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Unlimited consultations above threshold, major medical
expenses at 300% of the Bonitas rate, basic and advanced
dentistry - all covered by our BonComprehensive option. So in
these tough times, isn't it a treat to know there's a solution that
puts your mind at ease |
| This benefit covers medical expenses incurred in hospital, as well as major medical events e.g. oncology. All hospital admissions, oncology treatment plans and renal dialysis require pre-authorisation by Hospital Benefit Management (HBM) except in the case of emergencies. |
| Overall Annual Limit - Unlimited |
| Benefits payable at 300% of the Bonitas rate |
| Sub-limits applicable: |
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| GP & Specialist Consultants |
Unlimited, 300% Bonitas rate |
| Pathology |
Unlimited |
| Radiology (Specialised & General) |
Unlimited |
Paramedic/Auxiliary Services
e.g. physiotherapy, speech therapy, occupational therapy |
Unlimited |
Oncology
Biological Drugs |
Unlimited, sub-limit of R450 000 per medicine
R150 000 per family,
subject to clinical protocols amd 10% co-payment |
| Organ Transplants |
Unlimited |
| Renal Dialysis |
Unlimited |
| Maxillo Facial Surgery |
Unlimited, excluding orthognatic surgery |
| Medication to take out (TTO) |
R350 per beneficiary, per admission |
| Physical Rehabilitation |
R30 000 per family |
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| Covers medication for conditions that require medication on an ongoing basis. |
Unlimited cover for 64 diseases, subject to pre-authorisation
Biological drugs:
R120 000 per family, subject to clinical protocols and
10% co-payment |
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| BonComprehensive Chronic Disease List |
- Addison’s Disease
- Asthma
- Bipolar Mood Disorder
- Bronchiectasis
- Cardiac Failure
- Cardiomyopathy
- Chronic Renal Disease
- Chronic Obstructive Pulmonary Disease
- Coronary Artery Disease
- Crohn’s Disease
- Diabetes Insipidus
- Diabetes Mellitus Type1
- Diabetes Mellitus Type2
- Dysrhythmias
- Epilepsy
- Glaucoma
- Haemophilia
- Hyperlipidaemia
- Hypertension
- Hypothyroidism
- Multiple Sclerosis
- Parkinson’s Disease
- Rheumatoid Arthritis
- Schizophrenia
- Systemic Lupus Erythematosus
- Ulcerative Colitis
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27 Acne
28 Allergic Rhinitis
29 Ankylosing Spondylitis
30 Anorexia Nervosa*
31 Attention Deficit Disorder
32 Behcet’s Disease
33 Barrett’s Oesophagus
34 Bulimia Nervosa*
35 Cushing’s Disease*
36 Depression*
37 Dermatitis
38 Eczema
39 Generalized Anxiety Disorder
40 Gastro-Oesophageal Reflux (GORD)
41 Gout
42 Huntington’s Disease
43 Hyperthyroidism*
44 Hypoparathyroidism
45 Menopause*
46 Myaesthenia Gravis
47 Narcolepsy
48 Neuropathies
49 Obsessive Compulsive Disorder
50 Osteoporosis |
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51 Paget’s Disease
52 Panic Disorder
53 Paraplegia*
54 Pemphigus
55 Polyarteritis Nordosa
56 Post-Traumatic Stress Syndrome
57 Pulmonary Interstitial Fibrosis
58 Quadriplegia*
59 Stroke*
60 Systemic Sclerosis
61 Tourette’s Syndrome
62 Thrombocytopaenic Purpura*
63 Valvular Heart Disease*
64 Zollinger-Ellison Syndrome |
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| Covers day to day medical expenses e.g. GP & specialist consultations, acute medication, paramedical/auxiliary services, optometry, radiology, pathology etc. |
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Savings Benefit
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Per Month
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Per Annum
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| Principal Member |
R 422 |
R5 064 |
| Adult Dependant |
R 398 |
R4 776 |
| Child Dependant |
R 86 |
R1 032 |
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Threshold Benefit
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Threshold
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Self-Funding Gap
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| Principal Member |
R6 500 |
R1 436 |
| Adult Dependant |
R6 000 |
R1 224 |
| Child Dependant |
R1 700 |
R 668 |
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Acute Medication& Pharmacy Advised
Therapy |
Subject to savings and / or threshold
The following limits apply: |
| Member |
R 8 000 |
| Member + 1 |
R 9 500 |
| Member + 2 |
R12 000 |
| Member + 3 + |
R13 000 |
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| (90% of the Bonitas rate accrues to threshold; 10% co-payment in threshold) |
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| GP and Specialists Consultations |
Subject to savings and/or threshold, unlimited in threshold |
| General Radiology |
Subject to savings and/or threshold, unlimited in threshold |
| Pathology |
Subject to savings and/or threshold, unlimited in threshold |
| Paramedical Services/ Auxiliary Services e.g. speech therapy, occupational therapy, physiotherapy |
Subject to savings and/or threshold, limited to R5 500 per family |
| Optometry |
Subject to savings and/or threshold, limited to R2 250 per beneficiary |
| In addition: Dental Benefits |
| Basic Dentistry |
Subject to clinical protocols & Bonitas Dental Tariff (BDT)3 |
| Advanced Dentistry |
Subject to clinical protocols & Bonitas Dental Tariff (BDT)3 |
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| Additional benefits, medical expenses incurred in or out of hospital |
Maternity Care per event
(ante- and postnatal) |
Unlimited hospitalisation
(subject to pre-authorisation) and midwifery services. Antenatal classes to the value of R750 and private ward for post-delivery. 12 antenatal consultations, 2 X 2D scans and 4 postnatal consultations with midwife. |
| Refractive Surgery |
R11 000 per family
Subject to pre-authorisation. |
| Immune deficiency related to HIV infection |
Unlimited -
Subject to Aid for AIDS (AFA) registration and clinical protocols. |
| Mental Health Benefits |
R30 000 per family,
subject to pre-authorisation Sub-limit of R10 000 for consultations in & out of hospital. |
| Specialised Radiology (out of hospital) |
R22 000 per family -
Subject to pre-authorisation. |
| Emergency Transportation |
Unlimited, subject to Netcare 911. |
| Endoscopies in practitioners’ rooms |
Unlimited, subject to pre-authorisation. |
Prostheses Internal
Prostheses External |
R38 000 per family
R38 000 per family
Subject to pre-authorisation |
| HIV test and Flu vaccine |
Free |
| International cover |
R5 million per trip, unlimited no. of trips. |
| Appliances |
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| General appliances |
R6 500 per family |
| Wheelchairs & large orthopaedic appliances |
Included in the general appliance limit. |
| Stoma products & CPAP machines |
May exceed general appliance limit by R3 000. |
| Hearing aids |
R20 000 per family, biennial benefit. |
| Oxygen: Home ventilation |
Unlimited, subject to pre-authorisation by HBM. |
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| Dental Benefits Not Pooled In The Day or Day Benefits |

