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The Bonitas BonCap option offers substantial benefits at an affordable rate. This option is designed for members who require access to affordable cover at a preferred provider and generous major medical benefits. This option provides value for money by making use of the Prime Cure Network, with an overall annual limit of R500 000 per family.
The BonCap option offers extensive hospital cover with generous GP consultations and medicine benefits. Members and beneficiaries can access providers that are contracted to the Prime Cure Network. |
| This benefits covers medical expenses incurred when in hospital as well as major medical events e.g. oncology. Pre-authorisation through Prime Cure is compulsory for all hospital admissions (except in the case of emergencies). |
| Overall Annual Limit R500 000 per family |
| Benefits payable at 100% of the Bonitas rate |
| Sub-limits applicable: |
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| GP & Specialist Consultants |
Unlimited; subject to overall annual limit (R500 000) and Prime Cure Provider |
| Pathology |
Subject to overall annual limit and Prime Cure Provider |
| General Radiology |
Unlimited, subject to overall annual limit |
Paramedic/Auxiliary Services
e.g. physiotherapy, speech therapy, occupational therapy |
R5 500, subject to overall annual limit and Prime Cure Provider |
Oncology |
R100 000 per family and Prime Cure Provider |
| Organ Transplants |
PMBs only, subject to pre-authorisation and Prime Cure Provider |
| Renal Dialysis |
PMBs only, subject to pre-authorisation and Prime Cure Provider |
| Medication to take out (TTO) |
7-days supply per beneficiary, per admission |
| Physical Rehabilitation |
Subject to pre-authorisation and Prime Cure Provider |
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| Covers medication for conditions that require medication on an ongoing basis. |
| Chronic Disease List (CDL) as per the Prescribed Minimum Benefits (PMB), at the Designated Service Provider (DSP) i.e. Prime Cure, accredited pharmacies and Medipost Courier Pharmacy. Subject to pre-authorisation and Prime Cure medicine formulary |
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PMBs as per Chronic Disease List
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- 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&2
- Dysrhythmias
- Epilepsy
- Glaucoma
- Haemophilia
- Hyperlipidaemia
- Hypertension
- Hypothyroidism
- Multiple Sclerosis
- Parkinson’s Disease
- Rheumatoid Arthritis
- Schizophrenia
- Systemic Lupus Erythematosus
- Ulcerative Colitis
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| Covers day to day medical expenses e.g. GP & specialist consultations, acute medication, paramedical/auxiliary services, optometry, radiology, pathology etc. |
| Day to Day Benefit |
| These benefits cover out of hospital expenses which are accessed through the Prime Cure Network providers and are listed below. |
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| GP Consultations |
Subject to Prime Cure network |
| Out of Area / Emergency Consultations |
1 visit per beneficiary or 2 visits per family to a maximum of R650 and 20% co-payment |
| Acute Medication |
Prime Cure or accredited pharmacy and subject to medicine formulary |
| Over the Counter Medication |
R165 per beneficiary, per annum maximum of R55 per event |
| Specialist Consultation |
3 visits or R1 800 per beneficiary, up to 5 visits or R2 450 per family |
| Occupational Therapy & Physiotherapy |
R1 200 per beneficiary up to R1 800 per family |
| General Radiology |
Subject to case management and approved black and white X-rays at network providers |
| Pathology |
Subject to case management and a list of approved tests at a Network Provider |
| Basic Dentistry |
List of approved codes, subject to Prime Cure Provider limited to: One consultation per beneficiary, per annum One preventative treatment per beneficiary per annum e.g. cleaning, polishing, fillings, extractions, pain and sepsis treatment, X-rays and emergency root canal treatment |
| Emergency Dentistry |
1 episode per beneficiary, per annum |
| Plastic Dentures |
One set of dentures per family over a 24-month period applicable over the age of 21 20% co-payment |
| Specialised Dentistry |
No benefit |
Optometry
Examination / Consultation
Frame
Lens
Contact lenses |
One pair of spectacles every 24 months, subject to network provider
One optometric examination per beneficiary
Range of approved frames; 1 per beneficiary
Single vision or bifocal lens
No benefits |
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| Additional benefits; medical expenses incurred in or out of hospital |
Maternity Care per event
(ante- and postnatal)
Neonatal Care |
Network provider
R25 000 per family
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| Immune deficiency related to HIV infection |
Clinical protocol and subject to HIV Disease Management Programme |
Mental Health Benefits
(in and out of hospital) |
R5 500 per family, subject to pre-authorisation by contracted provider and registration on disease management programme |
Specialised Radiology
(joint limit in and out of hospital) |
R8 000 per family,
subject to preauthorisation |
| Emergency Transportation |
Unlimited, subject to Netcare 911 |
Prostheses
Internal
External |
R16 500 per family, subject to preauthorisation
No benefit |
| Appliances (Includes general appliances, wheelchairs, stoma products, CPAP, hearing aids) |
R3 000 per family |
| Oxygen Therapy & Home Ventilation |
Subject to overall annual limit (R500 000) and pre-authorisation by Prime Cure |
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