Fact sheet 3 How our plans work 4 Our plans 5 Savings 6 Contribution table 7

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2 INDEX INDEX Section A: Section B: Section C: Section D: Why Bonitas Fact sheet 3 How our plans work 4 Our plans 5 Savings 6 Contribution table 7 Contact details Queries and escalations 10 General 10 BonCap 10 Pharmacy Direct 11 Find a service provider 12 Membership and admin Individual underwriting 14 Group underwriting 16 Application process 17 Network service providers 18 GP referral process 19 PMB treatment plan 20 How to claim 21 Hospital pre-authorisation 22 Hospital networks 25 Locate a provider 35 Exclusions 36 Benefits and programmes Chronic medicine 43 Register with Pharmacy Direct 45 Over-the-counter and acute medicine 46 Maternity benefits 47 Childcare benefits 48 Optical benefits 50 Dental benefits 52 Radiology benefits 55 Cancer programme 56 HIV/AIDS programme 58 Diabetes management programme 60 Back and neck programme 62 Hip and knee programme 63 Wellness benefits 64 Preventative care benefits 65 International travel benefit 66 Emergency medical services 67 Please note: Product rules, limits, terms and conditions apply. Where there is a discrepancy between the content provided in this brochure, the website and the Scheme Rules, the Scheme Rules will prevail. The Scheme Rules are available on request. Benefits are subject to approval from the Council for Medical Schemes

3 SECTION A: WHY BONITAS WHY BONITAS

4 FACT SHEET WHY BONITAS FACT SHEET Affordable, quality healthcare for all South Africans A wide range of plans including savings, traditional, income based and hospital options Largest GP network and a specialist network to give more value for money Simple, easy to use benefits Separate benefits for dentistry and optometry on several options, paid from risk Cover for up to 60 chronic conditions and free medicine delivery Preventative care and wellness benefits paid from risk so benefits last longer Partnerships with quality service providers and healthcare professionals Additional benefits for maternity and children, including access to 24/7 paediatric telephonic advice, 365 days a year Managed Care programmes to help members manage a range of conditions including cancer, mental health, HIV/AIDS and diabetes Total benefi ciaries Principal members Average principal member age OUR MEMBERS 33 Average beneficiary age Pensioner rate (%) Number of dependants 1.16 Average family size per member R R R OUR FINANCES* R3.1 billion in reserves non-healthcare expenditure 9.53% 24.4% solvency ratio 91% of claims paid within 5 days calls a month *As per the audited 2016 Annual Financial Statements. OUR HIGHLIGHTS claims processed per day call centre calls answered in hospital admissions authorised per day 334 Wellness days held last year Page 3

5 HOW OUR PLANS WORK HOW OUR PLANS WORK SAVINGS OPTION OUT-OF-HOSPITAL Day-to-day medical expenses Use as you choose Carry over each year Self-payment gap Above threshold benefits Additional benefits (giving you more value, does not affect other benefit limits or savings) - Maternity - Preventative care - Wellness - Childcare Chronic benefits (including PMBs) IN-HOSPITAL Unlimited, at Bonitas Rate Network Non-network BONITAS SAVINGS OPTION BonComprehensive, BonClassic, BonComplete and BonSave - No hospital network BonFit - Hospital network Above threshold benefit available on BonComprehensive and BonComplete INCOME BASED OPTION OUT-OF-HOSPITAL Set benefit limits for daily medical expenses Chronic benefits For 27 PMBs IN-HOSPITAL Unlimited, at Bonitas Rate Network BONITAS INCOME BASED OPTION BonCap - Hospital network Please note: Contributions for BonCap are income-based. Income will be verified once a year. TRADITIONAL OPTION OUT-OF-HOSPITAL Day-to-day benefits Set benefit limits for daily medical expenses Does not carry over each year Chronic benefits (including PMBs) IN-HOSPITAL Unlimited, at Bonitas Rate Network Non-network B BONITAS TRADITIONAL OPTION Standard and Primary - No hospital network Standard Select - Hospital network Additional benefits (giving you more value, does not affect other benefit limits or savings) - Maternity - Preventative care - Wellness - Childcare Additional benefits (giving you more value, does not affect other benefit limits or savings) - Maternity - Preventative care - Wellness - Childcare HOSPITAL OPTION OUT-OF-HOSPITAL N/A Additional benefits (giving you more value, does not affect other benefit limits or savings) - Maternity - Preventative care - Wellness - Childcare Chronic benefits For 27 PMBs IN-HOSPITAL Unlimited, at Bonitas Rate Non-network BONITAS HOSPITAL OPTION Hospital Plus, Hospital Standard and BonEssesntial - No hospital network Page 4

6 OUR PLANS BONCOMPREHENSIVE This first-class savings plan offers ample savings, an above threshold benefit and extensive hospital cover. We offer a range of 12 products that are simple to understand, easy to use and give our members more value for money. BONCLASSIC This generous savings option offers a wide range of medical benefits, in and out of hospital. OUR PLANS Main member Adult dependant Child dependant R5 774 R5 446 R BONCOMPLETE This savings option offers generous savings, an above threshold benefit and rich hospital cover. Main member Adult dependant Child dependant R4 009 R3 442 R 990 BONSAVE This savings option offers savings to use as you choose for medical expenses and extensive hospital cover. Main member Adult dependant Child dependant R R2 572 R 873 BONFIT This savings plan offers basic cover for day-to-day medical needs and essential hospital cover. Main member Adult dependant Child dependant R2 304 R1 785 R 690 STANDARD This traditional option offers rich day-to-day benefits and comprehensive hospital cover. Main member Adult dependant Child dependant R1 930 R1 495 R 578 STANDARD SELECT This traditional option uses a quality provider network to offer rich day-to-day benefits and hospital cover. Main member Adult dependant Child dependant R3 265 R R 958 PRIMARY This traditional option offers simple day-to-day benefits and hospital cover. Main member Adult dependant Child dependant R2 828 R2 447 R 828 HOSPITAL PLUS This hospital plan offers comprehensive hospital benefits with some value-added benefits. Main member Adult dependant Child dependant R2 076 R1 624 R HOSPITAL STANDARD This hospital plan offers extensive hospital benefits with some value-added benefits. Main member Adult dependant Child dependant R2 897 R2 607 R 937 Main member Adult dependant Child dependant R1 830 R1 543 R 696 BONESSENTIAL This hospital plan offers rich hospital benefits with some value-added benefits. BONCAP This traditional entry-level plan offers basic day-to-day benefits and hospital cover using a network of doctors, providers and hospitals. Main member Adult dependant Child dependant R1 604 R1 227 R Main member Adult dependant Child dependant R0 to R7 500 R 918 R 870 R 432 R7 501 to R R R1 055 R 512 R to R R1 820 R1 620 R 689 R R2 235 R1 990 R 847 Page 5