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Dental Benefit Table |
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| Consultations |
2 annual check-ups per beneficiary. Covered at the NHRPL tariff. |
| X-rays: Intra-oral |
Covered at the NHRPL tariff |
| X-rays: Extra-oral |
1 in a 3 year period Additional benefit may be considered where specialised dental treatment planning/follow up is required |
| Oral Hygiene |
2 annual scale and polish treatments per beneficiary. No benefit for oral hygiene instructions. No benefit for adult fluoride |
| Fillings |
Covered at the NHRPL tariff. Benefit for re-treatment of a tooth is subject to clinical protocols. |
| Root Canal Therapy Extractions |
Covered at the NHRPL tariff where clinical protocols apply. |
| Plastic Dentures |
One set of plastic dentures (an upper and a lower) per beneficiary in a 4 year period. Covered at the NHRPL tariff. |

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Partial Metal Frame Dentures |
Two partial frames (an upper and a lower) per beneficiary in a 5 year period. Covered at the NHRPL tariff. Full metal dentures are not covered |
| Crown and Bridge* A bridge comprises of two or more crown units, which are payable from the available Crown and Bridge benefit. |
Pre-authorisation is required. 3 crown units per family per year. Benefits for crowns are granted once per tooth in a 5 year period. Covered at the NHRPL tariff |
| Implants* |
Pre-authorisation is required. 2 implants per beneficiary, in a five year period. Cost of implant components is limited to R1500 per implant |
| Orthodontics* |
Benefit on pre-authorisation will be applied to cases assessed as treatment mandatory, as per orthodontic indices. Covered at the Scheme Orthodontic tariff.
Benefit is limited to individuals younger than 18 years of age. Orthognathic surgery is not covered |
| Periodontics* |
Benefit is limited to conservative, non-surgical therapy only (root planing). Benefit will be applied to members who are registered on the Perio Programme. Surgical periodontics is a scheme exclusion. |
| Maxillo-Facial Surgery |
Surgery in the dental chair: Covered at the NHRPL tariff. See Surgery Exclusion Summary Surgery in hospital: See Hospitalisation* Note: Benefit for Temperomandibular (TMJ) therapy is limited to non-surgical intervention/treatments. |

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Hospitalisation (general anaesthetic) * |
Pre-authorisation is required. Certain Maxillo Facial procedures are covered inhospital, subject to admission protocols. See Exclusion Summary. General anaesthetic benefits are available for very young children 0-5 years for extensive dental treatment. Multiple hospital admissions are not covered. |
| Laughing gas in dental rooms |
Covered at the NHRPL tariff. |
| IV conscious sedation in rooms* |
Pre-authorisation is required Benefit is limited to extensive dental treatment where clinical protocols apply. |
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