Bonitas Standard 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 - Unlimited

Benefits payable at 100% of the Bonitas rate

Sub-limits applicable:
GP & Specialist Consultants	Unlimited, 150% Bonitas rate
Pathology	Unlimited
Radiology (Specialised & General)	Unlimited
Paramedic/Auxiliary Services e.g. physiotherapy, speech therapy, occupational therapy	Unlimited
Oncology	R200 000 per family
Organ Transplants	R200 000 per family
Renal Dialysis	R200 000 per family
Maxillo Facial Surgery	Unlimited, 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

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.

	In Network	Non Network sub-limit
Member	R3 000	R1 000
Member + 1	R4 500	R1 500
Member + 2	R4 900	R1 650
Member + 3	R5 200	R1 750
Member + 4 +	R5 600	R1 870

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	R2 500
Member + 1	R3 800
Member + 2	R4 100
Member + 3	R4 400
Member + 4 +	R4 700
Sub limit of R500 per beneficiary and R1500 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	No referral required for beneficiaries under age 2.

Specialist referral by a GP is also required for Prescribed Minimum Benefit Conditions.

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
Optometry	2-year benefit from anniversary of claiming, per beneficiary
Optometric examination	100% of cost at PPN optometrist or to a maximum of R220 at a non-network provider
Frames & prescription lenses/add-ons	R600 per beneficiary or to a maximum of R150 at a non-network provider
Clear Single Vision	R120 per lens or
Clear Aquity Flat-Top Bifocal	R250 per lens or
Clear Aquity Multifocal	R450 per lens or
Contact lenses	R1 200 per beneficiary

	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 Additionalbenefit 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	One partial frame (an upper or 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. 2 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*	No benefit
	Orthodontics*	Benefit on pre-authorisation will be applied to cases assessed as treatment mandatory, as per orthodontic indices. A 25 % copayment of the Scheme Orthodontic tariff applies. 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 Joint (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.