internal prosthesis per family
6 maternity
consultations
Wellness screening + Unlimited
2 x2D scans R1 270

What you pay
R2 486 R1 925 R744
OUT-OF-HOSPITAL BENEFITS 2 annual scale and polish treatments per beneficiary
These benefits provide cover for consultations with your GP or specialist, acute medicine, x-rays, (once every 6 months)
blood tests and other out-of-hospital medical expenses. Oral hygiene Fissure sealants are only covered for children under 16 years
Fluoride treatments are only covered for children from age 5 and
Main member Adult dependant Child dependant younger than 16 years
Savings R 4 776 R3 696 R1 428 Benefit for fillings is granted once per tooth, in 365 days
GP consultations Paid from available savings Fillings
protocols
Paid from available savings A treatment plan and x-rays may be required for multiple fillings
Specialist consultations
You must get a referral from your GP Benefit for root canal includes all teeth except primary teeth and
Root canal therapy and permanent molars
Acute medicine and
Paid from available savings extractions
over-the-counter medicine Managed Care protocols apply
BONSAVE
X-rays and ultrasounds Paid from available savings Plastic dentures and 1 set of plastic dentures (an upper and a lower) per beneficiary,
Blood tests and other associated laboratory costs once every 4 years
laboratory tests Maxillo-facial surgery and oral pathology
Paramedical/Allied medical Surgery in the dental chair Managed Care protocols apply
professionals
(such as physiotherapists, Paid from available savings A co-payment of R3 500 per hospital admission and admission
occupational therapists, protocols apply
General anaesthetic is only available to children under the age of
Optometry Paid from available savings 5 for extensive dental treatment
Hospitalisation
The following are paid from your unlimited overall annual impacted teeth
benefit (and not from your savings, so you get more value for money): Managed Care protocols apply
MRIs and CT scans R23 330 per family, in and out-of-hospital Laughing gas in dental
(specialised radiology) Pre-authorisation required rooms
Limited to extensive dental treatment
R15 890 per family
In and out-of-hospital consultations (included in the mental rooms
Mental health consultations health hospitalisation benefit) Pre-authorisation required
age of 21 years
R6 890 per family
General medical appliances An additional R6 550 per family will apply should Stoma care and
CPAP machines exceed the general medical appliances limit
crutches)
Basic dentistry Covered at the Bonitas Dental Tariff
Consultations 2 annual check-ups per beneficiary (once every 6 months)
1 per beneficiary, every 3 years
X-rays: Extra-oral Additional benefits may be considered if specialist dental
treatment is required
ADDITIONAL BENEFITS Wellness benefits
We believe in giving you more value. The following benefits are in addition to your savings and other 1 wellness screening per beneficiary at a participating pharmacy,
benefits. biokineticist or a Bonitas wellness day
If you use all your savings for the year, your family will still get • Blood pressure
Wellness screening
Additional GP consultations a maximum of 6 GP consultations (limited to 3 per beneficiary) • Glucose
paid at the Bonitas Rate • Cholesterol
• Body mass index
Contraceptives • Waist-to-hip ratio
R1 580 per family R1 270 per family which can be used for consultations and
For women aged up to 50 You must use the Designated Service Provider for treatment with:
pharmacy-dispensed contraceptives • GP
• Biokineticist
Maternity care
BONSAVE
• Dietician
6 antenatal consultations with a gynaecologist, GP or midwife Wellness extender • Physiotherapist, or
2 2D ultrasound scans • A programme to stop smoking
R1 220 for antenatal classes Each adult beneficiary must complete a wellness screening to
Per pregnancy access the wellness extender
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) International travel benefit
R5 million per beneficiary
Childcare
Per trip R10 million per family
Hearing screening For newborns, in or out-of-hospital (up to 90 days) Including cover for mandatory vaccines
Congenital hypothyroidism You must register for this benefit
screening
2 consultations per child under 1 year
Paediatric consultations CHRONIC BENEFITS
1 consultation per child between ages 1 and 2
BonSave ensures that you are covered for the 27 Prescribed Minimum Benefits listed below. You
GP consultations 1 consultation per child between ages 2 and 12 must use Pharmacy Direct, our Designated Service Provider, to get your medicine. If you choose not
According to Expanded Programme on Immunisation in South to use Pharmacy Direct or if you choose to use medicine that is not on the formulary, you will have
Immunisations to pay a 40% co-payment.
Africa
Preventative care
Prescribed Minimum Benefits covered
1 HIV test per beneficiary
General health
1 flu vaccine per beneficiary 1. Addison’s Disease 10. Crohn’s Disease 19. Hyperlipidaemia
1 mammogram every 2 years, for women over 40 2. Asthma 11. Diabetes Insipidus 20. Hypertension
Women’s health
1 pap smear every 3 years, for women between ages 21 and 65 3. Bipolar Mood Disorder 12. Diabetes Type 1 21. Hypothyroidism
1 prostate screening antigen test for men between ages 45 and 4. Bronchiectasis 13. Diabetes Type 2 22. Multiple Sclerosis
Men’s health
69, who are considered to be at high risk for prostate cancer 5. Cardiac Failure 14. Dysrhythmias 23. Parkinson’s Disease
1 pneumococcal vaccine every 5 years, for members aged 6. Cardiomyopathy 15. Epilepsy 24. Rheumatoid Arthritis
65 and over 7. Chronic Obstructive 16. Glaucoma 25. Schizophrenia
Elderly health
1 stool test for colon cancer, for members between ages Pulmonary Disease
50 and 75 8. Chronic Renal Disease 17. Haemophilia 26. Systemic Lupus
Erythematosus
9. Coronary Artery Disease 18. HIV/AIDS 27. Ulcerative Colitis
Service Provider
Back and neck
BONSAVE
the cover you need
(Medscheme)
education
IN-HOSPITAL BENEFITS A co-payment will apply to the following procedures in hospital:
This benefit offers cover for major medical events that result in a beneficiary being admitted into R1 450 co-payment R3 680 co-payment R7 250 co-payment
members. 1. Colonoscopy 1. Arthroscopy 1. Back Surgery including
Spinal Fusion
2. Conservative Back 2. Diagnostic Laparoscopy 2. Joint Replacements
Treatment
Specialist consultations/
Unlimited, covered at 150% of the Bonitas Rate 3. Cystoscopy 3. Laparoscopic 3. Laparoscopic
treatment
Hysterectomy Pyeloplasty
4. Facet Joint Injections 4. Laparoscopic 4. Laparoscopic Radical
Blood tests and other Appendectomy Prostatectomy
laboratory tests
5. Flexible Sigmoidoscopy 5. Percutaneous 5. Nissen Fundoplication
X-rays and ultrasounds Unlimited, covered at 100% of the Bonitas Rate Radiofrequency (Reflux Surgery)
BONSAVE
MRIs and CT scans Ablations
R23 330 per family, in and out-of-hospital (Percutaneous Rhizotomies)
(specialised radiology)
Paramedical/Allied medical 6. Functional Nasal Surgery
(such as physiotherapists, Your therapist must get a referral from the doctor treating you 7. Gastroscopy
dieticians and biokineticists) 8. Hysteroscopy
(not Endometrial Ablation)
R31 500 per family (excluding joint replacement prosthesis)
Internal prosthesis Managed Care protocols apply 9. Myringotomy
You must use a preferred supplier 10. Tonsillectomy and

Adenoidectomy
R32 210 per family
11. Umbilical Hernia Repair
Mental health
hospitalisation 12. Varicose Vein Surgery
R16 550 per family
Unlimited
R344 500 per family
Unlimited
Organ transplants
Sublimit of R31 500 per beneficiary for corneal grafts
Unlimited
HIV/AIDS Chronic medicine must be obtained from the
Designated Service Provider
BONFIT This savings plan offers basic cover for day-to-day medical needs and essential hospital cover.
What you get
R
Savings
Plus benefits for:

Preventative care:
Mental health
Basic dentistry
per child 0-1 years
covered
Unlimited
HIV test & flu vaccine
1 GP consultation per at 100% of the Bonitas Rate
in addition to savings
child aged 2 – 12 years Chronic medicine delivered
Mammogram to your doorstep through Hospital network applies
Pharmacy Direct
R1 580
for contraceptives
Pap smear
Managed care R344 500
Pneumococcal vaccine cancer benefit per family
programmes
Prostate screening to help you manage a range of elective procedures
Cancer Unlimited blood tests, scans &

Product rules, limits, terms and ✓ x-rays at 100% of the Bonitas Rate
conditions apply.
✓ HIV/AIDS
6 maternity
Wellness screening +
R15 750
R1 270
✓ Diabetes
consultations
Back and neck pain MRI & CT scan benefit per family
✓ in-hospital with no co-payments
2 x2D scans wellness extender for extra
1 amniocentesis Unlimited
What you pay
R2 027 R1 570 R607
OUT-OF-HOSPITAL BENEFITS 2 annual scale and polish treatments per beneficiary
(once every 6 months)
These benefits provide cover for consultations with your GP or specialist, acute medicine, x-rays,
blood tests and other out-of-hospital medical expenses. Oral hygiene 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
Main member Adult dependant Child dependant
Savings R 3 660 R2 832 R1 092
Fillings
protocols
GP consultations Paid from available savings A treatment plan and x-rays may be required for multiple fillings
Specialist consultations Root canal therapy and
You must get a referral from your GP extractions
BONFIT
laboratory tests
X-rays and ultrasounds Paid from available savings
ADDITIONAL BENEFITS
MRIs and CT scans Paid from available savings
We believe in giving you more value. The following benefits are in addition to your savings and other
(specialised radiology) Pre-authorisation required benefits.
Acute medicine Paid from available savings
Over-the-counter medicine Paid from available savings Contraceptives
Paramedical/Allied medical R1 580 per family
professionals For women aged up to 50 You must use the Designated Service Provider for
(such as physiotherapists, Paid from available savings pharmacy-dispensed contraceptives
dieticians and biokineticists) Maternity care
General medical appliances Paid from available savings 6 antenatal consultations with a gynaecologist, GP or midwife
Optometry Paid from available savings 2 2D ultrasound scans
R1 220 for antenatal classes
The following are paid from your unlimited overall annual Per pregnancy 1 amniocentesis
pre-authorisation for the delivery)
PMB consultations only
Childcare
In and out-of-hospital consultations (included in the mental
Mental health consultations health hospitalisation benefit) Hearing screening For newborns, in or out-of-hospital
Cover for educational psychologists for beneficiaries up to the Congenital hypothyroidism
age of 21 years screening
Basic dentistry Covered at the Bonitas Dental Tariff Babyline 24/7 helpline for medical advice for children under 3 years
Consultations 2 annual check-ups per beneficiary (once every 6 months) 2 consultations per child under 1 year
Paediatric consultations
X-rays: Intra-oral Managed Care protocols apply 1 consultation per child between ages 1 and 2
1 per beneficiary, every 3 years GP consultations 1 consultation per child between ages 2 and 12
X-rays: Extra-oral Additional benefits may be considered if specialist dental According to Expanded Programme on Immunisation in South
Immunisations
treatment is required Africa
Preventative care CHRONIC BENEFITS
1 HIV test per beneficiary BonFit ensures that you are covered for the 27 Prescribed Minimum Benefits listed below. You must
General health use Pharmacy Direct, our Designated Service Provider, to get your medicine. If you choose not to
1 flu vaccine per beneficiary
use Pharmacy Direct or if you choose to use medicine that is not on the formulary, you will have to
1 mammogram every 2 years, for women over 40 pay a 40% co-payment.
Women’s health
Men’s health
1. Addison’s Disease 10. Crohn’s Disease 19. Hyperlipidaemia
1 pneumococcal vaccine every 5 years, for members aged
65 and over
Elderly health 3. Bipolar Mood Disorder 12. Diabetes Type 1 21. Hypothyroidism
1 stool test for colon cancer, for members between ages
50 and 75 4. Bronchiectasis 13. Diabetes Type 2 22. Multiple Sclerosis
BONFIT
Wellness benefits 5. Cardiac Failure 14. Dysrhythmias 23. Parkinson’s Disease