7 SAVINGS The amount payable towards the member s PERSONAL MEDICAL SAVINGS ACCOUNT which is included in the total monthly contribution payable by a member Annual savings SAVINGS Plans % Main member Adult dependant Child dependant BonComprehensive * 18.9% R R R BonClassic 14.1% R R R BonComplete * 15% R R R BonSave 16% R R R BonFit 15% R R R * These plans have an above threshold benefit. HOW THE BALANCE OF YOUR PERSONAL MEDICAL SAVINGS IS USED Any amount available in the Personal Medical Savings Account shall be utilised to provide benefits in respect of day-to-day medical expenses. Provided there are actual funds available in a member s Personal Medical Savings Account, such funds may, in addition to providing for day-to-day benefits, be utilised to pay for services generally or specifically excluded from risk benefits or where the actual costs exceed the benefit payable or available. ADVANCES OF MEDICAL SAVINGS BENEFITS At the beginning of each benefit year or on the date of joining the Scheme or this benefit option, each member shall be allocated a medical savings benefit for the year. This benefit shall be deemed to be an advance by the Scheme to the member and shall be equal to 12 (twelve) times the amount, pro-rated in respect of a member who joins the Scheme or this benefit option during the course of the year. A member whose membership of the Scheme or of an option with a Personal Medical Savings Account is terminated during the course of a benefit year and whose claims exceeded the savings benefit advance, pro-rated on a monthly basis at the date of termination shall be liable to repay the excess / shortfall to the Scheme. BONCOMPREHENSIVE Main member Adult dependant Child dependant Savings R R R2 664 Self-payment gap R R R1 450 Threshold level R R R Above threshold benefit Unlimited Unlimited Unlimited BONCOMPLETE Main member Adult dependant Child dependant Savings R5 772 R4 620 R1 572 Self-payment gap R1 660 R1 400 R 355 Threshold level R7 432 R6 020 R1 927 Above threshold benefit R4 390 R2 590 R1 120 CLAIMS ACCUMULATE TO THE THRESHOLD AT 100% OF THE BONITAS RATE Please refer to Annexure B of the Scheme Rules at for the full list of claims that accumulate to the threshold. Page 6

8 CONTRIBUTION TABLE BONCOMPREHENSIVE Your 4th and subsequent children will be covered free of charge. CONTRIBUTION TABLE 2018 Main member Adult dependant Child dependant Risk R4 685 R4 419 R 953 Savings R1 089 R1 027 R 222 Total R5 774 R5 446 R1 175 BONCLASSIC Your 4th and subsequent children will be covered free of charge Main member Adult dependant Child dependant Risk R3 442 R2 955 R 850 Savings R 567 R 487 R 140 Total R4 009 R3 442 R 990 BONCOMPLETE Your 4th and subsequent children will be covered free of charge Main member Adult dependant Child dependant Risk R2 731 R2 187 R 742 Savings R R 385 R Total R3 212 R2 572 R 873 BONSAVE Your 4th and subsequent children will be covered free of charge Main member Adult dependant Child dependant Risk R1 935 R1 499 R 579 Savings R 369 R 286 R Total R2 304 R1 785 R 690 BONFIT Your 4th and subsequent children will be covered free of charge Main member Adult dependant Child dependant Risk R1 640 R1 270 R 491 Savings R 290 R 225 R 87 Total R1 930 R1 495 R 578 Page 7

9 STANDARD Your 4th and subsequent children will be covered free of charge Main member Adult dependant Child dependant CONTRIBUTION TABLE Total R3 265 R2 831 R 958 STANDARD SELECT Your 4th and subsequent children will be covered free of charge Main member Adult dependant Child dependant Total R2 828 R2 447 R 828 PRIMARY Your 4th and subsequent children will be covered free of charge Main member Adult dependant Child dependant Total R2 076 R1 624 R 661 HOSPITAL PLUS Your 4th and subsequent children will be covered free of charge Main member Adult dependant Child dependant Total R2 897 R2 607 R 937 HOSPITAL STANDARD Your 4th and subsequent children will be covered free of charge Main member Adult dependant Child dependant Total R1 830 R1 543 R 696 BONESSENTIAL Your 4th and subsequent children will be covered free of charge Main member Adult dependant Child dependant Total R1 604 R1 227 R 470 BONCAP You will pay for all child dependants Main member Adult dependant Child dependant R0 to R7 500 R 918 R 870 R 432 R7 501 to R R R1 055 R 512 R to R R1 820 R1 620 R 689 R R2 235 R1 990 R 847 Page 8

10 SECTION B: CONTACT DETAILS CONTACT DETAILS

11 QUERIES AND ESCALATIONS GENERAL Description Contact details Turnaround time Chronic medicine authorisations 5 to 7 days Commissions commissions@medscheme.co.za 3 days 5 days new broker contract General queries and customer service queries@bonitas.co.za or day Group take-ons bontakeons@medscheme.co.za N/A Group underwriting requests underwriting@afrocentricds.com N/A Individual underwriting review requests underwriting@afrocentricds.com 5 days QUERIES AND ESCALATIONS Hospital authorisations hospital@bonitas.co.za 1 day Membership updates membermaint@bonitas.co.za 3 days New membership applications newapplications@bonitas.co.za 1 day Oncology authorisations oncology@bonitas.co.za 3 days Pre-underwriting requests newapplications@bonitas.co.za (Subject: Pre-underwriting) 2 days Submission of claims claims@bonitas.co.za 10 days (including processing and payment) Processed claims queries queryclaims@bonitas.co.za 7 days FOR ANY QUERIES THAT DO NOT MEET THE SERVICE LEVEL, PLEASE ESCALATE: Description Contact details Turnaround time Broker escalated queries brokerescalations@bonitas.co.za 1 day BONCAP Description Contact details Turnaround time Chronic medicine authorisations boncapchronic@bonitas.co.za 5 to 7 days Hospital authorisations boncapauthorisations@bonitas.co.za 1 day Income verification boncapincome@medscheme.co.za 3 days Queries and customer service boncap@bonitas.co.za or days Page 10

12 QUERIES AND ESCALATIONS PHARMACY DIRECT 1st Level 2nd Level Customer Service: Escalated queries & general communication Lead: Senior Fund Account Manager, Bonitas Arregante Storbeck Support 1: Senior Fund Account Manager, Bonitas Hansley Kiewiets Support 2: Senior Fund Account Manager, Bonitas Natasha Kroukamp General Manager: Georgina Schutte Principal Pharmacist: Ansie van der Merwe QUERIES AND ESCALATIONS Clinical: Escalated queries & clinical communication Lead: Business Unit Manager, Bonitas Sunet Delport Principal Pharmacist: Ansie van der Merwe Support: Pharmacist, Bonitas Abbe van Wyk Support: Senior Pharmacist Assistant, Bonitas Sulize Nel Broker Support: Malebo Semenya N/A Take-on Communication Channels: Member information & prescriptions N/A Page 11

