Product Brochure. Bonitas Medical Fund I I

Transcription

1 2015 Product Brochure Bonitas Medical Fund I I

2 You can t put a price on experience With a proudly South African heritage spanning over 32 years, Bonitas has an intimate understanding of how the healthcare industry works. Our aim is to make quality healthcare accessible to all South Africans and add value to their lives. Affordable and generous, our benefits are designed to give our members more value for money. We have a wide range of products that are simple to understand so you know exactly what you re covered for. They re also easy to use, ensuring you get the support you need when you need it. Our members know that when things get tough, we re there to support them and take care of the little details so that they can receive the best of care and focus on getting better. Please note: The information contained in this brochure is subject to approval by the Council for Medical Schemes. Terms, conditions and Scheme Rules apply. Product Brochure 2015 Page 2

3 Why choose Bonitas? We re South Africa s second largest open medical scheme We cover main members and lives in total. Main members Dependants Our reputation speaks for itself Financially sound and reliable, we have over 32 years of experience in the healthcare industry. We support our members We aim to provide value-for-money healthcare benefits and add value to our members lives. We pay out more claims than any other open medical scheme 93% We re fully committed to making healthcare more affordable for all South Africans and pay out 93% of all claims the highest by an open medical scheme. We: Have the largest GP network in SA Are the only medical scheme to pay for dental benefits from risk Offer free flu vaccines and HIV tests on all options Pay supplementary benefits from risk so savings and dayto-day benefits last longer Check us out online Visit our website at to learn more about our products. Product Brochure 2015 Page 3

4 INDEX 1. BonComprehensive 2. BonClassic 3. Standard 4. BonSave 5. Primary 6. BonEssential 7. BonCap 8. Contact us Product Brochure 2015 Page 4

5 BonComprehensive Our premium product, BonComprehensive, is designed to meet the most arduous healthcare needs. It features extensive and exclusive benefits that cater for young and old alike. This elite option is perfect for those who appreciate high-quality, class and superior benefits. It offers rich benefits so that you and your loved ones have comprehensive cover and care. What it costs Main member Adult dependant Child dependant R4 488 R4 232 R913 Your fourth and subsequent children will be covered free of charge. Hospital benefits Unlimited hospitalisation covered at 300% of the Bonitas Rate at any hospital BonComprehensive members have unlimited hospitalisation, at any hospital in South Africa. This is covered at 300% of the Bonitas Rate. You also get the following: Unlimited GP and Specialist consultations while in hospital Unlimited pathology covered at 100% of the Bonitas Rate in hospital Unlimited radiology covered at 100% of the Bonitas Rate in hospital Unlimited paramedical services covered at 100% of the Bonitas Rate in hospital Unlimited maxillo-facial surgery covered at 100% of the Bonitas Rate in hospital (excluding orthognathic surgery) Unlimited physical therapy (physiotherapy and biokinetics) while in hospital Unlimited cover for organ transplants while in hospital Unlimited cover for HIV immune deficiency (subject to Aid for AIDS registration and protocols) R per family for physical rehabilitation R per family for alternatives to hospitalisation such as nursing and out-patient antibiotic therapy R450 per person per admission for medicine on discharge Product Brochure 2015 Page 5

6 Out-of-hospital benefits Abundant savings and a threshold benefit You and your dependants get savings to use for GP and specialist consultations, pathology, optometry, acute and over-the-counter medication, paramedical services and basic and specialised dentistry. Once your savings are exhausted, you will have to pay for the above yourself until you reach the amount in the self-payment gap, then your threshold benefit will kick in and you ll have access to more benefits. Main member Adult dependant Child dependant Savings R R R2 736 Self-payment gap R997 R624 R692 Threshold R R R3 428 Please note: The threshold benefits is unlimited and 25% co-payment may apply to certain procedures. Limits and scheme rules apply. Dental benefits to put a smile on your face Basic and specialised dentistry is covered from your savings. This is subject to scheme protocols. A 25% co-payment applies in threshold. Optical benefits to help you see clearly Optometry is covered from savings and limited to R2 600 per person. A 25% co-payment applies in threshold. Paramedical services are also covered Paramedical services such as occupational therapy, podiatry, speech therapy, dietetics and physiotherapy will be paid from savings. A 25% co-payment will apply in threshold. Generous oncology benefits On BonComprehensive you get R per family for the treatment of cancer. This can be used in and out of hospital. There is also a biological benefit of R per family. This must be pre-authorised. 100% cover for chronic renal dialysis We cover renal dialysis at 100% of the Bonitas rate at any hospital or dialysis centre in South Africa. Maternity benefits that bring your baby into the world with the best start BonComprehensive covers the following maternity benefits from risk so it won t impact your savings: 12 consultations while you re pregnant Two 2D ultrasounds Antenatal classes to the value of R1 060 You ll also get the Bonitas baby pack which features a beautiful baby bag and goodies for both mom and baby. Product Brochure 2015 Page 6 Unlimited hospitalisation A private ward after delivery Four consultations with a midwife after you give birth