1 wellness screening per beneficiary at a participating pharmacy, 6. Cardiomyopathy 15. Epilepsy 24. Rheumatoid Arthritis
biokineticist or a Bonitas wellness day 7. Chronic Obstructive 16. Glaucoma 25. Schizophrenia
Wellness screening includes the following tests: Pulmonary Disease
Wellness screening • Blood pressure 8. Chronic Renal Disease 17. Haemophilia 26. Systemic Lupus
• Glucose Erythematosus
• Cholesterol
• Body mass index
• Waist-to-hip ratio
treatment with:
• GP
• Biokineticist
• Dietician
access the wellness extender

Service Provider
Back and neck
BONFIT
the cover you need
(Medscheme)
education
IN-HOSPITAL BENEFITS Unlimited, if you register on the HIV/AIDS programme
This benefit offers cover for major medical events that result in a beneficiary being admitted into HIV/AIDS Chronic medicine must be obtained from the Designated Service
hospital. We negotiate extensively with private hospitals to ensure the best possible value for our Provider
members.
A co-payment will apply to the following procedures in hospital:
Please note: You must use a hospital on the BonFit network or you will have to pay a
30% co-payment. R1 450 co-payment R3 680 co-payment R7 250 co-payment
1. Colonoscopy 1. Arthroscopy 1. Back Surgery including
Unlimited, network specialists covered in full at the Bonitas Rate Spinal Fusion
treatment Unlimited, non-network specialists paid at 100% of the 2. Conservative Back 2. Diagnostic Laparoscopy 2. Joint Replacements
Bonitas Rate Treatment
GP consultations/treatment Unlimited, covered at 100% of the Bonitas Rate 3. Cystoscopy 3. Laparoscopic 3. Laparoscopic
BONFIT
Blood tests and other Hysterectomy Pyeloplasty

laboratory tests 4. Facet Joint Injections 4. Laparoscopic 4. Laparoscopic Radical
X-rays and ultrasounds Unlimited, covered at 100% of the Bonitas Rate Appendectomy Prostatectomy
R15 750 per family 5. Flexible Sigmoidoscopy 5. Percutaneous 5. Nissen Fundoplication

MRIs and CT scans Radiofrequency (Reflux Surgery)
(specialised radiology) Pre-authorisation required Ablations
Paramedical/Allied medical (Percutaneous Rhizotomies)
6. Functional Nasal Surgery
dieticians and biokineticists) 7. Gastroscopy
PMB only 8. Hysteroscopy
Internal and external (not Endometrial Ablation)
prostheses
You must use a preferred supplier 9. Myringotomy
R32 210 per family 10. Tonsillectomy and

Mental health Adenoidectomy
hospitalisation 11. Umbilical Hernia Repair
12. Varicose Vein Surgery
R16 550 per family
Unlimited
R344 500 per family
Organ transplants Unlimited
Unlimited
Kidney dialysis You must use a Designated Service Provider, or a
STANDARD This traditional option offers rich day-to-day benefits and comprehensive hospital cover.
What you get
Rich GP and
R
day-to-day
benefits
R1 220
R antenatal classes
Plus benefits for:

Preventative care:
R19 280 Unlimited
and MRIs & CT scans HIV test & flu vaccine chronic benefit per family
Optometry once every 45 chronic conditions covered
two years
Basic & specialised

per child 0-1 years
Full lipogram
R344 500
dentistry 2 GP consultations per
Pap smear programmes No co-payment for scans
R1 580
for contraceptives

✓ Cancer
Prostate screening
✓ Mental health R277 700
conditions apply. ✓ HIV/AIDS
✓
✓
Diabetes
R165 600
12
Back and neck pain
maternity Wellness screening + internal nerve stimulators
per family
R1 750
consultations ✓ Hip and knee replacements
2 x2D scans Unlimited

wellness extender for extra terminal care benefit
What you pay
R3 556 R3 083 R1 043
OUT-OF-HOSPITAL BENEFITS The following are paid from your unlimited overall annual
Out-of-hospital claims will be paid from available day-to-day benefits. There is a separate benefit benefit (and not from your day-to-day benefits, so you get more value for money):
for GP consultations.

GP consultations (specialised radiology) Pre-authorisation required
If you do not use a GP on our network, your benefit for GP consultations will be limited to the
R15 890 per family
non-network GP consultation benefit. This is shown in the table below.
Mental health consultations health hospitalisation benefit)
R4 170 (R1 350 of this can be used for
Main member only Cover for educational psychologists for beneficiaries up to the
non-network GP consultations)
age of 21 years
R6 110 (R2 090 of this can be used for
Main member + 1 dependant R7 670 per family
STANDARD
General medical appliances An additional R6 550 per family will apply should Stoma Care and
R6 770 (R2 280 of this can be used for (such as wheelchairs and
Main member + 2 dependants CPAP machines exceed the general medical appliances limit
non-network GP consultations) crutches)
R7 110 (R2 380 of this can be used for You must use a preferred supplier
Main member + 3 dependants
non-network GP consultations) R16 000 per family, once every 2 years (based on the date of your
R7 720 (R2 570 of this can be used for previous claim)
Main member + 4 or more dependants
non-network GP consultations) Hearing aids
Day-to-day benefits R5 825 per family, once every 2 years (based on the date of your
These benefits provide cover for consultations with your specialist, acute medicine, x-rays, blood Optometry previous claim)
tests and other out-of-hospital medical expenses. Each beneficiary can choose glasses or contact lenses
There is a separate benefit for tests and consultations for PMB treatment plans (excluding 1 per beneficiary, at a network provider, at network rates
GP consultations) so this will not affect your day-to-day benefits. Eye tests OR
Main member only R5 820
Main member + 1 dependant R8 850 Single vision lenses (Clear) 100% towards the cost of lenses at network rates
Main member + 2 dependants R10 240
Main member + 3 dependants R11 180 Bifocal lenses (Clear) 100% towards the cost of lenses at network rates
Main member + 4 or more dependants R1 2 180
100% towards the cost of lenses at network rates
Paid from available day-to-day benefits Multifocal lenses (Clear)
Specialist consultations R710 per lens, per beneficiary, out of network
Blood tests and other laboratory tests Paid from available day-to-day benefits R1 275 per beneficiary at a network provider
Frames
X-rays and ultrasounds Paid from available day-to-day benefits R850 per beneficiary at a non-network provider
Acute medicine Paid from available day-to-day benefits Contact lenses R1 870 per beneficiary (included in the family limit)
Paramedical/Allied medical professionals Basic dentistry Covered at the Bonitas Dental Tariff
(such as physiotherapists, occupational Paid from available day-to-day benefits
therapists, dieticians and biokineticists)
R775 per beneficiary X-rays: Intra-oral Managed Care protocols apply
Over-the-counter medicine R2 350 per family 1 per beneficiary, every 3 years

