BonComprehensive Product Information

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

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.