7 Wellness benefits to keep you in tip-top condition BonComprehensive offers each member and their dependants one wellness assessment a year. This must be done by a registered provider and includes: A blood pressure test A glucose test A cholesterol test A BMI test A waist to hip ratio measurement Extensive cover for Chronic Conditions BonComprehensive offers generous and extensive benefits for chronic conditions including cover for 54 chronic conditions, access to the Centre for Diabetes and Endocrinology and a limit of R for biological drugs. BonComprehensive offers cover for 54 chronic conditions This is limited to R per beneficiary and R per family on the Comprehensive Formulary. 1. Acne 2. Addison s disease 3. Allergic rhinitis 4. Ankylosing spondylitis 5. Attention Deficit Disorder (5-18 year olds) 6. Asthma 7. Barrett s oesophagus 8. Behcet s disease 9. Bipolar disorder 10. Bronchiectasis 11. Cardiac failure 12. Cardiomyopathy 13. Chronic obstructive pulmonary disease 14. Chronic renal disease 15. Coronary artery disease 16. Crohn s disease 17. Depression 18. Dermatitis 19. Diabetes insipidus 20. Diabetes Type Diabetes Type Dysrhythmias 23. Eczema 24. Epilepsy 25. Gastro-Oesophageal Reflux Disorder 26. Generalised anxiety disorder 27. Glaucoma 28. Gout 29. Haemophilia 30. Huntington s disease 31. Hyperlipidaemia 32. Hypertension 33. Hypoparathyroidism 34. Hypothyroidism 35. Multiple sclerosis 36. Myasthenia Gravis 37. Narcolepsy 38. Neuropathies 39. Obsessive compulsive disorder 40. Osteoporosis 41. Paget s disease 42. Panic disorder 43. Parkinson s disease 44. Pemphigus 45. Polyarteritis nordosa 46. Post-traumatic stress syndrome 47. Pulmonary interstitial fibroids 48. Rheumatoid arthritis 49. Schizophrenia 50. Systemic lupus erythematosus 51. Systemic sclerosis 52. Tourette s syndrome 53. Ulcerative colitis 54. Zollinger-Ellison syndrome You will have to pay a 40% co-payment for medicine not listed on the formulary. If you go over these limits you will be covered for Prescribed Minimum Benefit conditions on the Restrictive Formulary using Pharmacy Direct. Elite access to the Centre for Diabetes and Endocrinology Members with diabetes also have access to the Centre for Diabetes and Endocrinology which offers: Consultations with a specialist or accredited diabetes doctor Wide-ranging diabetes education with a registered nurse Dietary advice from a dietician A 24-hour emergency hotline R per family for biological drugs Boasting cutting edge technology, biological drugs include antibodies, interleukins, and vaccines made from living cells. They are most often used in the treatment of cancer. Supplementary benefits Our supplementary benefits are paid from risk so they won t impact your savings or hospital benefits. They can be used for treatment in and out of hospital and are designed to give you more value. Product Brochure 2015 Page 7