X-rays: Extra-oral Additional benefit may be considered if specialist dental
Paid from available day-to-day benefits
treatment planning/follow up is required
2 annual scale and polish treatments per beneficiary (once every Maxillo-facial surgery and oral pathology
6 months)
Surgery in the dental chair Managed Care protocols apply
Oral hygiene Fissure sealants are only covered for children under 16 years
Fluoride treatments are only covered for children from age protocols apply
5 and younger than 16 years
Benefit for fillings is granted once per tooth, in 365 days 5 for extensive dental treatment
Hospitalisation
Benefit for re-treatment of a tooth is subject to Managed Care (general anaesthetic) General anaesthetic benefit is available for the removal of
Fillings
protocols impacted teeth
A treatment plan and x-rays may be required for multiple fillings Managed Care protocols apply
Root canal and extractions Managed Care protocols apply Pre-authorisation required
1 set of plastic dentures (an upper and a lower) per beneficiary, Laughing gas in dental
Plastic dentures and once every 4 years Managed Care protocols apply
STANDARD
rooms
associated laboratory costs
Pre-authorisation required Limited to extensive dental treatment
Specialised dentistry Covered at the Bonitas Dental Tariff IV conscious sedation in
rooms
1 partial frame (an upper or lower) per beneficiary, once every Pre-authorisation required
Partial metal frame 5 years
dentures and associated
laboratory costs
Pre-authorisation required ADDITIONAL BENEFITS
1 crown per family, per year
We believe in giving you more value. The following benefits are in addition to your day-to-day and
Crowns, bridges and Benefit for crowns will be granted once per tooth, every 5 years other benefits.
associated laboratory costs A treatment plan and x-rays may be requested
Pre-authorisation required Contraceptives
Orthodontic treatment is granted once per beneficiary, per R1 580 per family
lifetime For women aged up to 50 You must use the Designated Service Provider for
Pre-authorisation cases will be clinically assessed by using an pharmacy-dispensed contraceptives
orthodontic needs analysis Maternity care
Benefit allocation is subject to the outcome of the needs analysis 12 antenatal consultations with a gynaecologist, GP or midwife
Tariff
Orthodontics and associated Benefit for orthodontic treatment will be granted where function R1 220 for antenatal classes
laboratory costs is impaired (not granted for cosmetic reasons) Per pregnancy 1 amniocentesis
Only 1 family member may begin orthodontic treatment in a 4 consultations with a midwife after delivery
calendar year A Bonitas baby bag (you must register for this after obtaining
Benefit for fixed comprehensive treatment is limited to pre-authorisation for the delivery)
beneficiaries from age 9 and younger than 18 years Childcare
Managed Care protocols apply Hearing screening For newborns, in or out-of-hospital
Pre-authorisation required Congenital hypothyroidism
Benefit is limited to conservative, non-surgical therapy only screening
and will only be applied to members who are registered on the Babyline 24/7 helpline for medical advice for children under 3 years
Periodontics 2 consultations per child under 1 year
Managed Care protocols apply Paediatric consultations
2 consultations per child between ages 1 and 2
Immunisations
According to Expanded Programme on Immunisation in CHRONIC BENEFITS
South Africa
Standard offers generous cover for the 45 chronic conditions listed below. Your chronic medicine
Preventative care benefit is R9 610 per beneficiary and R19 280 per family on the applicable formulary. If you choose
1 HIV test per beneficiary to use medicine that is not on the formulary, you will have to pay a 40% co-payment. You can get
General health your medicine from any pharmacy. Pre-authorisation is required.
Once the amount above is finished, you will still be covered for the 27 Prescribed Minimum Benefits,
Cardiac health 1 full lipogram every 5 years, for members aged 20 and over listed below, through Pharmacy Direct our Designated Service Provider. If you choose not to use
1 mammogram every 2 years, for women over 40 Pharmacy Direct, you will have to pay a 40% co-payment.
Women’s health
Men’s health
69, who are considered to be at high risk for prostate cancer 1. Addison’s Disease 10. Crohn’s Disease 19. Hyperlipidaemia
1 pneumococcal vaccine every 5 years, for members aged 2. Asthma 11. Diabetes Insipidus 20. Hypertension
STANDARD
65 and over
Elderly health 3. Bipolar Mood Disorder 12. Diabetes Type 1 21. Hypothyroidism
50 and 75
Wellness benefits
biokineticist or a Bonitas wellness day 7. Chronic Obstructive 16. Glaucoma 25. Schizophrenia
Pulmonary Disease
• Blood pressure 8. Chronic Renal Disease 17. Haemophilia 26. Systemic Lupus
Wellness screening
• Glucose Erythematosus
• Cholesterol 9. Coronary Artery Disease 18. HIV/AIDS 27. Ulcerative Colitis
• Body mass index
• Waist-to-hip ratio Additional conditions covered
treatment with: 28. Acne 34. Dermatitis 40. Narcolepsy
• GP
29. Allergic Rhinitis 35. Depression 41. Obsessive Compulsive
• Biokineticist
Disorder
• Dietician
Wellness extender • Physiotherapist, or 30. Ankylosing Spondylitis 36. Eczema 42. Panic Disorder
• A programme to stop smoking 31. Attention Deficit 37. Gastro-Oesophageal 43. Post-Traumatic Stress
Each adult beneficiary must complete a wellness screening to Disorder Reflux Disease Disorder
access the wellness extender (in children aged 5-18) (GORD)
Child dependants can access the wellness extender once an adult 32. Barrett’s Oesophagus 38. Generalised Anxiety 44. Tourette’s Syndrome
beneficiary has completed a wellness screening Disorder
International travel benefit 33. Behcet’s Disease 39. Gout 45. Zollinger-Ellison
R5 million per beneficiary Syndrome
Service Provider
Back and neck
STANDARD
Mental wellness
(Medscheme)
education
pathways
This benefit offers cover for major medical events that result in a beneficiary being admitted into Cancer treatment You must use a preferred provider
members.
Unlimited
Pre-authorisation is required. Organ transplants
Unlimited, network specialists covered in full at the Bonitas Rate Unlimited
Specialist consultations/ Kidney dialysis
treatment Unlimited, non-network specialists paid at 100% of the Bonitas You must use a Designated Service Provider, or a 20%
Rate co-payment will apply
GP consultations/treatment Unlimited, covered at 100% of the Bonitas Rate Unlimited, if you register on the HIV/AIDS programme
Blood and other laboratory HIV/AIDS Chronic medicine must be obtained from the Designated Service
Unlimited, covered at 100% of the Bonitas Rate Provider
tests
STANDARD

Paramedical/Allied medical Unlimited, covered at 100% of the Bonitas Rate
professionals
in hospital
R44 210 per family

Spinal surgery
preferred provider
R277 700 per family
Cochlear implants
R40 600 per family
Mental health
hospitalisation
R16 550 per family
Unlimited
STANDARD SELECT This traditional option uses a quality provider network to offer rich
day-to-day benefits and hospital cover.
What you get 15% Cheaper than the

STANDARD OPTION
Rich day-to-day
R
benefits and GP
nomination
R1 220
R antenatal classes
Plus benefits for:

Preventative care:
R19 280 Unlimited
chronic benefit per family at 100% of the Bonitas Rate
and MRIs & CT scans HIV test & flu vaccine
Hospital network applies
Optometry once every 45 chronic conditions covered
two years
Basic & specialised

per child 0-1 years
Full lipogram
Chronic medicine delivered R344 500
Mammogram to your doorstep through
dentistry 2 GP consultations per
Pap smear
Pharmacy Direct cancer benefit per family
No co-payment for scans
R1 580
for contraceptives

Managed care
programmes
Prostate screening
R277 700
Product rules, limits, terms and cochlear implants per family
conditions apply. ✓ Cancer
✓
✓
Mental health
R165 600
12
HIV/AIDS
maternity Wellness screening + internal nerve stimulators
consultations
R1 750
✓ Diabetes per family
2 x2D scans
✓ Back and neck pain Unlimited
1 amniocentesis consultations and treatment ✓ Hip and knee replacements
Main member Adult dependant Child dependant You only pay for a maximum of
three children. Full-time students
What you pay
R3 080 R2 665 R902
RR pay child rates up to age 24 years.
OUT-OF-HOSPITAL BENEFITS Paramedical/Allied medical professionals
(such as physiotherapists, occupational Paid from available day-to-day benefits
Out-of-hospital claims will be paid from available day-to-day benefits. There is a separate benefit
therapists, dieticians and biokineticists)
GP consultations The following are paid from your unlimited overall annual
You must choose 1 GP on our network for each beneficiary. This is your nominated GP for the benefit (and not from your day-to-day benefits, so you get more value for money):
year. If you do not use your nominated GP, your benefit will be limited to the non-nominated GP
consultation benefit as indicated in the table below. MRIs and CT scans R26 100 per family, in and out-of-hospital
R4 170 (R1 350 of this can be used for R15 890 per family
Main member only
non-nominated GP consultations)
STANDARD SELECT
R6 110 (R2 090 of this can be used for Mental health consultations health hospitalisation benefit)
Main member + 1 dependant
non-nominated GP consultations) Cover for educational psychologists for beneficiaries up to the
R6 770 (R2 280 of this can be used for age of 21 years
Main member + 2 dependants
non-nominated GP consultations) R7 670 per family
R7 110 (R2 380 of this can be used for General medical appliances An additional R6 550 per family will apply should Stoma Care and
Main member + 3 dependants (such as wheelchairs and
non-nominated GP consultations) CPAP machines exceed the general medical appliances limit
crutches)
R7 720 (R2 570 of this can be used for You must use a preferred supplier
Main member + 4 or more dependants
previous claim)
Day-to-day benefits Hearing aids
These benefits provide cover for consultations with your specialist, acute medicine, x-rays, blood You must use a preferred supplier
tests and other out-of-hospital medical expenses. R5 825 per family, once every 2 years (based on the date of your
There is a separate benefit for tests and consultations for PMB treatment plans (excluding GP Optometry previous claim)
consultations) so this will not affect your day-to-day benefits. Each beneficiary can choose glasses or contact lenses
1 per beneficiary, at a network provider, at network rates