13 FIND A SERVICE PROVIDER We ve partnered with several reputable service providers to ensure that our members receive excellent service and more value for money. Emergency assistance Chronic medicine Optical benefits Call: queriescqc@er24.co.za claims@er24.co.za Call: Fax: care@pharmacydirect.co.za Call: Fax: Optical benefits Dental benefits HIV/AIDS programme FIND A SERVICE PROVIDER Call: Call: Fax: bonitas@denis.co.za Please call me: Call: Fax: afa@afadm.co.za Diabetes programme Back and neck programme Hip and knee programme Call: diabeticcare@bonitas.co.za Call: Call: Babyline Wellness Odyssey Call: All claims are paid at the Bonitas Rate, unless otherwise stated. All benefi ts and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefi ts are subject to approval Page 12

14 SECTION C: MEMBERSHIP AND ADMIN MEMBERSHIP AND ADMIN

15 INDIVIDUAL UNDERWRITING CATEGORIES FOR INDIVIDUAL UNDERWRITING: A B C Members who NEVER belonged to a medical scheme before, or whose break in cover has been MORE than 3 months Members who ARE ACTIVE members on a medical scheme and have a break in membership of LESS than 90 days and a previous membership of LESS than 24 months Members who ARE ACTIVE members on a medical scheme for MORE than 24 months UNDERWRITING DECISIONS PER CATEGORY: A B C No cover for more than 90 days No cover for less than 90 days and previous cover for less than 24 months Cover for more than 24 months 3 12 LJP 3-month general waiting period 12-month condition specific waiting period Late-joiner penalty 12 LJP 12-month condition specific waiting period Late-joiner penalty 3 LJP 3-month general waiting period Late-joiner penalty INDIVIDUAL UNDERWRITING NO PMB ELIGIBILITY FULL PMB COVER FULL PMB COVER Ordinary dependants Special dependants Grandchildren Spouse, common-law spouse (partner), same-sex spouse/partner, fiancée, customary partners, biological children, adopted children, foster children, stepchildren and disabled biological children Brother, sister, parents, nephew, niece, cousins, grandparents, mother-in-law, father-in-law and grandchildren Full underwriting will apply to registration of all special dependants at all times For the purpose of determining contributions, any special dependant under the age of 21 years will be regarded as a child dependant and child rates will apply Special dependants, who are dependants on a membership where the main member is compelled to resign from a closed scheme due to a change of employment, will be accepted underwriting free if application is made to join Bonitas as a dependant within 3 months after termination at closed scheme (no waiting periods, but late-joiner penalties if applicable) Grandchildren will ONLY be accepted underwriting free if: The parent (MOTHER OR FATHER of the baby) has been an ACTIVE member on the grandparent s existing membership BEFORE the start of the pregnancy The Act stipulates the following: A medical scheme may not impose a general or a condition-specific waiting period on a child dependant born during the period of membership Definition of a child in the main rules: a member s natural child, or a stepchild or legally adopted child or a foster child or a child who has been placed in the custody of the member or his/her spouse or partner A newborn baby who is the grandchild of a member does not qualify as a child dependant in terms of the rules and will thus be defined as a special dependant. UNDERWRITING will therefore be applied to any special dependant born into scheme membership The relationship of the newborn baby should always be clearly stated on the application form to ensure that the correct underwriting rule is applied Page 14

16 Newborns (Ordinary dependants only) Newly-weds The Scheme must be NOTIFIED within 30 days from date of birth The main member must register the baby within 3 months from date of birth, with an inception date backdated to the date of birth of the baby for NO UNDERWRITING to apply If application is made to register the newly-wed within 3 months after marriage, NO UNDERWRITING will apply Inception date of the newly-wed does not necessarily need to be date of marriage, but should fall within the 3 months that are provided to register the newly-wed Foster and adopted child dependants Dependants transferring from closed schemes and becoming dependants on Bonitas If above criteria is not met, the newly-wed will be seen as a late registration and full underwriting will apply If application is made to register a foster or adopted child dependant within 3 months from date on which fostership or adoption was granted, with an inception date backdated to the date of adoption or fostership of child, NO UNDERWRITING will apply If above criteria is not met, foster/adopted child will be seen as a late registration and full underwriting will apply All dependants who are forced to terminate their membership in accordance with the scheme rules of a closed scheme in the following cases: Overaged dependants who have reached the maximum age as child dependant of that specific closed scheme Spouse that has divorced the main member Main member has passed away Beneficiaries going on pension Local students (SA citizens) Over-aged dependants Definition of late-joiner Credible coverage General waiting period Condition specific waiting period Will be accepted underwriting free if application is made to join Bonitas as dependants or as main member, within 3 months after termination at closed scheme, irrespective of length of cover at the closed scheme (no waiting periods, but late-joiner penalties if applicable) All dependants, who are dependants on a membership where the main member is compelled to resign from a closed scheme due to a change of employment, will be accepted underwriting free if application is made to join Bonitas as dependants within 3 months after termination at closed scheme (no waiting periods, but late-joiner penalties if applicable) When a beneficiary goes on pension and applies to become a new Bonitas member or a new dependant and is forced to resign from their current scheme because they are going on pension, it will be regarded as a change of employment, thus no waiting periods will apply as per the Act, if the break in cover is not greater than 3 months (no waiting periods, but late-joiner penalties may apply) Local students will be accepted underwriting free irrespective of choice of Bonitas option as a main member but only if valid copy of ID, proof of residence and proof of FULL-TIME studentship is submitted along with the application form Dependant 21 to 24 years old (including the last day of the calendar month that the dependant turns 24 years of age) who is a student will be seen as a CHILD DEPENDANT Students are classified into 3 groups namely: full-time students, part-time students and in-service training students all 3 of these groups qualify as CHILD DEPENDANTS (21 24 years old) as long as sufficient proof of studentship is supplied, namely proof of registration or a letter from the applicable institution clearly stating the nature of studentship Dependant 21 years and older who is not a student will be seen as an ADULT DEPENDANT, except disabled biological children Child rates will be charged for disabled children of 21 years and older where sufficient proof has been provided that the child is indeed disabled and where application for child rates has been approved by a clinical specialist and Fund Management Any other dependant can remain on the Scheme as a dependant after age 24 years, but will be seen as an ADULT DEPENDANT Dependants who turn 21 and 24 will be terminated if no response is received to the notifications sent in respect of the age reviews Where no response is received for any age review the dependants will be terminated These terminated over-aged dependants will be accepted underwriting free if application is made to reinstate their membership within 3 months from termination date If application is made to reinstate these dependants after 3 months from termination date, they will have to reapply for membership and full underwriting will apply Late-joiner means an applicant or the adult dependant of an applicant, who at the time of application for membership or admission as a dependant, as the case may be, is 35 years of age or older, but excludes any beneficiary who enjoyed cover with one or more registered medical schemes in South Africa as from a date preceding 1 April 2001, without a break in cover exceeding three consecutive months since 1 April 2001 Credible coverage is seen as medical aid cover on a South African registered medical aid scheme Coverage from age 21 and older only, is seen as credible coverage and must be taken into consideration when calculating the late joiner penalty Late joiner penalties are applied from age 36 only in line with the applicable penalty band as stipulated in the Medical Schemes Act No. 131 of 1998 A period in which a beneficiary is not entitled to claim any benefits A period during which a beneficiary is not entitled to claim benefits in respect of a condition for which medical advice, diagnosis, care or treatment was recommended or received within the twelve-month period ending on the date on which an application for membership was made INDIVIDUAL UNDERWRITING Page 15