8 Ensure peace of mind with mental health benefits BonComprehensive members get R per family for mental health. This can be used in and out of hospital and must be pre-authorised. Up to R of the benefit can be used for consultations. Get medical cover while you re on holiday The international travel benefit ensures you and your dependants have access to medical care while travelling in a foreign country. Preventative care to help you stay healthy Early detection makes prevention possible. Our preventative care benefit offers the following screening procedures: 1 mammogram every 3 years for females aged 50 to 74 1 pap smear every 3 years for females aged 21 to 65 1 bone density test for females over 65 1 Prostate Specific Antigen test for men aged 55 to 69 who are considered to be at high risk, after a thorough discussion with their doctor 1 Pneumococcal vaccination per person aged 65 and older 1 Faecal Occult blood test per person aged between 50 and 75 1 lipogram every 5 years for members over 20 1 HIV test and flu vaccine per person 1 TSH test for children below 1 month Immunisation for children up to 12 Infant Paediatric Benefit for children under 2 This benefit can be used at a GP or paediatrician and offers: 3 consultations per child for children under 1 year old 2 consultations per child for children between 1 and 2 years old Childhood illness benefit to keep your kids healthy This benefit gives each of your children between 2 and 12 years old, 2 GP consultations per year. Benefits for appliances such as wheelchairs and hearing aids We offer the following benefits: R7 200 per family for general appliances such as wheelchairs R per family every two years for hearing aids (a 10% co-payment applies) R3 700 per person for foot orthotics (a 10% co-payment applies) Cover for stoma products and CPAP machines that may exceed the general appliances limit by R5 050 Unlimited cover for oxygen and home ventilation if pre-authorised You also get: R per family for refractive surgery covered at 100% of the Bonitas Rate R per family for cochlear implants R per family for internal nerve stimulators R per family for specialised radiology out of hospital R per family for internal and external prostheses Emergency medical transport from ER24 If you require and appreciate a select product that s a cut-above the rest then BonComprehensive is the choice for you. Product Brochure 2015 Page 8

9 BonClassic One of the most generous options, BonClassic, offers quality cover without you having to break the bank. The perfect blend of the modernity and tradition, BonClassic boasts superior benefits at affordable rates. It offers rich cover for you and your loved ones with added boosts to help your benefits last longer. What it costs Main member Adult dependant Child dependant R2 921 R2 509 R721 Your fourth and subsequent children will be covered free of charge. Hospital benefits Unlimited hospitalisation at 100% of the Bonitas Rate BonClassic covers all major hospital events including oncology treatment, organ transplants and renal dialysis. You also get the following: Unlimited GP and Specialist consultations while in hospital Unlimited pathology covered at 100% of the Bonitas Rate in hospital Unlimited radiology covered at 100% of the Bonitas Rate in hospital Unlimited paramedical services covered at 100% of the Bonitas Rate in hospital Unlimited maxillo-facial surgery covered at 100% of the Bonitas Rate in hospital (excluding orthognathic surgery) Unlimited physical therapy (physiotherapy and biokinetics) while in hospital Unlimited cover for organ transplants while in hospital Unlimited cover for HIV immune deficiency for Prescribed Minimum Benefit conditions (subject to Aid for AIDS registration and protocols) R per family for physical rehabilitation R per family for alternatives to hospitalisation such as nursing and out-patient antibiotic therapy R380 per person per admission for medicine on discharge Benefits 2015 Page 9

10 Out-of-hospital benefits Use your savings for consultations and acute medicine You and your dependants get savings to use for GP and specialist consultations, pharmacy-advised therapy and acute medicine. Main member Adult dependant Child dependant Savings R5 256 R4 524 R1 296 Once you have used all your savings, specialists will be paid from risk at 130% of the Bonitas rate. Get even more value with these benefit boosts BonClassic is designed to help you get more value for your money. As a result you get the following: R2 550 per person (limited to R5 600 per family) for pathology R2 550 per person (limited to R3 930 per family) for general radiology R1 250 per person (limited to R2 550 per family) for physical therapy Dental benefits to put a smile on your face Basic dentistry is covered at R3 800 per family. Specialised dentistry (such as advanced dentistry, minor oral surgery and orthodontic treatment) is covered at R4 550 per family. Optical benefits to help you see clearly Optical benefits work on a 2-year cycle so you can only access your benefits once every two years. You get: R5 060 per family R700 per person for frames R150 per lens per person for single vision lenses R325 per lens per person for bifocal lenses R600 per lens per person for multifocal lenses R1 550 per lens per beneficiary for contact lenses Eye tests are covered at R460 per person at a preferred provider and at R310 per person at a non-network provider. Paramedical services are also covered Paramedical services such as occupational therapy, podiatry, speech therapy, dietetics and physiotherapy will be paid as follows: R2 440 for the main member R3 700 for the main member + 1 other member R4 300 for the main member + 2 other members R4 550 for the main member + 3 other members R4 900 for the main member + 4 or more members Generous oncology benefits On BonClassic you get R per family at a preferred provider for the treatment of cancer. This can be used in and out of hospital and must be pre-authorised. 100% cover for chronic renal dialysis We cover renal dialysis at 100% of the Bonitas rate at a Prefered Provider. Benefits 2015 Page 10