Main member only R5 820
Eye tests OR
Main member + 1 dependant R8 850
Main member + 2 dependants R10 240
Main member + 3 dependants R11 180 Single vision lenses (Clear) 100% towards the cost of lenses at network rates
Main member + 4 or more dependants R12 180 or R175 per lens, per beneficiary, out of network
Specialist consultations or R410 per lens, per beneficiary, out of network
100% towards the cost of lenses at network rates
Blood tests and other laboratory tests Paid from available day-to-day benefits Multifocal lenses (Clear)
X-rays and ultrasounds Paid from available day-to-day benefits
R1 275 per beneficiary at a network provider
Acute medicine Paid from available day-to-day benefits Frames
R775 per beneficiary
Over-the-counter medicine R2 350 per family Contact lenses R1 870 per beneficiary (included in the family limit)
Paid from available day-to-day benefits Basic dentistry Covered at the Bonitas Dental Tariff
X-rays: Intra-oral Managed Care protocols apply Benefit is limited to conservative, non-surgical therapy only
1 per beneficiary, every 3 years and will only be applied to members who are registered on the
X-rays: Extra-oral Additional benefit may be considered if specialist dental Periodontics
treatment planning/follow up is required Managed Care protocols apply
2 annual scale and polish treatments per beneficiary (once every Pre-authorisation required
6 months) Maxillo-facial surgery and oral pathology
Oral hygiene Fissure sealants are only covered for children under 16 years Surgery in the dental chair Managed Care protocols apply
Fluoride treatments are only covered for children from age 5 and A co-payment of R3 500 per hospital admission and admission
younger than 16 years protocols apply
Benefit for re-treatment of a tooth is subject to Managed Care 5 for extensive dental treatment
STANDARD SELECT
Fillings Hospitalisation
protocols (general anaesthetic) General anaesthetic benefit is available for the removal of
A treatment plan and x-rays may be required for multiple fillings impacted teeth
Root canal and extractions Managed Care protocols apply Managed Care protocols apply
1 set of plastic dentures (an upper and a lower) per beneficiary, Pre-authorisation required
Plastic dentures and once every 4 years
associated laboratory costs Laughing gas in dental
Pre-authorisation required rooms
Specialised dentistry Covered at the Bonitas Dental Tariff Limited to extensive dental treatment
1 partial frame (an upper or lower) per beneficiary, once every Managed Care protocols apply
rooms
Partial metal frame 5 years Pre-authorisation required
dentures and associated
laboratory costs
1 crown per family, per year ADDITIONAL BENEFITS
Crowns, bridges and Benefit for crowns will be granted once per tooth, every 5 years
associated laboratory costs A treatment plan and x-rays may be requested other benefits.
Orthodontic treatment is granted once per beneficiary, per Contraceptives
lifetime R1 580 per family
Pre-authorisation cases will be clinically assessed by using an For women aged up to 50 You must use the Designated Service Provider for
orthodontic needs analysis pharmacy-dispensed contraceptives
Benefit allocation is subject to the outcome of the needs analysis Maternity care
Tariff 12 antenatal consultations with a gynaecologist, GP or midwife
Orthodontics and associated Benefit for orthodontic treatment will be granted where function 2 2D ultrasound scans
laboratory costs is impaired (not granted for cosmetic reasons) R1 220 for antenatal classes
Only 1 family member may begin orthodontic treatment in a Per pregnancy 1 amniocentesis
calendar year
Benefit for fixed comprehensive treatment is limited to
beneficiaries from age 9 and younger than 18 years
Childcare
Congenital hypothyroidism International travel benefit
screening
Babyline 24/7 helpline for medical advice for children under 3 years R10 million per family
Per trip
2 consultations per child under 1 year (up to 90 days) Including cover for mandatory vaccines
2 consultations per child between ages 1 and 2 You must register for this benefit
According to Expanded Programme on Immunisation in South
Immunisations
Africa CHRONIC BENEFITS
Preventative care
Standard Select offers generous cover for the 45 chronic conditions listed below. Your chronic
1 HIV test per beneficiary medicine benefit is R9 610 per beneficiary and R19 280 per family on the applicable formulary. You
General health
STANDARD SELECT
1 flu vaccine per beneficiary must use Pharmacy Direct, our Designated Service Provider, to get your medicine. If you choose not
to use Pharmacy Direct or if you choose to use medicine that is not on the formulary, you will have
Cardiac health 1 full lipogram every 5 years, for members aged 20 and over to pay a 40% co-payment.
1 mammogram every 2 years, for women over 40 Once the amount above is finished, you will still be covered for the 27 Prescribed Minimum Benefits,
Women’s health
1 pap smear every 3 years, for women between ages 21 and 65 listed below.
Men’s health
69, who are considered to be at high risk for prostate cancer Prescribed Minimum Benefits covered
1 pneumococcal vaccine every 5 years, for members aged 1. Addison’s Disease 10. Crohn’s Disease 19. Hyperlipidaemia
65 and over
Elderly health 2. Asthma 11. Diabetes Insipidus 20. Hypertension
50 and 75 3. Bipolar Mood Disorder 12. Diabetes Type 1 21. Hypothyroidism
Wellness benefits 4. Bronchiectasis 13. Diabetes Type 2 22. Multiple Sclerosis
1 wellness screening per beneficiary at a participating pharmacy, 5. Cardiac Failure 14. Dysrhythmias 23. Parkinson’s Disease
biokineticist or a Bonitas wellness day 6. Cardiomyopathy 15. Epilepsy 24. Rheumatoid Arthritis
Wellness screening includes the following tests: 7. Chronic Obstructive 16. Glaucoma 25. Schizophrenia
Wellness screening • Blood pressure Pulmonary Disease
• Glucose
• Cholesterol Erythematosus
• Body mass index
• Waist-to-hip ratio 9. Coronary Artery Disease 18. HIV/AIDS 27. Ulcerative Colitis
treatment with: Additional conditions covered
• GP
• Biokineticist 28. Acne 34. Dermatitis 40. Narcolepsy
• Dietician 29. Allergic Rhinitis 35. Depression 41. Obsessive Compulsive
Wellness extender • Physiotherapist, or Disorder
30. Ankylosing Spondylitis 36. Eczema 42. Panic Disorder
access the wellness extender 31. Attention Deficit 37. Gastro-Oesophageal 43. Post-Traumatic Stress
Disorder Reflux Disease Disorder
(in children aged 5-18) (GORD)
32. Barrett’s Oesophagus 38. Generalised Anxiety 44. Tourette’s Syndrome
Disorder
33. Behcet’s Disease 39. Gout 45. Zollinger-Ellison
Syndrome
Service Provider
Back and neck
STANDARD SELECT
Mental wellness
(Medscheme)
education
pathways
This benefit offers cover for major medical events that result in a beneficiary being admitted into Cancer treatment You must use a preferred provider
members.
Unlimited
Pre-authorisation is required. Organ transplants
Please note: You must use a hospital on the Standard Select network or you will have to pay a
30% co-payment. Unlimited
Unlimited, network specialists covered in full at the Bonitas Rate co-payment will apply
treatment Unlimited, non-network specialists paid at 100% of the Bonitas Unlimited, if you register on the HIV/AIDS programme
Rate HIV/AIDS
Chronic medicine must be obtained from Pharmacy Direct
STANDARD SELECT

Blood and other laboratory
tests

R44 210 per family

Spinal surgery
Hip and knee replacements You must use the Designated Service Provider
R277 700 per family
Cochlear implants
R40 600 per family
Mental health
hospitalisation
R16 550 per family
Unlimited
PRIMARY This traditional option offers simple day-to-day benefits and hospital cover.
What you get
GP and
R day-to-day
benefits

Mental health and MRIs & CT
scans
1 Paediatric consultation
per child 0-1 years
HIV test & flu vaccine
covered
Unlimited
Optometry once every
two years
child aged 2 – 12 years Mammogram
Basic dentistry
Pap smear
Pharmacy Direct
R165 500
Newborn hearing screening Managed care cancer benefit per family
programmes Co-payments apply to 22
R1 580
for contraceptives
elective procedures

Product rules, limits, terms and x-rays at 100% of the Bonitas Rate
✓ Cancer
conditions apply.
+ ✓
R31 500
Wellness screening HIV/AIDS
R1 270
✓
✓
Diabetes
Back and neck pain

6 maternity
consultations
consultations and treatment Unlimited
2 x2D scans
1 amniocentesis
What you pay
R2 240 R1 752 R713
(such as physiotherapists, occupational therapists, Paid from available day-to-day benefits
Out-of-hospital claims will be paid from available day-to-day benefits. There is a separate benefit
If you do not use a GP on our network, your benefit for GP consultations will be limited to the benefit (and not from your day-to-day benefits, so you get more value for money):
non-network GP consultation benefit. This is shown in the table below.
Main member only R1 900 (R615 of this may be used for
non-network GP consultations) R9 560 per family
Main member + 1 dependant R3 490 (R1 160 of this may be used for
PRIMARY
Main member + 2 dependants R4 130 (R1 320 of this may be used for
non-network GP consultations) Cover for educational psychologists for beneficiaries up to the
age of 21 years
non-network GP consultations) R6 890 per family
Main member + 4 or more dependants R5 030 (R1 750 of this may be used for An additional R6 550 per family will apply should Stoma Care and
non-network GP consultations) CPAP machines exceed the general medical appliances limit
crutches)
Day-to-day benefits R4 480 per family, once every 2 years (based on the date of your
These benefits provide cover for consultations with your specialist, acute medicine, x-rays, blood Optometry previous claim)
tests and other out-of-hospital medical expenses. Each beneficiary can choose glasses or contact lenses
There is a separate benefit for tests and consultations for PMB treatment plans (excluding
GP consultations). Therefore this will not affect your day-to-day benefits. Eye tests OR
Main member only R2 3 1 0 100% towards the cost of lenses at network rates
Single vision lenses (Clear)
Main member + 1 dependant R4 140 or R175 per lens, per beneficiary, out of network
Main member + 2 dependants R4 860 100% towards the cost of lenses at network rates
Bifocal lenses (Clear)
Main member + 3 dependants R5 230 or R410 per lens, per beneficiary, out of network
Main member + 4 or more dependants R5 660 100% towards the cost of lenses at network rates
Paid from available day-to-day benefits R710 per lens, per beneficiary, out of network
You must get a referral from your GP R525 per beneficiary at a network provider
Frames
Blood tests and other laboratory tests Paid from available day-to-day benefits R350 per beneficiary at a non-network provider
X-rays and ultrasounds Paid from available day-to-day benefits Contact lenses R1 235 per beneficiary (included in the family limit)
Acute medicine Paid from available day-to-day benefits Covered at the Bonitas Dental Tariff
R490 per beneficiary Basic dentistry
You must use a provider on the DENIS network
Over-the-counter medicine R1 430 per family Consultations 2 annual check-ups per beneficiary (once every 6 months)
X-rays: Intra-oral Managed Care protocols apply ADDITIONAL BENEFITS
X-rays: Extra-oral 1 per beneficiary, every 3 years We believe in giving you more value. The following benefits are in addition to your day-to-day and
2 annual scale and polish treatments per beneficiary (once every other benefits.
6 months)
Oral hygiene Fissure sealants are only covered for children under 16 years Contraceptives
R1 580 per family
younger than 16 years For women aged up to 50 You must use the Designated Service Provider for
pharmacy-dispensed contraceptives
Maternity care
Fillings 6 antenatal consultations with a gynaecologist, GP or midwife
protocols
A treatment plan and x-rays may be required for multiple fillings
1 amniocentesis
PRIMARY
Managed Care protocols apply Per pregnancy
Root canal therapy and 4 consultations with a midwife after delivery
extractions Benefit for root canal includes all teeth except primary teeth and A Bonitas baby bag (you must register for this after obtaining
permanent molars pre-authorisation for the delivery)
1 set of plastic dentures (an upper and a lower) per beneficiary,
Plastic dentures and Childcare
once every 4 years
associated laboratory costs Hearing screening For newborns, in or out-of-hospital
Maxillo-facial surgery and oral pathology For infants under 1 month old
screening
1 consultation per child under 1 year
protocols apply Paediatric consultations
5 for extensive dental treatment GP consultations 1 consultation per child between ages 2 and 12
Hospitalisation
According to Expanded Programme on Immunisation in
(general anaesthetic) General anaesthetic benefit is available for the removal of Immunisations
South Africa
impacted teeth
Preventative care
Pre-authorisation required General health
Laughing gas in dental 1 flu vaccine per beneficiary
rooms 1 mammogram every 2 years, for women over 40
Women’s health
Limited to extensive dental treatment 1 pap smear every 3 years, for women between ages 21 and 65
Managed Care protocols apply 1 prostate screening antigen test for men between ages 45 and
rooms Men’s health
65 and over
Elderly health
50 and 75
1 wellness screening per beneficiary at a participating pharmacy, Primary ensures that you are covered for the 27 Prescribed Minimum Benefits listed below. You
biokineticist or a Bonitas wellness day must use Pharmacy Direct, our Designated Service Provider, to get your medicine. If you choose not
to use Pharmacy Direct or if you choose to use medicine that is not on the formulary, you will have
to pay a 40% co-payment.
• Glucose
• Cholesterol Prescribed Minimum Benefits covered
• Body mass index
• Waist-to-hip ratio 1. Addison’s Disease 10. Crohn’s Disease 19. Hyperlipidaemia
R1 270 per family which can be used for consultations and 2. Asthma 11. Diabetes Insipidus 20. Hypertension
treatment with: 3. Bipolar Mood Disorder 12. Diabetes Type 1 21. Hypothyroidism
• GP
• Biokineticist 4. Bronchiectasis 13. Diabetes Type 2 22. Multiple Sclerosis
PRIMARY
• Dietician 5. Cardiac Failure 14. Dysrhythmias 23. Parkinson’s Disease