17 GROUP UNDERWRITING Only employer groups of 10 and more employees will be considered for group underwriting. GROUP UNDERWRITING WILL BE APPLIED IN ONE OF THREE WAYS: Annual underwriting-free group Underwriting-free take-on period (1-3 months, depending on group size) Individual underwriting applied to each individual beneficiary within the group Determining the status of a particular group will be the responsibility of the Underwriting Department of AfroCentric Distribution Services. In order for the Underwriting Department to consider the underwriting of a group, the group s demographic information must be submitted in Excel format as well as a business questionnaire and sent to underwriting@afrocentricds.com. Bonitas reserves the right to review or revoke the underwriting decision should the status of the group change within the first three (3) months of joining the Scheme, or the information on the application forms differs from the information provided on the initial underwriting request. FREE UNDERWRITING / NO UNDERWRITING AS PER CATEGORY A & B No condition specific waiting periods No general waiting periods No late-joiner penalties Except: Employees joining more than 3 months after their permanent employment date (start date) at the company Ordinary dependants who do not join from exactly the same inception date as the main member during an underwriting free take-on period, except for newborns and newly-weds who will be accepted underwriting free if they follow the correct procedures as set out above for newly-weds and newborns All special dependants, will be fully underwritten at all times IN THESE CASES INDIVIDUAL UNDERWRITING RULES APPLY Decisions made by: Category Rules New applications Dependants Period of underwriting status New employees AfroCentric Distribution Services Underwriting Department with the result being one of the following 3 categories: Annual underwriting-free group A B C No underwriting for new and existing employees and their ordinary dependants who join from the same inception date as the main member Full underwriting for: Special dependants Late registration of ordinary dependants Underwriting-free groups will be reviewed on an annual basis No underwriting for new employees and their ordinary dependants who join on the same inception date, within 3 months from permanent employment date at group Underwriting-free take-on period of 1-3 months No underwriting for new and existing employees and their ordinary dependants who join from the same inception date as the main member Full underwriting for: Special dependants Late registration of ordinary dependants 1-3 months, unless an extension is granted by the Underwriting Department If take-on period expires: Underwriting automatically defaults to Individual Underwriting (Group C), unless notification is provided by the Underwriting Department to change underwriting status to that of an annual underwriting-free group No underwriting for new employees and their ordinary dependants who join on the same inception date, within 3 months from permanent employment date at group Individual underwriting Individual underwriting as per categories set out above for main member and their ordinary dependants during the one month take-on period Full underwriting for: Special dependants Late registration of ordinary dependants 1 month If take-on period expires: Underwriting remains on the current Individual Underwriting rule No underwriting for new employees and their ordinary dependants who join on the same inception date, within 3 months from permanent employment date at group GROUP UNDERWRITING Special dependants will be fully underwritten at all times Special dependants will be fully underwritten at all times Special dependants will be fully underwritten at all times Page 16

18 APPLICATION PROCESS MANDATORY SUPPORTING DOCUMENTS: NEW APPLICATIONS We require the following with all new applications: Fully completed application and signed declaration with a copy of the main member s ID or passport and ID numbers for all beneficiaries listed on the application form, and Membership certificates as proof of previous medical scheme cover In addition, we require: Proof of income as set out in the application form for individual members for BonCap A copy of the most recent payslip for Persal members Where the contribution payer s details differ from the main member, we require the following: A copy of a cancelled cheque or bank statement showing the account holder s details, and A letter from the contribution payer instructing Bonitas to debit his/her account Where a company is paying the monthly contributions, we require the following: A copy of a cancelled cheque or bank statement showing the company s details, and A letter from the company (on company letterhead) authorising Bonitas to deduct monthly contributions from the company s bank account WHICH FORM TO USE: Group take-on application Members joining a new paypoint during an underwriting-free take-on period Members joining an existing paypoint during an underwriting-free window period during the year or at year end Members joining an existing annual underwriting-free paypoint All new employees joining an existing paypoint after the initial take-on period or a window period and within 3 months from their employment date Name of form Individual member application Group take-on application Health questionnaire Change in banking details Option change Change of dependants Change in details Principal member change Termination of membership Broker application Company application Individual member application All direct paying members Members joining a new paypoint during an individual underwriting take-on period Members joining an existing individual underwriting paypoint If special dependants are added during a take-on or window period of a group, an Indivudual member application form needs to be completed To be used for: Direct paying members joining Bonitas Members joining Bonitas from a paypoint or employer group Confirms current health status for members reinstating application Updates to banking details Changes in option Addition or termination of a dependant Updates to personal details, address, contact details and/or marital status Changing a dependant to a main member Cancellation of membership Brokers contracting to sell Bonitas policies Companies joining Bonitas as an employer group APPLICATION PROCESS Page 17

19 NETWORK SERVICE PROVIDERS We negotiate rates with preferred providers and Designated Service Providers to ensure that they do not charge you more than the agreed rate. This will ensure that your benefits last as long as possible and give you more value for money. The Scheme reserves the right to charge a member interest (to a maximum of the prevailing mora interest rate) on medical savings benefit advances not settled within 30 (thirty) days of resignation from the Scheme or an option with a savings component. Please note: Where you are required to use a Designated Service Provider and you do not do so, a significant co-payment will apply. You can call us on or log in to to view the list of preferred providers and Designated Service Providers. SPECIALIST NETWORK INCLUDES, BUT IS NOT LIMITED TO, THE FOLLOWING SPECIALISTS: Cardiology Cardiothoracic Surgery Dermatology Gastroenterology Neurology Neurosurgery Obstetrics and Gynaecology Ophthalmology Orthopaedics Otorhinolaryngology (ENT) Paediatrics Plastic and Reconstructive Surgery Psychiatry Pulmonology Rheumatology Specialist Medicine Surgery Urology SPECIALIST NETWORK TARIFFS APPLY TO IN- AND OUT-OF-HOSPITAL BENEFITS ON: BonClassic BonComplete BonSave BonFit Standard Standard Select Primary Hospital Standard BonEssential NETWORK SERVICE PROVIDERS HOW TO ADD A GP TO THE NETWORK Please encourage your doctor to join the network. You can call or nc@medscheme.co.za and provide the details of your doctor. The healthcare professional contracting team will follow up with the doctor. Page 18

