Bonitas Primary Medical Package Info

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 R600 000 per family

Benefits payable at 100% of the Bonitas rate

Sub-limits applicable:
GP & Specialist Consultants	Unlimited; subject to overall annual limit (R600 000)
Pathology	Unlimited; subject to overall annual limit1
General Radiology	Unlimited, subject to overall annual limit
Paramedic/Auxiliary Services e.g. physiotherapy, speech therapy, occupational therapy	Subject to overall annual limit
Oncology	R100 000 per family
Organ Transplants	PMBs at public hospitals only
Renal Dialysis	PMBs at public hospitals only
Maxillo Facial Surgery	Unlimited, subject to overall annual limit, excluding orthognatic surgery
Medication to take out (TTO)	R250 per beneficiary, per admission
Physical Rehabilitation	R30 000 per family

Covers day to day medical expenses e.g. GP & specialist consultations, acute medication, paramedical/auxiliary services, optometry, radiology, pathology etc.

GP Benefit

	In Network	Non Network sub-limit
Member	R 1 400	R 470
Member + 1	R 2 700	R 900
Member + 2	R 3 100	R 1 050
Member + 3	R 3 400	R 1 140
Member + 4 +	R 3 800	R 1 270

The Bonitas GP Network is the scheme’s Designated Service Provider for the provision of Prescribed Minimum Benefits, A co-payment of 40% will thus apply for out of network visits once limits are exhausted.

Day to Day Benefit

The day to day benefit is the pool of benefits from which your GP can prescribe the appropriate care to improve your health. This benefit covers acute medication, out of hospital radiology and pathology, paramedical services etc. Specialist consultations will only be payable on referral by your GP.

Member	R 1 200
Member + 1	R 2 300
Member + 2	R 2 600
Member + 3	R 2 900
Member + 4 +	R 3 200
Sub limit of R300 per beneficiary and R900 per family for pharmacy advised therapy. (PAT).

Specialist Consultations

The introduction of specialist referral management will require all beneficiaries to obtain referral from a GP to consult with a specialist. The following exceptions apply:

Gynaecologist	Female beneficiaries, 1 visit per annum without referral.
Paediatricians
Specialist referral by a GP is also required for Prescribed Minimum Benefit Conditions.

	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
	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	No benefit
	Crown and Bridge* A bridge comprises of two or more crown units, which are payable from the available Crown and Bridge benefit.	No benefit
	Implants*	No benefit
	Orthodontics*	No benefit
	Periodontics*	No benefit
	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 Joint (TMJ) therapy is limited to non-surgical intervention/treatments.
	Hospitalisation (general anaesthetic) *	Pre-authorisation is required. Admission protocols apply. Impacted teeth removals only. 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.