Each adult beneficiary must complete a wellness screening to 7. Chronic Obstructive 16. Glaucoma 25. Schizophrenia
Pulmonary Disease
access the wellness extender
Child dependants can access the wellness extender once an adult 8. Chronic Renal Disease 17. Haemophilia 26. Systemic Lupus
beneficiary has completed a wellness screening Erythematosus
International travel benefit 9. Coronary Artery Disease 18. HIV/AIDS 27. Ulcerative Colitis

Service Provider
Back and neck
PRIMARY
the cover you need
(Medscheme)
education
IN-HOSPITAL BENEFITS A co-payment will apply to the following procedures in hospital:
This benefit offers cover for major medical events that result in a beneficiary being admitted into R1 450 co-payment R3 680 co-payment R7 250 co-payment
members. 1. Colonoscopy 1. Arthroscopy 1. Back Surgery including
Spinal Fusion
2. Conservative Back 2. Diagnostic Laparoscopy 2. Joint Replacements
Treatment
Unlimited, network specialists covered in full at the Bonitas Rate
Specialist consultations/ 3. Cystoscopy 3. Laparoscopic 3. Laparoscopic
treatment Unlimited, non-network specialists paid at 100% of the Bonitas Hysterectomy Pyeloplasty
Rate
4. Facet Joint Injections 4. Laparoscopic 4. Laparoscopic Radical
GP consultations/treatment Unlimited, covered at 100% of the Bonitas Rate Appendectomy Prostatectomy
Blood tests and other 5. Flexible Sigmoidoscopy 5. Percutaneous 5. Nissen Fundoplication
Unlimited, covered at 100% of the Bonitas Rate Radiofrequency (Reflux Surgery)
laboratory tests
PRIMARY
Ablations
X-rays and ultrasounds Unlimited, covered at 100% of the Bonitas Rate (Percutaneous Rhizotomies)
MRIs and CT scans R13 000 per family, in and out-of-hospital 6. Functional Nasal Surgery
(specialised radiology) Pre-authorisation required 7. Gastroscopy
Paramedical/Allied medical 8. Hysteroscopy
professionals (not Endometrial Ablation)
occupational therapists, in hospital 9. Myringotomy
10. Tonsillectomy and
R31 500 per family (excluding joint replacement prosthesis) Adenoidectomy
Internal prosthesis Managed Care protocols apply 11. Umbilical Hernia Repair
You must use a preferred supplier 12. Varicose Vein Surgery
R15 830 per family
Mental health
hospitalisation
R16 550 per family
Unlimited
R165 500 per family
Organ transplants PMB only
Unlimited
HIV/AIDS
PRIMARY SELECT This traditional option uses a quality provider network to offer simple
day-to-day benefits and hospital cover.

PRIMARY OPTION
Day-to-day
benefits and GP
R
nomination

Mental health and MRIs & CT 1 Paediatric consultation
per child 0-1 years
covered
Unlimited
scans HIV test & flu vaccine
1 GP consultation per at 100% of the Bonitas Rate
Optometry once every child aged 2 – 12 years
Mammogram to your doorstep through
two years Pharmacy Direct Hospital network applies
Pap smear
Basic dentistry Newborn hearing screening
Managed care R165 500
programmes cancer benefit per family
R1 580
for contraceptives
elective procedures
✓ Cancer Unlimited blood tests, scans &
conditions apply.
Wellness screening + ✓ HIV/AIDS
R1 270
✓
✓
Diabetes
Back and neck pain R31 500

6 maternity internal prosthesis per family
consultations
Unlimited
2 x2D scans terminal care benefit
1 amniocentesis
What you pay
R1 904 R 1 489 R606
Out-of-hospital claims will be paid from available day-to-day benefits. There is a separate benefit (such as physiotherapists, occupational therapists, Paid from available day-to-day benefits
for GP consultations. dieticians and biokineticists)
You must choose 1 GP on our network for each beneficiary. This is your nominated GP for the benefit (and not from your day-to-day benefits, so you get more value for money):
year. If you do not use your nominated GP, your benefit will be limited to the non-nominated GP
consultation benefit as indicated in the table below. MRIs and CT scans R13 000 per family, in and out-of-hospital
Main member only R1 900 (R615 of this may be used for
R9 560 per family
PRIMARY SELECT
Main member + 1 dependant R3 490 (R1 160 of this may be used for
age of 21 years
Main member + 3 dependants R4 440 (R1 480 of this may be used for R6 890 per family
non-nominated GP consultations) An additional R6 550 per family will apply should Stoma Care and
Main member + 4 or more dependants R5 030 (R1 750 of this may be used for CPAP machines exceed the general medical appliances limit
crutches)
non-nominated GP consultations) You must use a preferred supplier
Day-to-day benefits Optometry previous claim)
These benefits provide cover for consultations with your specialist, acute medicine, x-rays, blood Each beneficiary can choose glasses or contact lenses
tests and other out-of-hospital medical expenses.
There is a separate benefit for tests and consultations for PMB treatment plans (excluding GP
Eye tests OR
consultations). Therefore this will not affect your day-to-day benefits.
Main member only R2 3 1 0 Single vision lenses (Clear) 100% towards the cost of lenses at network rates
Main member + 1 dependant R4 140 or R175 per lens, per beneficiary, out of network
Main member + 2 dependants R4 860 Bifocal lenses (Clear) 100% towards the cost of lenses at network rates
Main member + 3 dependants R5 230 or R410 per lens, per beneficiary, out of network
Main member + 4 or more dependants R5 660 100% towards the cost of lenses at network rates
Specialist consultations R525 per beneficiary at a network provider
You must get a referral from your GP Frames
Blood tests and other laboratory tests Paid from available day-to-day benefits
Contact lenses R1 235 per beneficiary (included in the family limit)
X-rays and ultrasounds Paid from available day-to-day benefits
Acute medicine Paid from available day-to-day benefits Basic dentistry
You must use a provider on the DENIS network
R490 per beneficiary
Over-the-counter medicine R1 430 per family
X-rays: Extra-oral 1 per beneficiary, every 3 years
2 annual scale and polish treatments per beneficiary (once every ADDITIONAL BENEFITS
6 months)
Oral hygiene Fissure sealants are only covered for children under 16 years other benefits.
younger than 16 years Contraceptives
Benefit for fillings is granted once per tooth, in 365 days R1 580 per family
Benefit for re-treatment of a tooth is subject to Managed Care For women aged up to 50 You must use the Designated Service Provider for
Fillings pharmacy-dispensed contraceptives
protocols
A treatment plan and x-rays may be required for multiple fillings Maternity care
Managed Care protocols apply 6 antenatal consultations with a gynaecologist, GP or midwife
Root canal therapy and 2 2D ultrasound scans
Benefit for root canal includes all teeth except primary teeth and
PRIMARY SELECT
extractions
permanent molars 1 amniocentesis
Per pregnancy
1 set of plastic dentures (an upper and a lower) per beneficiary, 4 consultations with a midwife after delivery
Plastic dentures and once every 4 years A Bonitas baby bag (you must register for this after obtaining
associated laboratory costs pre-authorisation for the delivery)
Childcare
Maxillo-facial surgery and oral pathology
A co-payment of R3 500 per hospital admission and admission For infants under 1 month old
screening
protocols apply
5 for extensive dental treatment 1 consultation per child under 1 year
Hospitalisation Paediatric consultations
impacted teeth GP consultations 1 consultation per child between ages 2 and 12
Managed Care protocols apply According to Expanded Programme on Immunisation in
Immunisations
Pre-authorisation required South Africa
Laughing gas in dental Preventative care

rooms 1 HIV test per beneficiary
General health
Limited to extensive dental treatment 1 flu vaccine per beneficiary
Managed Care protocols apply 1 mammogram every 2 years, for women over 40
rooms Women’s health
Pre-authorisation required 1 pap smear every 3 years, for women between ages 21 and 65
Men’s health
65 and over
Elderly health
50 and 75
1 wellness screening per beneficiary at a participating pharmacy, Primary Select ensures that you are covered for the 27 Prescribed Minimum Benefits listed below
biokineticist or a Bonitas wellness day on the applicable formulary. You must use Pharmacy Direct, our Designated Service Provider, to get
Wellness screening includes the following tests: your medicine. If you choose not to use Pharmacy Direct or if you choose to use medicine that is not
• Blood pressure on the formulary, you will have to pay a 40% co-payment.
Wellness screening
• Glucose
• Cholesterol Prescribed Minimum Benefits covered
• Body mass index
• Waist-to-hip ratio 1. Addison’s Disease 10. Crohn’s Disease 19. Hyperlipidaemia
treatment with:
• GP 3. Bipolar Mood Disorder 12. Diabetes Type 1 21. Hypothyroidism
• Biokineticist
PRIMARY SELECT

• Dietician
• Physiotherapist, or 5. Cardiac Failure 14. Dysrhythmias 23. Parkinson’s Disease
Wellness extender
• A programme to stop smoking 6. Cardiomyopathy 15. Epilepsy 24. Rheumatoid Arthritis
Each adult beneficiary must complete a wellness screening to 7. Chronic Obstructive 16. Glaucoma 25. Schizophrenia
access the wellness extender Pulmonary Disease
beneficiary has completed a wellness screening Erythematosus
Service Provider
Back and neck
PRIMARY SELECT
the cover you need
(Medscheme)
education
IN-HOSPITAL BENEFITS Organ transplants PMB only
This benefit offers cover for major medical events that result in a beneficiary being admitted into Unlimited
hospital. We negotiate extensively with private hospitals to ensure the best possible value for our Kidney dialysis You must use a Designated Service Provider, or a
members. 20% co-payment will apply
Pre-authorisation is required. Unlimited, if you register on the HIV/AIDS programme
Please note: You must use a hospital on the Primary Select network or you will have to pay a HIV/AIDS
30% co-payment.
Unlimited, network specialists covered in full at the Bonitas Rate A co-payment will apply to the following procedures in hospital:
treatment Unlimited, non-network specialists paid at 100% of the Bonitas
Rate R1 450 co-payment R3 680 co-payment R7 250 co-payment
PRIMARY SELECT
GP consultations/treatment Unlimited, covered at 100% of the Bonitas Rate 1. Colonoscopy 1. Arthroscopy 1. Back Surgery including
Spinal Fusion
Unlimited, covered at 100% of the Bonitas Rate 2. Conservative Back 2. Diagnostic Laparoscopy 2. Joint Replacements
laboratory tests
Treatment
3. Cystoscopy 3. Laparoscopic 3. Laparoscopic
MRIs and CT scans R13 000 per family, in and out-of-hospital Hysterectomy Pyeloplasty
(specialised radiology) Pre-authorisation required 4. Facet Joint Injections 4. Laparoscopic 4. Laparoscopic Radical
Paramedical/Allied medical Appendectomy Prostatectomy
(such as physiotherapists, Your therapist must get a referral from the doctor treating you Radiofrequency (Reflux Surgery)
occupational therapists, in hospital Ablations
(Percutaneous Rhizotomies)
R31 500 per family (excluding joint replacement prosthesis)
Internal prosthesis Managed Care protocols apply
You must use a preferred supplier 7. Gastroscopy
R15 830 per family 8. Hysteroscopy
Mental health (not Endometrial Ablation)
hospitalisation
You must use a Designated Service Provider 9. Myringotomy
Take-home medicine R380 per beneficiary, per hospital stay 10. Tonsillectomy and
Adenoidectomy
11. Umbilical Hernia Repair
R16 550 per family 12. Varicose Vein Surgery
Unlimited
R165 500 per family
BONCAP This income based entry-level plan offers basic day-to-day benefits and hospital cover using a
network of doctors, providers and hospitals.
What you get
Basic day-to-day
R
benefits and GP
consultations with
network GP
Plus benefits for: Maternity care Preventative care: Unlimited