11 Maternity benefits that bring your baby into the world with the best start BonClassic covers the following maternity benefits from risk so it won t impact your savings: 12 consultations while you re pregnant Two 2D ultrasounds Antenatal classes to the value of R1 040 Unlimited hospitalisation Four consultations with a midwife after you give birth You ll also get the Bonitas baby pack which features a beautiful baby bag and goodies for both mom and baby. Wellness benefits to keep you in tip-top condition BonClassic offers each member and their dependants one wellness assessment a year. This must be done by a registered provider and includes: A blood pressure test A glucose test A cholesterol test A BMI test A waist to hip ratio measurement Comprehensive cover for Chronic Conditions BonClassic offers generous and extensive benefits for chronic conditions including cover for 63 chronic conditions and a limit of R for biological drugs. BonClassic offers cover for 63 chronic conditions 1. Addison s disease 2. Alzheimer s disease 3. Angina 4. Ankylosing spondylitis 5. Asthma 6. Attention Deficit Disorder (in 5-18 year olds) 7. Barrett s oesophagus 8. Benign prostatic hypertrophy 9. Bipolar disorder 10. Bronchiectasis 11. Bulimia Nervosa 12. Cancer 13. Cardiac Arrhythmias 14. Cardiac failure 15. Cardiomyopathy 16. Chronic bronchitis 17. Chronic obstructive pulmonary disease 18. Chronic renal disease 19. Coronary artery disease 20. Crohn s disease 21. Cushing syndrome 22. Cystic Fibrosis 23. Deep vein thrombosis 24. Depression 25. Dermatomyositis 26. Diabetes insipidus 27. Diabetes Type Diabetes Type Dysrhythmias 30. Eczema 31. Emphysema 32. Epilepsy 33. Gastro-Oesophageal Reflux Disorder 34. Generalised anxiety disorder 35. Glaucoma 36. Gout 37. Haemophilia 38. Hormone replacement therapy 39. Hyperlipidaemia 40. Hypertension 41. Hypoparathyroidism 42. Hypothyroidism 43. Infective Endocarditis 44. Ischaemic heart disease 45. Motor neuron disease 46. Multiple sclerosis 47. Obsessive compulsive disorder 48. Osteoporosis 49. Paget s disease 50. Panic disorder 51. Paraplegia and Quadreplegia 52. Parkinson s disease 53. Polyarteritis nordosa 54. Post-traumatic stress syndrome 55. Pulmonary interstitial fibrosis 56. Rheumatoid arthritis 57. Schizophrenia 58. Scleroderma 59. Systemic lupus erythematosus 60. Thromboangitis Obliterans 61. Tourette s syndrome 62. Ulcerative colitis 63. Zollinger-Ellison syndrome This is limited to R9 200 per beneficiary and R per family on the Restrictive Formulary. Pharmacy Direct, our designated service provider, will deliver the medicine to you. If you do not use Pharmacy Direct or use a medicine which is not on the formulary a 40% co-payment will apply. If you go over these limits you will be covered for Prescribed Minimum Benefit conditions. R per family for biological drugs Boasting cutting edge technology, biological drugs include antibodies, interleukins, and vaccines made from living cells. They are most often used in the treatment of cancer. A 10% co-payment applies for biological drugs. This benefit is subject to clinical protocols. Benefits 2015 Page 11