20 GP REFERRAL PROCESS There is a growing trend of fragmented care, where a number of our beneficiaries are receiving duplicate treatment from multiple doctors and providers. This leads to poor patient experience and unsatisfactory outcomes. The GP referral process aims to provide safe, appropriate and effective care. In an effort to enhance the coordination of care, members are required to obtain a referral number from their GP before consulting with certain specialists. From January 2017, claims for specialist consultations without a valid referral number from a GP have been rejected (for member s own pocket) whenever the specialist consultation is payable from risk. The following exceptions were approved by Bonitas Medical Fund for all options, except BonCap, where the member doesn t have to obtain a referral letter: One gynaecologist consultation or visit per year for female beneficiaries Maternity consultations Paediatrician consultations for children under the age of two Oncology consultations Ophthalmology consultations HOW TO REGISTER FOR A SPECIALIST REFERRAL AUTHORISATION Your GP can contact the Bonitas Healthcare Professional call centre on and register an authorisation for you or they can use the online facility. If your GP refuses to obtain a specialist referral authorisation on your behalf, you must obtain a referral letter from the GP stating which specialist you are required to visit. You can then call the call centre on and the agent will assist you in obtaining a referral number. The specialist referral authorisations are valid for 6 months per practice type. On BonCap if you do not obtain a referral from Network GP for a specialist consultation, it will not be covered. GP REFERRAL PROCESS Page 19

21 PMB TREATMENT PLAN There is a separate benefit for tests and consultations for PMB treatment plans (excluding GP consultations). Therefore, this will not affect your day-to-day benefits. Please see an example of a PMB treatment plan below: Diagnosis Description Start Date End Date HYPERLIPIDAEMIA 01-Jan Dec-2017 In terms of the approved treatment guideline for your condition, Bonitas Medical Fund will fund the following benefits as per the Scheme Rules. (Please note that certain of these benefits may only be obtained from a Designated Service Provider and co-payments may apply). Service Description Extended Description Tariff Codes Disciplines Allowed No. Per Year Dietician Consultation 84201, 84202, 84203, 84204, Dieticians 1 ECG Without effort 1232 General Practitioner, Specialist Family Medicine ECG , , , , , , , , , , , , , , , , General Practitioner, Specialist Family Medicine GP Consultations 0190, 0191, 0192 General Practitioner, Specialist Family Medicine Pathology Pathology Alanine aminotransferase (ALT) Aspartate aminotransferase 4131 Pathologists Pathologists 2 Pathology Chol/HDL/LDL/Trig 4025 Pathologists 1 Pathology Cholesterol total 4027 Pathologists 1 Pathology Creatine kinase (CK) 4132 Pathologists 2 Pathology Glucose-Quantitative 4057 Pathologists 1 Pathology HDL cholesterol 4028 Pathologists 1 Pathology LDL cholesterol- Chemical 4026 Pathologists 1 Pathology Triglyceride 4147 Pathologists PMB TREATMENT PLAN PAYMENT OF SERVICES FOR PMB CONDITIONS Bonitas will pay for the diagnosis, treatment and care of a number of chronic conditions as per the Prescribed Minimum Benefits (PMB) legislation. To manage the care of these conditions, your Scheme has put a Care Plan in place which assigns a basket of care specific to your PMB condition. Chronic medicine is not included in the Care Plan. WHAT IS A CARE PLAN? Your Care Plan is a list of the type and number of services that are likely to be needed by a patient with your diagnosis and that your Scheme will cover. It includes out of hospital treatment such as doctor consultations, radiology and pathology tests that are listed on your Care Plan. HOW WILL THE CARE PLAN BE COVERED? As per legislation, you will be provided, at the very least, with the minimum treatment needed for your PMB condition. Your Scheme will cover the cost of this treatment. Please note that a DSP (Designated Service Provider) may need to be utilised to avoid co-payments. If you have available benefits, this will be utilised until depleted and then treatment will be paid from the Overall Annual Limit, if clinical criteria are met. WHAT IF I NEED MORE TREATMENT THAN IS LISTED IN MY CARE PLAN? If you need treatment and care in excess of your Care Plan, a clinical motivation must be provided and approved before more services will be covered. DO I NEED TO DO ANYTHING? No, this letter is proof that a Care Plan has automatically been put in place. Please make sure that every claim you or your doctor send to your Scheme has an ICD-10 code reflected on it so that it can be identified on the system and paid from the correct benefit. WHERE DO I SEND MY REQUEST? You can pmb@bonitas.co.za. Page 20

22 HOW TO CLAIM You must send us your claim within 4 months of receiving treatment or it will not be paid. Send us your claim in one of the following ways. Post your claim to: Bonitas Claims Department PO Box 74 Vereeniging, 1930 OR your claim to claims@bonitas.co.za OR Drop off your claim at one of our walk-in centres TIPS TO GET YOUR CLAIMS PAID QUICKLY Ensure your bank details are correct Claims refunds are only paid into a bank account by electronic funds transfer (EFT). Please call us on if you need to update your banking details. Please ensure that your claim shows the following: Your name and initials Your medical aid number Treatment date Name of the patient as shown on your membership card Amount charged Tariff ICD-10 code (diagnosis code) Healthcare provider s practice number Please check that prescriptions for medicine show all your details. Also check that the correct amount of medicine dispensed is shown on the claim. If the pharmacy omits any of these details, we will not be able to process your claim. HOW TO CLAIM CHECK THAT YOUR CLAIM HAS BEEN PAID We pay claims weekly. A statement showing your claims will be sent to you at the end of the month by post or . You can also log in to to view the status of your claims. Page 21