Newborn hearing screening 27 chronic conditions
covered
GP-referred acute HIV test & flu vaccine
medicine, x-rays and blood tests Chronic medicine delivered Hospital network applies
Mammogram
Optometry once every Pharmacy Direct Unlimited
two years
Pap smear terminal care benefit
Managed care
Basic dentistry Pneumococcal vaccine programmes
Specialist benefit if to help you manage a range of
referred by network GP Wellness screening Prostate screening conditions including:
Product rules, limits, terms and ✓ Cancer
R1 050
for contraceptives
conditions apply.
✓ HIV/AIDS
Main member Adult dependant Child dependant

If your monthly income is:
R0 to R8 030 R1 009 R956 R475
RR R1 226 R1 159 R563
R8 031 to R13 050
R13 051 to R17 830 R2 000 R1 780 R757
What you pay R17 831 + R2 456 R2 187 R931
OUT-OF-HOSPITAL BENEFITS 100% towards the cost of lenses at network rates
These benefits cover your day-to-day medical expenses at of 100% of the Bonitas Rate. R710 per lens, per beneficiary, out of network
R225 per beneficiary at a network provider

Unlimited consultations, using a maximum of 2 network GPs Frames
Network GP consultations Approval is required from the 8th GP consultation per
beneficiary Contact lenses R1 035 per beneficiary (included in the family limit)
1 out-of-network consultation per beneficiary You must use a provider on the DENIS network
Non-network GP
Maximum of 2 consultations per family, limited to R1 050 Basic dentistry Covered at the Bonitas Dental Tariff
consultations
20% co-payment applies Managed Care protocols apply
Main member only R1 840 Consultations 1 consultation per beneficiary, per year
GP-referred acute Main member + 1 dependant R3 060 1 specific (emergency) consultation for pain and sepsis
Emergency consultation
medicine, x-rays and blood Main member + 2 dependants R3 660 per beneficiary
tests Main member + 3 dependants R4 000 X-rays: Intra-oral 4 x-rays per beneficiary
Main member + 4 or more dependants R4 440 1 per beneficiary, in a lifetime
X-rays: Extra-oral
Limited to 3 visits or R3 110 per beneficiary X-rays must be submitted to DENIS for review
(this benefit includes prescribed Limited to 5 visits or R4 620 per family 1 polish
acute medicine, blood tests, Subject to referral from a network GP Scaling and polishing OR
x-rays, MRIs and CT scans)
Pre-authorisation required for MRIs and CT scans 1 scaling and polishing per beneficiary
BONCAP
Antenatal consultations are subject to the GP consultations Fluoride treatments 1 treatment for beneficiaries under 16 years
Maternity care and specialist consultations benefits 1 per tooth, once every 3 years for beneficiaries under
Fissure sealants
4 consultations with a midwife after delivery 16 years
Limited to R95 per event Infection control,
Over-the-counter medicine instrument sterilisation and 1 set per beneficiary, per visit
Maximum of R265 per beneficiary, per year local anaesthetic
Paramedical/Allied medical Laughing gas in dental Inhalation sedation limited to extensive dental treatment
professionals rooms only
(such as physiotherapists, PMB only
occupational therapists, Emergency root canal For emergency treatment only
dieticians and biokineticists) therapy Subject to DENIS treatment protocols
General medical appliances R5 440 per family Pulp treatments For amputation of pulp of primary teeth
crutches) You must use a preferred supplier Subject to DENIS treatment protocols
Extractions
You must use the contracted service provider (removal of teeth) Extractions and treatment of septic sockets
Optometry
Managed Care protocols apply 4 fillings per beneficiary
1 per beneficiary, at a network provider, at network rates Benefit for fillings is granted once per tooth, in 365 days
Dental fillings
Eye tests OR Benefit for retreatment of a tooth is subject to Managed Care
protocols
Single vision lenses (Clear) 100% towards the cost of lenses at network rates
1 set of plastic dentures (an upper and a lower) per family, ADDITIONAL BENEFITS
once every 2 years for beneficiaries 21 years and over
We believe in giving you more value. These additional benefits will not affect your other benefit
20% co-payment applies limits.
Plastic dentures
A further 20% co-payment will apply if authorisation is Contraceptives
applied for after the treatment has been done R1 050 per family
PMB only For women aged up to 50 You must use the Designated Service Provider for
pharmacy-dispensed contraceptives
Please note: No benefit for Osseo-integrated implants and
Maxillo-facial surgery in Orthognathic surgery Childcare
dental chair Access to a maxillo-facial specialist by DENIS Hearing screening For newborns, in or out-of-hospital
pre-authorisation only Congenital hypothyroidism
Pre-authorisation from DENIS required screening
IV conscious sedation in the Limited to extensive dental treatment
rooms Preventative care
Pre-authorisation from DENIS required
Hospitalisation PMB only General health
(general anaesthetic) Pre-authorisation from DENIS required
Women’s health
Men’s health
BONCAP
65 and over
Elderly health
50 and 75
Wellness benefits
• Glucose
• Cholesterol
• Body mass index
CHRONIC BENEFITS MANAGED CARE PROGRAMMES
BonCap ensures that you are covered for the 27 Prescribed Minimum Benefits listed below. You We offer a range of managed care programmes to support you and help put you on the path to
must use Pharmacy Direct, our Designated Service Provider, to get your medicine. If you choose not good health. These programmes empower you to manage your condition effectively in the most
to use Pharmacy Direct or if you choose to use medicine that is not on the formulary, you will have clinically-proven way, ensuring your benefits last longer.
You will need to register to join these programmes.

Puts you first, offering emotional and medical support
1. Addison’s Disease 10. Crohn’s Disease 19. Hyperlipidaemia Delivers cost-effective care of the highest quality
2. Asthma 11. Diabetes Insipidus 20. Hypertension Liaises with your doctor to ensure your treatment plan is
3. Bipolar Mood Disorder 12. Diabetes Type 1 21. Hypothyroidism Cancer clinically appropriate to meet your needs
the cover you need
7. Chronic Obstructive 16. Glaucoma 25. Schizophrenia
Pulmonary Disease Provides you with appropriate treatment and tools to live a
normal life
Erythematosus Covers medicine to treat HIV (including drugs to prevent
mother-to-child transmission and infection after sexual assault
or needle-stick injury) through Pharmacy Direct, our Designated
Service Provider
BONCAP
Treatment and prevention of opportunistic infections such as

HIV/AIDS Covers regular blood tests to monitor disease progression,
(Aid for AIDS) response to therapy and to detect possible side-effects of
treatment
Offers HIV-related consultations to visit your doctor to monitor
your clinical status
Gives ongoing patient support via a team of trained and
experienced counsellors
Offers access to telephonic support from doctors
Helps in finding a registered counsellor for emotional support
IN-HOSPITAL BENEFITS Alternatives to hospital R14 280 per family
Hospitalisation is covered at 100% of the Bonitas Rate at all hospitals on the BonCap Network. You (hospice, step-down facilities) Pre-authorisation required
must get pre-authorisation for your hospital admission. You will have to pay a R6 700 co-payment if Unlimited
you use a non-network hospital (except for emergencies) or you do not get pre-authorisation within
Terminal care Including hospice/private nursing, home oxygen, pain
48 hours of admission.
management, psychologist and social worker support
GP consultations Unlimited, covered at 100% of the Bonitas Rate PMB only

Cancer treatment
Specialist consultations Unlimited, covered at 100% of the Bonitas Rate Subject to using the Designated Service Provider
Blood tests and other Unlimited

R25 440 per family Organ transplants
laboratory tests Pre-authorisation required
Blood transfusions R18 480 per family Unlimited
X-rays and ultrasounds Unlimited, covered at 100% of the Bonitas Rate You must use a Designated Service Provider, or a
Kidney dialysis
R11 610 per family 20% co-payment will apply
MRIs and CT scans
(specialised radiology) Pre-authorisation required Pre-authorisation required
Paramedical/Allied medical Unlimited, if you register on the HIV/AIDS programme

R4 340 per family HIV/AIDS
professionals Chronic medicine must be obtained from Pharmacy Direct
(such as physiotherapists, Your therapist must have a referral from the doctor treating you
occupational therapists)
Back and neck surgery
Joint replacement surgery
BONCAP
Caesarean sections done for non-medical reasons
Functional nasal and sinus surgery
Surgical procedures that are Varicose vein surgery

not covered Hernia repair surgery
Laparoscopic or keyhole surgery
Gastroscopies, colonoscopies and all other endoscopies
Bunion surgery
In-hospital dental surgery
PMB only

prostheses Pre-authorisation required
PMB only
Mental health
hospitalisation
Subject to using the Designated Service Provider
Neonatal care Limited to R45 380 per family, except for PMBs
R49 610 per family
Physical rehabilitation
HOSPITAL STANDARD This hospital plan offers extensive hospital benefits with some value-added benefits.
What you get
R1 580
for contraceptives
R26 100
MRI & CT scans benefit per
family in and out of hospital
R1 270 27 chronic conditions
covered consultations & treatment
Basic dentistry
hospitalisation
wellness extender for extra Chronic medicine delivered
6 maternity
consultations
consultations and treatment to your doorstep through
Pharmacy Direct
R344 500 R32 210
2 x2D scans Mental health
cancer benefit per family hospitalisation per family
1 amniocentesis
Managed care Co-payments apply to 22
Unlimited
programmes elective procedures
Preventative care: to help you manage a range of
HIV test & flu vaccine ✓ Cancer
per child 0-1 years Mammogram ✓ HIV/AIDS
R44 210
✓ Diabetes internal prosthesis per family
Pap smear

