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  BonComprehensive 2010
     
  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:  
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
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
BonComprehensive Chronic Disease List
  1. Addison’s Disease
  2. Asthma
  3. Bipolar Mood Disorder
  4. Bronchiectasis
  5. Cardiac Failure
  6. Cardiomyopathy
  7. Chronic Renal Disease
  8. Chronic Obstructive Pulmonary Disease
  9. Coronary Artery Disease
  10. Crohn’s Disease
  11. Diabetes Insipidus
  12. Diabetes Mellitus Type1
  13. Diabetes Mellitus Type2
  14. Dysrhythmias
  15. Epilepsy
  16. Glaucoma
  17. Haemophilia
  18. Hyperlipidaemia
  19. Hypertension
  20. Hypothyroidism
  21. Multiple Sclerosis
  22. Parkinson’s Disease
  23. Rheumatoid Arthritis
  24. Schizophrenia
  25. Systemic Lupus Erythematosus
  26. Ulcerative Colitis
  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
  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
Covers day to day medical expenses e.g. GP & specialist consultations, acute medication, paramedical/auxiliary services, optometry, radiology, pathology etc.
Savings Benefit
Per Month
Per Annum
Principal Member R 422 R5 064
Adult Dependant R 398 R4 776
Child Dependant R 86 R1 032
Threshold Benefit
Threshold
Self-Funding Gap
Principal Member R6 500 R1 436
Adult Dependant R6 000 R1 224
Child Dependant R1 700 R 668
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
   
(90% of the Bonitas rate accrues to threshold; 10% co-payment in threshold)
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
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  
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.
Dental Benefits Not Pooled In The Day or Day Benefits







Dental Benefit Table  
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.


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.


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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