23 HOSPITAL PRE-AUTHORISATION Your in-hospital benefi ts will depend on the plan you re on. You must get pre-authorisation for all hospital admissions. This is subject to Scheme Rules and available benefi ts. HOSPITAL BENEFITS Hospital benefi ts offer cover for major medical events that result in a benefi ciary being admitted to hospital. The level of cover you have in hospital depends on the plan you ve chosen. We encourage all our members to use healthcare providers on our network, as this will ensure that the providers are paid in full. WHAT ARE HOSPITAL CO-PAYMENTS AND WHEN WILL I HAVE TO PAY THESE? Co-payments are amounts that have to be paid to the hospital directly before admission. PLEASE NOTE: Co-payments will apply in hospital in the following instances: If you are required to use a specifi c network of hospitals and you choose not to If you are required to use a Designated Service Provider or preferred provider and you choose not to There is a list of procedures for which your plan requires you to pay a co-payment on BonSave, BonFit, Primary, Hospital Plus, Hospital Standard and BonEssential. These are shown in the table below: A 30% co-payment will apply to non-network admissions on Standard Select and BonFit. A R6 350 co-payment will apply to non-network admissions on BonCap. This will not apply to emergency admissions. All hospital admissions must be pre-authorised. R1 380 co-payment R3 500 co-payment R6 900 co-payment 1. Colonoscopy 1. Arthroscopy 1. Back Surgery including Spinal Fusion 2. Conservative Back Treatment 2. Diagnostic Laparoscopy 2. Joint Replacements 3. Cystoscopy 3. Laparoscopic Hysterectomy 3. Laparoscopic Pyeloplasty 4. Facet Joint Injections 4. Laparoscopic Appendectomy 4. Laparoscopic Radical Prostatectomy 5. Flexible Sigmoidoscopy 6. Functional Nasal Surgery 5. Percutaneous Radiofrequency Ablations (Percutaneous Rhizotomies) 5. Nissen Fundoplication (Refl ux Surgery) HOSPITAL PRE-AUTHORISATION 7. Gastroscopy 8. Hysteroscopy (not Endometrial Ablation) 9. Myringotomy 10. Tonsillectomy and Adenoidectomy 11. Umbilical Hernia Repair 12. Varicose Vein Surgery Please note: On Hospital Plus, the R6 900 co-payment will not apply when a hip or knee replacement is performed by a provider contracted to ICPS or JointCare A R5 650 co-payment will apply if spinal surgery is performed without an assessment and/or intervention by DBC on BonClassic, BonComplete, Standard and Standard Select If you do not use the preferred provider for hip and knee replacements, you will have to pay a R5 650 co-payment on BonClassic, BonComplete and Standard If you do not use the Designated Service Provider for hip and knee replacements on Standard Select, the procedure will not be covered HOW DO I FIND A HOSPITAL ON THE NETWORK? Simply call us on and we will assist you, or log in to and use the Find a Network Provider tool. We negotiate extensively with hospitals to ensure the best possible value for our members. As a result, we ve partnered with strategically selected private hospital groups to help further our aim of making quality healthcare more affordable and accessible. Page 22

24 Members have access to all private hospitals countrywide; however, a 30% co-payment may apply at the following hospitals: Rosepark Hospital Bedford Gardens Private Hospital Brenthurst Clinic Carstenhof Clinic Flora Clinic Genesis Clinic (Saxonwold) Wilgeheuwel Private Hospital Eugene Marais Hospital Faerie Glen Hospital Little Company of Mary Hospital Wilgers Hospital Hilton Life Private Hospital Kingsbury Hospital Vincent Pallotti Hospital Please note: This does not apply to Standard Select and BonFit, which make use of specific hospital networks. PRE-AUTHORISATION All hospital stays (including emergencies) must be pre-authorised to ensure that your hospital stay is covered. It is best to do this at least two days before you go to hospital. If you do not get pre-authorisation, you will be liable for the full hospital account. How do I get pre-authorisation? Step 1: Have the following information ready: Membership number Benefi ciary name and date of birth Date of admission and proposed date of the operation Name of the doctor, his/her telephone number and practice number Name of the hospital, the telephone number and practice number All the relevant procedure and associated medical diagnosis codes (your doctor can assist you with this) Step 2: Call us on or the information in Step 1 to us at hospital@bonitas.co.za HOSPITAL PRE-AUTHORISATION Step 3: Once your procedure has been authorised, you will receive a letter confi rming pre-authorisation by or post. This letter contains important information about your hospital stay. Please make sure that you read and understand the contents of the letter, as it explains how your procedure will be covered. If you are unsure of anything, please discuss the letter with your doctor. Please note the following pre-authorisation information provided in the letter: The unique pre-authorisation number The initial approved length of stay The status of all the codes (whether approved or rejected in accordance with the Scheme Rules) WHAT ABOUT EMERGENCIES? Emergencies must be pre-authorised within 48 hours of admission to hospital or on the fi rst working day after a weekend or public holiday. No account will be paid unless pre-authorisation is obtained. WHAT OTHER TREATMENTS OR PROCEDURES REQUIRE PRE-AUTHORISATION? You will also need pre-authorisation for the following: Renal clinic admissions for dialysis Procedures in the doctors rooms instead of hospitalisation Physical rehabilitation care in rehabilitation facilities Drug and alcohol rehabilitation in specifi c facilities Hospice admissions Oxygen therapy at home All specialised radiology (such as MRIs and CT scans) Page 23

25 WHY ARE SOME REQUESTS FOR PRE-AUTHORISATION DECLINED? Pre-authorisation requests may be declined if: The planned procedure is not covered by your benefi t option as specifi ed in the Scheme Rules The planned procedure is not in line with the acceptable treatment standards for a particular condition The appropriate clinical information has not been received Your Bonitas membership is inactive THE ROLE OF HOSPITAL CASE MANAGERS While you are in hospital, case managers ensure that the appropriate care is provided at all times and that the appropriate discharge planning takes place where clinically indicated and where benefi ts are available. This takes place according to the Scheme Rules, clinical protocols and funding guidelines. When extended length of stay or level of care is requested, the case manager will request supporting information to be able to make an informed clinical decision. If there is any doubt at all, a medical adviser will assist and motivation might be requested from your treating provider, if needed. All changes in initial approvals are communicated to the hospital and treating provider. With long-term cases, your family members may also be involved. HOSPITAL PRE-AUTHORISATION FOR HOSPITAL PRE-AUTHORISATION Call: hospital@bonitas.co.za Page 24

26 HOSPITAL NETWORKS HOSPITAL NAME SUBURB STANDARD SELECT BONFIT EASTERN CAPE Life Beacon Bay Hospital Beacon Bay Life Isivivana Private Hospital Humansdorp Life Mercantile Private Hospital Korsten Life Queenstown Private Hospital Queenstown Life St Dominic's Hospital Southernwood Life St George's Hospital Centrahil Life St James Hospital Southernwood Life St Mary's Private Hospital Mthatha FREE STATE Life Rosepark Hospital Fichardt Park Netcare Vaalpark Hospital Vaalpark GAUTENG Genesis Clinic Saxonwold Life Brenthurst Clinic Parktown Life Carstenhof Clinic Glen Austin Life Flora Clinic Floracliffe Life Fourways Hospital Fourways HOSPITAL NETWORKS Life Robinson Private Hospital Randfontein Life Suikerbosrand Clinic Heidelberg Life Wilgeheuwel Hospital Radiokop Ext 13 Netcare Bougainville Private Hospital Daspoort Netcare Clinton Hospital New Redruth Netcare Femina Hospital Arcadia Netcare Jakaranda Hospital Muckleneuk Netcare Linmed Hospital Rynfi eld Netcare Montana Private Hospital Montanapark Netcare Moot General Hospital Rietfontein Netcare Sunward Park Hospital Sunward Park Netcare Union Hospital Alberton Netcare Unitas Hospital Lyttelton Manor KWAZULU-NATAL Netcare Kingsway Hospital Amanzimtoti Page 25