Prostate screening
conditions apply.
What you pay
R2 040 R1 720 R776
ADDITIONAL BENEFITS R1 270 per family which can be used for consultations and
treatment with:
• GP
limits.
• Biokineticist
• Dietician
Contraceptives
R1 580 per family • A programme to stop smoking
For women aged up to 50 You must use the Designated Service Provider for Each adult beneficiary must complete a wellness screening to
pharmacy-dispensed contraceptives access the wellness extender
Maternity care Child dependants can access the wellness extender once an adult
1 amniocentesis
Per pregnancy
4 consultations with a midwife after delivery Per trip R10 million per family
A Bonitas baby bag (you must register for this after obtaining (up to 90 days) Including cover for mandatory vaccines
Childcare
CHRONIC BENEFITS
screening Hospital Standard ensures that you are covered for the 27 Prescribed Minimum Benefits listed
Babyline 24/7 helpline for medical advice for children under 3 years below on the applicable formulary. You must use Pharmacy Direct, our Designated Service Provider,
to get your medicine. If you choose not to use Pharmacy Direct or if you choose to use medicine
2 consultations per child under 1 year that is not on the formulary, you will have to pay a 40% co-payment.
GP consultations 1 consultation per child between ages 2 and 12
Preventative care 1. Addison’s Disease 10. Crohn’s Disease 19. Hyperlipidaemia
1 HIV test per beneficiary 2. Asthma 11. Diabetes Insipidus 20. Hypertension
General health
1 flu vaccine per beneficiary 3. Bipolar Mood Disorder 12. Diabetes Type 1 21. Hypothyroidism
HOSPITAL STANDARD
1 mammogram every 2 years, for women over 40 4. Bronchiectasis 13. Diabetes Type 2 22. Multiple Sclerosis
Women’s health
1 pap smear every 3 years, for women between ages 21 and 65 5. Cardiac Failure 14. Dysrhythmias 23. Parkinson’s Disease
1 prostate screening antigen test for men between ages 45 and 6. Cardiomyopathy 15. Epilepsy 24. Rheumatoid Arthritis
Men’s health
7. Chronic Obstructive 16. Glaucoma 25. Schizophrenia
1 pneumococcal vaccine every 5 years, for members aged Pulmonary Disease
65 and over
Elderly health 8. Chronic Renal Disease 17. Haemophilia 26. Systemic Lupus
1 stool test for colon cancer, for members between ages Erythematosus
50 and 75
Wellness benefits
• Glucose
• Cholesterol
• Body mass index
Service Provider
Back and neck
the cover you need
HOSPITAL STANDARD

(Medscheme)
education
This benefit offers cover for major medical events that result in a beneficiary being admitted into Terminal care Including hospice/private nursing, home oxygen,
hospital. We negotiate extensively with private hospitals to ensure the best possible value for our pain management, psychologist and social worker support
members.
R344 500 per family
Unlimited, network specialists covered in full at the Bonitas Rate Sublimit of R44 220 per beneficiary for Brachytherapy
Specialist consultations/ Unlimited
Organ transplants
Rate Sublimit of R31 500 per beneficiary for corneal grafts
GP consultations/treatment Unlimited, covered at 100% of the Bonitas Rate Unlimited
Blood tests and other Kidney dialysis You must use a Designated Service Provider, or a
laboratory tests 20% co-payment will apply
X-rays and ultrasounds Unlimited, covered at 100% of the Bonitas Rate Unlimited, if you register on the HIV/AIDS programme
HIV/AIDS
MRIs and CT scans R26 100 per family, in and out-of-hospital Chronic medicine must be obtained from Pharmacy Direct
Paramedical/Allied medical A co-payment will apply to the following procedures in hospital:
(such as physiotherapists, Your therapist must get a referral from the doctor treating you R1 450 co-payment R3 680 co-payment R7 250 co-payment
occupational therapists, in hospital 1. Colonoscopy 1. Arthroscopy 1. Back Surgery including
Spinal Fusion
R44 210 per family (excluding joint replacement prosthesis) 2. Conservative Back 2. Diagnostic Laparoscopy 2. Laparoscopic
Internal prosthesis Managed Care protocols apply Treatment Pyeloplasty
You must use a preferred supplier 3. Cystoscopy 3. Laparoscopic 3. Laparoscopic Radical

Hysterectomy Prostatectomy
PMB only
External prosthesis 4. Facet Joint Injections 4. Laparoscopic 4. Nissen Fundoplication
Managed Care protocols apply Appendectomy (Reflux Surgery)
General anaesthetic is only available to children under the age of 5. Flexible Sigmoidoscopy 5. Percutaneous
5 years for extensive dental treatment Radiofrequency
HOSPITAL STANDARD
Ablations
Hospitalisation for General anaesthetic benefits are available for the removal of (Percutaneous Rhizotomies)
basic dentistry impacted teeth
(general anaesthetic) 6. Functional Nasal Surgery
R3 500 co-payment for hospital admissions
7. Gastroscopy
8. Hysteroscopy
IV conscious sedation Managed Care protocols apply (not Endometrial Ablation)
in rooms Pre-authorisation required 9. Myringotomy
R32 210 per family 10. Tonsillectomy and
Mental health Adenoidectomy
Physiotherapy will be excluded for all mental health admissions
hospitalisation 11. Umbilical Hernia Repair
12. Varicose Vein Surgery
R16 550 per family
BONESSENTIAL This hospital plan offers comprehensive hospital benefits with some value-added benefits.
What you get
R1 260
for contraceptives
R32 210
Mental health
hospitalisation per family
+ Unlimited
Wellness screening
R910 27 chronic conditions

Unlimited
wellness extender for extra Chronic medicine delivered

consultations and treatment to your doorstep through
6 maternity
consultations
Pharmacy Direct
R344 500
cancer benefit per family
2 x2D scans
Managed care Co-payments apply to 22
1 amniocentesis
programmes elective procedures
conditions including: Unlimited blood tests, scans &
Mammogram ✓ HIV/AIDS
R31 500
Pap smear
✓ Diabetes
Back and neck pain

✓
Newborn hearing screening Pneumococcal vaccine
R15 750
Prostate screening MRI & CT scans benefit per
Product rules, limits, terms and family
conditions apply.
What you pay
R1 731 R1 324 R507
ADDITIONAL BENEFITS R910 per family which can be used for consultations and
treatment with:
• GP
limits.
• Biokineticist
• Dietician
Contraceptives • Physiotherapist, or
Wellness extender
Maternity care
1 amniocentesis
Per pregnancy R10 million per family
4 consultations with a midwife after delivery Per trip
pre-authorisation for the delivery) You must register for this benefit
Childcare
CHRONIC BENEFITS
screening
BonEssential ensures that you are covered for the 27 Prescribed Minimum Benefits listed below. You
Babyline 24/7 helpline for medical advice for children under 3 years must use Pharmacy Direct, our Designated Service Provider, to get your medicine. If you choose not
GP consultations 1 consultation per child between ages 2 and 12 to use Pharmacy Direct or if you choose to use medicine that is not on the formulary, you will have
Preventative care
1 HIV test per beneficiary Prescribed Minimum Benefits covered
General health
Women’s health 2. Asthma 11. Diabetes Insipidus 20. Hypertension
3. Bipolar Mood Disorder 12. Diabetes Type 1 21. Hypothyroidism
BONESSENTIAL
Men’s health 4. Bronchiectasis 13. Diabetes Type 2 22. Multiple Sclerosis
1 pneumococcal vaccine every 5 years, for members aged 5. Cardiac Failure 14. Dysrhythmias 23. Parkinson’s Disease
65 and over 6. Cardiomyopathy 15. Epilepsy 24. Rheumatoid Arthritis
Elderly health
1 stool test for colon cancer, for members between ages 7. Chronic Obstructive 16. Glaucoma 25. Schizophrenia
50 and 75 Pulmonary Disease
Wellness benefits 8. Chronic Renal Disease 17. Haemophilia 26. Systemic Lupus
Erythematosus
biokineticist or a Bonitas wellness day 9. Coronary Artery Disease 18. HIV/AIDS 27. Ulcerative Colitis
• Glucose
• Cholesterol
• Body mass index
Service Provider
Back and neck
the cover you need
BONESSENTIAL
(Medscheme)
education
IN-HOSPITAL BENEFITS Kidney dialysis
You must use a Designated Service Provider, or a
This benefit offers cover for major medical events that result in a beneficiary being admitted into
hospital. We negotiate extensively with private hospitals to ensure the best possible value for our Unlimited, if you register on the HIV/AIDS programme
members. HIV/AIDS
Spinal Fusion
laboratory tests
Treatment
MRIs and CT scans R15 750 per family Hysterectomy Pyeloplasty
(specialised radiology) Pre-authorisation required 4. Facet Joint Injections 4. Laparoscopic 4. Laparoscopic Radical
Paramedical/Allied medical Appendectomy Prostatectomy
(such as physiotherapists, Your therapist must get a referral from the doctor treating you Radiofrequency (Reflux Surgery)
occupational therapists, in hospital Ablations
dieticians and biokineticists) (Percutaneous Rhizotomies)
R31 500 per family (excluding joint replacement prosthesis) 6. Functional Nasal Surgery
Internal prosthesis Managed Care protocols apply
You must use a preferred supplier 7. Gastroscopy
PMB only 8. Hysteroscopy
(not Endometrial Ablation)
External prosthesis Managed Care protocols apply
9. Myringotomy
R32 210 per family Adenoidectomy
Mental health
BONESSENTIAL
Physiotherapy will be excluded for all mental health admissions 11. Umbilical Hernia Repair
hospitalisation
You must use a Designated Service Provider 12. Varicose Vein Surgery
R16 550 per family
Unlimited
R344 500 per family
Organ transplants
Unlimited
(excluding corneal grafts)
BONESSENTIAL SELECT This hospital plan uses a quality provider network to offer comprehensive hospital
benefits with some value-added benefits.