27 HOSPITAL NAME SUBURB STANDARD SELECT BONFIT KWAZULU-NATAL Netcare Kokstad Private Hospital Kokstad Netcare Parklands Hospital Overport Netcare St Anne's Hospital Pietermaritzburg Netcare St Augustine's Hospital Bulwer Netcare The Bay Hospital Richards Bay LIMPOPO Netcare Pholoso Hospital Faunapark MPUMALANGA Life Cosmos Hospital Witbank Life Midmed Hospital Middelburg Life Piet Retief Hospital Piet Retief NORTH WEST Life Anncron Hospital Wilkoppies Life Peglerae Hospital Rustenburg Sunningdale Hospital Wilkoppies Wilmedpark Private Hospital Wilkoppies WESTERN CAPE HOSPITAL NETWORKS Life Bay View Private Hospital Mossel Bay Life Kingsbury Hospital Claremont Life Knysna Private Hospital Knysna Life West Coast Private Hospital Vredenburg Netcare Blaauwberg Hospital Sunningdale Netcare Ceres Private Hospital Ceres Netcare Christiaan Barnard Memorial Hospital Cape Town Netcare Kuils River Hospital Kuils River Netcare N1 City Hospital Goodwood Page 26

28 DAY CLINICS NAME SUBURB STANDARD SELECT BONFIT EASTERN CAPE Medical Forum Theatre Mill Park FREE STATE Bethlehem Medical Centre Bethlehem Bonnet Dr ML & Partners t/a Citymed Dagkliniek Dan Pienaar Cure Day Clinics - Bloemfontein Brandwag Welkom Medical Centre St Helena GAUTENG Advanced Medgate Day Clinic Horizon View Birchmed Surgical Centre Birchleigh Boksburg Medical & Dental Centre (Theatre) Bardene Cure Day Clinics - Erasmuskloof Erasmuskloof Ext 3 Cure Day Clinics - Medkin Pretoria Cure Day Clinics - Midstream Midstream Estate Fauchard Clinic Florida Park Fordsburg Clinic Selby Ext 19 Germiston Medical & Dental Centre Lambton Intercare Day Hospital Hazeldean Hazelwood HOSPITAL NETWORKS Intercare Day Hospital Irene Irene Intercare Sandton Day Clinic Morningside Karibu Day Clinic Benoni South Life Brooklyn Surgical Centre Brooklyn Life Pretoria North Surgical Centre Pretoria North Mayo Clinic of South Africa Constantia Kloof Medicross Constantia Park - Day Surgery Constantia Park Medicross Silverton Medical & Dental Centre (Theatre) Silverton Medicross The Berg - Day Theatre Bergbron Mercidoc Day Clinic Kempton Park Netcare Constantia Day Hospital Florida Park KWAZULU-NATAL Bluff Medical & Dental Centre Bluff Care Clinic (Westville) Westville KZN Day Clinic Umhlanga Rocks Medicross Malvern - Day Surgery Malvern Page 27

29 DAY CLINICS NAME SUBURB STANDARD SELECT BONFIT KWAZULU-NATAL Shelly Beach Day Clinic Shelly Beach Westridge Surgical West Ridge LIMPOPO Mediclinic Limpopo Day Clinic Polokwane MPUMALANGA Advanced Emalahleni Day Hospital Emalahleni Kriel Medical Centre Kriel NORTH WEST Medicross Potchefstroom Baby Clinic Potchefstroom WESTERN CAPE Advanced Durbanville Surgical Centre Newlands Aevitas Fertility Clinic Northern Paarl Cure Day Clinic - Stephen's Paarl George Cure Day Clinics - Somerset West Durbanville George Surgical Centre Monte Vista Life Sport Science Orthopaedic Surgical Day Centre Somerset West Mediclinic Durbanville - Day Clinic Durbanville HOSPITAL NETWORKS Medicross Langeberg Medical & Dental Centre Durbanville Medicross Parow Medical & Dental Centre (Theatre) Pinelands Medicross Tokai Family Medical & Dental Centre Kraaifontein Monte Vista Kliniek Parow The Surgical Institute Tokai Wesfl eur Private Clinic Atlantis Page 28

30 BONCAP HOSPITAL NETWORKS HOSPITAL NAME SUBURB BONCAP EASTERN CAPE Life Beacon Bay Hospital Beacon Bay Life Isivivana Private Hospital Humansdorp Life Mercantile Private Hospital Korsten Life Queenstown Private Hospital Queenstown Life St Dominic's Hospital Southernwood Life St Mary's Private Hospital Mthatha Mthatha Private Hospital Mthatha Netcare Cuyler Hospital Uitenhage Netcare Settlers Private Hospital Grahamstown FREE STATE Bethlehem Medical Centre Bethlehem Citymed Theatre Dan Pienaar Cure Day Clinics - Bloemfontein Brandwag Life Rosepark Hospital Fichardt Park Mediclinic Hoogland Bethlehem Netcare Kroon Hospital Kroonstad Netcare Pelonomi Private Hospital Heidedal BONCAP HOSPITAL NETWORKS Netcare Vaalpark Hospital Vaalpark St Helena Private Hospital St Helena Universitas Private Hospital Universitas Welkom Medical Centre St Helena GAUTENG Advanced Groenkloof Day Hospital - Head Offi ce Muckleneuk Advanced Medgate Day Hospital Home Helderkruin Ahmed Kathrada Private Hospital Lenasia Ext 8 Arwyp Medical Centre Kempton Park Birchmed Surgical Centre Birchleigh Boksburg Medical & Dental Centre (Theatre) Bardene Botshilu Private Hospital Soshanguve Brooklyn Surgical Centre Brooklyn Page 29