BONESSENTIAL OPTION
R1 260
for contraceptives
R15 750
MRI & CT scans benefit per
family

R910 27 chronic conditions
at 100% of the Bonitas Rate R32 210
wellness extender for extra Chronic medicine delivered Mental health
consultations and treatment to your doorstep through hospitalisation per family
6 maternity
consultations
Pharmacy Direct Hospital network applies
Unlimited
2 x2D scans
1 amniocentesis
Managed care R344 500 terminal care benefit
programmes cancer benefit per family

elective procedures
Mammogram ✓ HIV/AIDS Unlimited blood tests, scans &
Pap smear
✓ Diabetes

Pneumococcal vaccine R31 500
Prostate screening internal prosthesis per family

conditions apply.
What you pay
R1 477 R1 130 R433
ADDITIONAL BENEFITS R910 per family which can be used for consultations and
treatment with:
• GP
limits.
• Biokineticist
• Dietician
Contraceptives • Physiotherapist, or
Wellness extender
Maternity care
1 amniocentesis
Per pregnancy R10 million per family
4 consultations with a midwife after delivery Per trip
pre-authorisation for the delivery) You must register for this benefit
Childcare
CHRONIC BENEFITS
screening
BonEssential Select ensures that you are covered for the 27 Prescribed Minimum Benefits listed
Babyline 24/7 helpline for medical advice for children under 3 years below. You must use Pharmacy Direct, our Designated Service Provider, to get your medicine. If you
GP consultations 1 consultation per child between ages 2 and 12 choose not to use Pharmacy Direct or if you choose to use medicine that is not on the formulary,
you will have to pay a 40% co-payment.
Preventative care
1 HIV test per beneficiary Prescribed Minimum Benefits covered
General health
Women’s health 2. Asthma 11. Diabetes Insipidus 20. Hypertension
BONESSENTIAL SELECT
3. Bipolar Mood Disorder 12. Diabetes Type 1 21. Hypothyroidism
Men’s health 4. Bronchiectasis 13. Diabetes Type 2 22. Multiple Sclerosis
1 pneumococcal vaccine every 5 years, for members aged 5. Cardiac Failure 14. Dysrhythmias 23. Parkinson’s Disease
65 and over 6. Cardiomyopathy 15. Epilepsy 24. Rheumatoid Arthritis
Elderly health
1 stool test for colon cancer, for members between ages 7. Chronic Obstructive 16. Glaucoma 25. Schizophrenia
50 and 75 Pulmonary Disease
Wellness benefits 8. Chronic Renal Disease 17. Haemophilia 26. Systemic Lupus
Erythematosus
biokineticist or a Bonitas wellness day 9. Coronary Artery Disease 18. HIV/AIDS 27. Ulcerative Colitis
• Glucose
• Cholesterol
• Body mass index
Service Provider
Back and neck
the cover you need
BONESSENTIAL SELECT

(Medscheme)
education
IN-HOSPITAL BENEFITS Organ transplants
Unlimited
This benefit offers cover for major medical events that result in a beneficiary being admitted into (excluding corneal grafts)
You must use a Designated Service Provider, or a
members. Kidney dialysis
Pre-authorisation is required. Unlimited, if you register on the HIV/AIDS programme
Please note: You must use a hospital on the BonEssential Select network or you will have to pay a HIV/AIDS
30% co-payment.
Spinal Fusion
laboratory tests
Treatment
R31 500 per family (excluding joint replacement prosthesis) Hysterectomy Pyeloplasty
Internal prosthesis Managed Care protocols apply 4. Facet Joint Injections 4. Laparoscopic 4. Laparoscopic Radical
You must use a preferred supplier Appendectomy Prostatectomy
PMB only
Radiofrequency (Reflux Surgery)
External prosthesis Managed Care protocols apply Ablations
(Percutaneous Rhizotomies)
MRIs and CT scans R15 750 per family
7. Gastroscopy
professionals Unlimited, covered at 100% of the Bonitas Rate 8. Hysteroscopy
(such as physiotherapists, (not Endometrial Ablation)
Your therapist must get a referral from the doctor treating you
BONESSENTIAL SELECT
in hospital 9. Myringotomy
R32 210 per family Adenoidectomy
Mental health
Physiotherapy will be excluded for all mental health admissions 11. Umbilical Hernia Repair
hospitalisation
You must use a Designated Service Provider 12. Varicose Vein Surgery
R16 550 per family
Unlimited
R344 500 per family
WHAT YOU NEED TO KNOW
PREFERRED PROVIDERS AND DESIGNATED SERVICE PROVIDERS UNDERWRITING
We negotiate rates with preferred providers and Designated Service Providers to ensure Late-joiner penalties and waiting periods may apply to your membership. This is a requirement
that they do not charge you more than the agreed rate. This will ensure that your benefits of the Medical Schemes Act 131 of 1998.
last as long as possible and give you more value for money.
A late-joiner penalty applies to members 35 years of age or older, who have had a break in
Please note: Where you are required to use a Designated Service Provider and you do not do medical aid membership for more than 3 months from 1 April 2001. Late-joiner penalties will
so, a significant co-payment will apply. 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.
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. 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 (PMB) in some
circumstances.
UNDERSTANDING THE BONITAS RATE A condition-specific waiting period lasts 12 months. During this period you and your dependants
The Bonitas Rate is the rate at which we reimburse healthcare providers. are not entitled to claim benefits related to a specific condition.
Where we pay 100% of the Bonitas Rate and your healthcare provider charges more than Please refer to Annexure D of the Fund Rules for more information. Visit www.bonitas.co.za for
this, you will have to pay the outstanding amount. For example, if you visit a healthcare the latest version.
provider who 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 who charges the Bonitas Rate, we will pay the bill in full PROVIDERS ON THE NETWORK WILL BE PAID IN FULL
(provided that you have benefits available).
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).
On some options we pay more than 100% of the Bonitas Rate.
DEPENDANTS
An adult dependant is any dependant on your medical aid who is 21 years or older. PRORATION OF BENEFITS
If you join Bonitas during the year, benefits will automatically be prorated. This means that you
A child dependant is any dependant on your medical aid who is under 21 years. 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 July, you will have access to six months’
If your child is a student and is registered on your medical aid, child rates will apply up to and worth of benefits, which is 50% of the total benefits.
including the last day of the month in which he/she turns 24 years old. We will require valid
IMPORTANT INFORMATION
proof of registration from a recognised tertiary institution for child rates to apply to a
student.
PLEASE NOTE:
Some exclusions may apply. These exclusions are included in the Fund Rules which are
available at www.bonitas.co.za.
FIND A SERVICE PROVIDER
We’ve partnered with several reputable service providers to ensure that our members receive excellent service and more value for money.
Emergency assistance Chronic medicine Optical benefits Dental benefits
Call: 084 124 Call: 0860 027 800 Call: 0861 103 529 Call: 0860 336 346
Email: queriescqc@er24.co.za Fax: 0866 114 000 www.ppn.co.za Fax: 0866 770 336
Email: claims@er24.co.za Email: care@pharmacydirect.co.za Email: bonitas@denis.co.za
www.er24.co.za www.pharmacydirect.co.za www.denis.co.za
HIV/AIDS programme Diabetes programme Back and neck programme Hip and knee programme
Please call me: 083 410 9078 Call: 0860 002 108 Call: 0860 105 104 Call: 0861 112 666
Call: 0860 100 646 Email: diabeticcare@bonitas.co.za Email: admin@icpservices.co.za
Fax: 0800 600 773
Email: afa@afadm.co.za
www.aidforaids.co.za
Babyline Cancer programme
FIND A SERVICE PROVIDER

Call: 0860 999 121 Call: 0860 100 572
Email: oncology@bonitas.co.za
0860 002 108
www.bonitas.co.za
Bonitas Medical Fund
@BonitasMedical
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 Fund
Rules, the Fund Rules will prevail. The Fund Rules are available on request. Benefits are subject to approval from the Council for Medical Schemes
CMS01-V1-01AUG2018

2019 Full-Bonitas Brochure

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2019 Full-Bonitas Brochure

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PRODUCT

Preventative care and wellness benefits in

How to choose the right plan page 3 INCOME BASED OPTION

Our plans page 4 BonCap page 60

How our plans work page 5 HOSPITAL OPTIONS

Overview of our plans page 7 Hospital Standard page 65

Standard Select page 42

Primary Select page 54

Some plans require you to use a specific GP

You can also speak to a broker or financial advisor

BONCLASSIC STANDARD SELECT BONESSENTIAL

BONCOMPLETE PRIMARY BONESSENTIAL SELECT

BONSAVE PRIMARY SELECT

OUT-OF-HOSPITAL ADDITIONAL OUT-OF-HOSPITAL ADDITIONAL

MANAGED CARE MANAGED CARE

IN-HOSPITAL CHRONIC IN-HOSPITAL CHRONIC

FROM R2 027 FROM R1 904

FROM R1 009 FROM R1 477

OVERVIEW OF OUR PLANS

What you get

Plus benefits for:

R1 580 2 GP consultations per

GP consultations Paid from available savings or above threshold benefit

34. Barrett’s Oesophagus 45. Huntington’s Disease 56. Pulmonary Interstitial

R277 700 per family

What you get

Plus benefits for: R1 220 Preventative care:

R1 580 R277 700

R1 110 per beneficiary at a network provider

2. Asthma 11. Diabetes Insipidus 20. Hypertension

Child dependants can access the wellness extender once an adult

31. Barrett's Oesophagus 38. Obsessive Compulsive 45. Scleroderma

X-rays and ultrasounds Unlimited, covered at 100% of the Bonitas Rate

MRIs and CT scans R28 990 per family, in and out-of-hospital

Internal and external Managed Care protocols apply

What you get

Plus benefits for: Preventative care:

✓ Back and neck pain Unlimited

2 x2D scans R1 750

Savings R 6 432 R5 148 R1 752 Contact lenses R1 820 per beneficiary

• Dietician 3. Bipolar Mood Disorder 12. Diabetes Type 1 21. Hypothyroidism

29. Allergic Rhinitis

Unlimited, covered at 100% of the Bonitas Rate

MRIs and CT scans R23 330 per family, in and out-of-hospital

Internal and external Managed Care protocols apply

What you get

Newborn hearing screening

Unlimited blood tests, scans &

2 x2D scans R1 270

You must use a preferred supplier 10. Tonsillectomy and

What you get

Plus benefits for:

Cancer Unlimited blood tests, scans &

Wellness benefits 5. Cardiac Failure 14. Dysrhythmias 23. Parkinson’s Disease

Per trip R10 million per family

Blood tests and other Hysterectomy Pyeloplasty

R15 750 per family 5. Flexible Sigmoidoscopy 5. Percutaneous 5. Nissen Fundoplication

R32 210 per family 10. Tonsillectomy and

What you get

Plus benefits for:

Basic & specialised

Newborn hearing screening

2 x2D scans Unlimited

MRIs and CT scans R26 100 per family, in and out-of-hospital