31 HOSPITAL NAME SUBURB BONCAP GAUTENG Centre of Advanced Medicine Waverley Centurion Day Hospital Centurion Clinix Botshelong-Empilweni Private Hospital Vosloorus Ext 9 Clinix Naledi-Nkanyezi Private Hospital Sebokeng Clinix Tshepo-Themba Private Hospital Dobsonville Cure Day Clinics - Erasmuskloof Erasmuskloof Ext 3 Cure Day Clinics - Fourways Fourways Cure Day Clinics - Medkin Pretoria Cure Day Clinics - Midstream Midstream Estate Dr S K Matseke Memorial Hospital Diepkloof Zone 6 Edenvale Day Clinic Edenvale Ekurhuleni Surgiklin Day Clinic Kempton Park Fauchard Clinic Florida Park Fordsburg Clinic Selby Ext 19 Germiston Medical & Dental Centre Lambton Intercare Hazeldean Day Hospital Hazelwood Intercare Irene Day Hospital Irene Intercare Sandton Day Hospital Morningside BONCAP HOSPITAL NETWORKS Kilnerpark Narko Clinic Kilner Park Lenmed Daxina Private Hospital Lenasia South Lenmed Randfontein Private Hospital Greenhills Life Brenthurst Clinic Parktown Life Carstenhof Clinic Glen Austin Life Eugene Marais Hospital Les Marais Life Glynnwood Hospital Benoni South Life Pretoria North Surgical Centre Pretoria North Life Robinson Private Hospital Randfontein Life Springs Parkland Clinic Pollak Park Life St Mary's Women's Clinic - Springsmed Maternity Home & Female Clinic Springs Life Suikerbosrand Clinic Heidelberg Mediclinic Legae Mabopane Medicross Silverton Medical & Dental Centre (Theatre) Silverton Medicross the Berg - Day Theatre Bergbron Page 30

32 HOSPITAL NAME SUBURB BONCAP GAUTENG Midvaal Private Hospital Three Rivers Netcare Constantia Day Hospital Florida Park Netcare Garden City Hospital Mayfair West Netcare Jakaranda Hospital Muckleneuk Netcare Krugersdorp Hospital Krugersdorp Netcare Montana Private Hospital Montanapark Netcare Mulbarton Hospital Mulbarton Netcare Protea Day Clinic Krugersdorp Netcare Rand Hospital Berea Netcare Unitas Hospital Lyttelton Manor South Day Clinic Turffontein Stix Morewa Memorial Hospital Selby The Fountain Private Hospital Carletonville Zamokuhle Private Hospital Hospital View Zuid-Afrikaans Hospitaal Muckleneuk KWAZULU-NATAL Lorne Street Anaesthetic Clinic Durban Shelly Beach Day Clinic Shelly Beach BONCAP HOSPITAL NETWORKS Westridge Surgical West Ridge Howick Day Clinic Howick Life Empangeni Garden Clinic Empangeni Life Mount Edgecombe Hospital Phoenix Durdoc Medical Centre Durban Netcare St Augustine's Hospital Bulwer Netcare St Anne's Hospital Pietermaritzburg Life Chatsmed Garden Hospital Chatsworth Lenmed La Verna Hospital Ladysmith City Hospital Ltd Durban Lenmed Shifa Private Hospital Sydenham Netcare the Bay Hospital Richards Bay Mediclinic Newcastle Newcastle Hibiscus Hospital Port Shepstone Netcare Umhlanga Hospital Umhlanga Rocks Page 31

33 HOSPITAL NAME SUBURB BONCAP KWAZULU-NATAL Bluff Medical & Dental Centre Bluff Medicross Malvern - Day Surgery Malvern Medicross Pinetown Medical & Dental Centre (Theatre) Pinetown LIMPOPO Clinix Phalaborwa Private Hospital Tzaneen Mediclinic Limpopo Phalaborwa Mediclinic Limpopo Day Clinic Chromite Mediclinic Thabazimbi Polokwane Mediclinic Tzaneen Thabazimbi Rustenburg Platinum Mine Private Hospital Polokwane MPUMALANGA Advanced Emalahleni Day Hospital Emalahleni Kiaat Private Hospital Nelspruit Kriel Medical Centre Kriel Life Cosmos Hospital Witbank Life Midmed Hospital Middelburg Life Piet Retief Hospital Piet Retief Mediclinic Barberton Barberton BONCAP HOSPITAL NETWORKS Mediclinic Ermelo Ermelo Mediclinic Highveld Trichardt NORTH WEST Andrew Saffy Memorial Hospital Marikana Clinix Itokolle-Victoria Private Hospital Mafi keng Life Anncron Hospital Wilkoppies Life Peglerae Hospital Rustenburg Medicare Centre - Rustenburg Rustenburg Mediclinic Brits Brits Medicross Potchefstroom Baby Clinic Potchefstroom Mooimed Private Hospital Potchefstroom Netcare Ferncrest Hospital Tlhabane Rustenburg Platinum Mines Hospital (Rustenburg Section) Rustenburg Platinum Mines Hospital (Rustenburg Section) Bleskop Bleskop Sunningdale Hospital Wilkoppies Page 32

34 HOSPITAL NAME SUBURB BONCAP NORTH WEST Vryburg Private Hospital Vryburg Wilmedpark Private Hospital Wilkoppies NORTHERN CAPE Kimberley Narko Clinic (Pty) Ltd Kimberley Lenmed Health Kathu Private Hospital Kathu Lenmed Royal Hospital and Heart Centre Royldene Medi - Harts Day Clinic Hartswater Mediclinic Gariep Eltoro Park Mediclinic Upington Upington WESTERN CAPE Advanced Durbanville Surgical Centre Durbanville Advanced Knysna Surgical Centre (Pty) Ltd Fisherhaven Advanced Panorama Surgical Centre (Pty) Ltd Panorama Advanced Vergelegen Surgical Centre Somerset West Advanced Worcester Surgical Centre Worcester Busamed Paardevlei Private Hospital Paardevlei Cango Medicentre Oudtshoorn Cape Dental Theatres Wynberg BONCAP HOSPITAL NETWORKS Cure Day Clinic - Stephen's Paarl Northern Paarl Cure Day Clinics - Bellville Bellville Cure Day Clinics - Somerset West (Pty) Ltd Somerset West Intercare Day Hospital Century City (Pty) Ltd Century City Life Bay View Private Hospital Mossel Bay Life West Coast Private Hospital Vredenburg Mediclinic Paarl Paarl Mediclinic Worcester Worcester Medicross Langeberg Medical & Dental Centre Kraaifontein Medicross Parow Medical & Dental Centre (Theatre) Parow Medicross Tokai Family Medical & Dental Centre Tokai Melomed Bellville Bellville Melomed Gatesville Gatesville Melomed Mitchells Plain Mitchells Plain Melomed Tokai Tokai Page 33

35 HOSPITAL NAME SUBURB BONCAP WESTERN CAPE Netcare Blaauwberg Hospital Sunningdale Netcare Kuils River Hospital Kuils River Netcare N1 City Hospital Goodwood Netcare UCT Private Academic Hospital Observatory Thembani Theatres Khayelitsha Vidamed Private Hospital Mossel Bay Wesfl eur Private Clinic Atlantis BONCAP HOSPITAL NETWORKS Page 34

36 LOCATE A PROVIDER LOCATE A PROVIDER All claims are paid at the Bonitas Rate, unless otherwise stated. All benefi ts and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefi ts are subject to approval Page 35