12 Supplementary benefits Our supplementary benefits are paid from risk so they won t impact your savings or hospital benefits. They can be used for treatment in and out of hospital and are designed to give you more value. Ensure peace of mind with mental health benefits BonClassic members get R per family for mental health. This can be used in and out of hospital and must be pre-authorised. Up to R of the benefit can be used for consultations. Get medical cover while you re on holiday The international travel benefit ensures you and your dependants have access to medical care while travelling in a foreign country. Benefits for appliances such as wheelchairs and hearing aids We offer the following benefits: R6 700 per family for general appliances such as wheelchairs, stoma products and CPAP machines R per family every three years for hearing aids (a 10% co-payment applies) R3 700 per person for foot orthotics (a 10% co-payment applies) Unlimited cover for oxygen and home ventilation if pre-authorised You also get: R per family for cochlear implants R per family for specialised radiology in and out of hospital R per family for internal and external prostheses 1 HIV test and flu vaccine per person Emergency medical transport from ER24 If you want top-notch care that covers the needs of you and your loved ones, then BonClassic is the option for you. Benefits 2015 Page 12

13 Standard Perfect for families, the Standard Option offers top quality cover at affordable prices. Featuring rich benefits that ensure you get the best of care, this option is definitely of a high standard. What it costs Main member Adult dependant Child dependant R2 406 R2 081 R703 Your fourth and subsequent children will be covered free of charge. Hospital benefits Unlimited hospitalisation at 100% of the Bonitas Rate Get full cover for hospital stays at any private hospital in South Africa. Hospitalisation is covered at 100% of the Bonitas Rate. We cover all major hospital events including oncology treatment and renal dialysis. You also get the following: Unlimited GP and Specialist consultations while in hospital Unlimited pathology covered at 100% of the Bonitas Rate in hospital Unlimited radiology covered at 100% of the Bonitas Rate in hospital Unlimited paramedical services covered at 100% of the Bonitas Rate in hospital Unlimited maxillo-facial surgery covered at 100% of the Bonitas Rate in hospital (excluding orthognathic surgery) Unlimited physical therapy (physiotherapy and biokinetics) while in hospital Unlimited cover for organ transplants while in hospital R cover for HIV immune deficiency (subject to Aid for AIDS registration and protocols) R per family for physical rehabilitation R per family for alternatives to hospitalisation such as nursing and out-patient antibiotic therapy R380 per person per admission for medicine on discharge Benefits 2015 Page 13

14 Out-of-hospital benefits Use your savings as you choose Your savings can be used for acute medicine, consultations, pathology, radiology and just about any out-of-hospital claim. All claims will be paid from savings first before you use your generous day-to-day benefits. As an added bonus if you don t use your savings they will be carried over to the next year. Main member Adult dependant Child dependant R1 152 R996 R336 Generous day-to-day benefits to ensure you get the best of care You and your loved ones get day-to-day benefits to use for GP and specialist consultations and pharmacy-advised therapy. Day-to-day benefits Main member only R8 375 Main member + 1 dependant R Main member + 2 dependants R Main member + 3 dependants R Main member + 4 or more dependants R Please note: Day-to-day benefits include savings and claims paid from savings. Sub-limits apply as shown below. GP sub-limits to ensure you re treated right You and your dependants get savings to use for GPs in and out of the Bonitas network. This is subject to the overall limit for day-to-day benefits. Main member only Main member + 1 dependant Main member + 2 dependants Main member + 3 dependants Main member + 4 or more dependants Sub-limit for pharmacy advised therapy You get R2 000 per family for pharmacy advised therapy such as over-the-counter medicine. This is limited to R660 per beneficiary. Sub-limits for other out-of-hospital claims This can be used for out-of-hospital radiology, pathology, paramedical services (such as audiology, physiotherapy, occupational therapy and so on) and specialist consultations if referred by your doctor. This is subject to the overall limit for day-to-day benefits. Each female member gets one gynaecologist visit a year without referral while each child under 2 can visit the paediatrician without referral. You can also visit an ophthalmologist and oncologist without referral. Optical benefits to help you see clearly Optical benefits work on a 2-year cycle so you can only access your benefits once every two years. You get: R5 270 per family R800 per person for frames R150 per lens per person for single vision lenses GP benefit R3 400 (only R1 100 can be used at GPs outside our network) R5 000 (only R1 700 can be used at GPs outside our network) R5 500 (only R1 850 can be used at GPs outside our network) R5 800 (only R1 950 can be used at GPs outside our network) R6 300 (only R2 100 can be used at GPs outside our network) Out-of-hospital benefits Main member only R4 975 Main member + 1 dependant R7 640 Main member + 2 dependants R8 500 Main member + 3 dependants R9 535 Main member + 4 or more dependants R R325 per lens per person for bifocal lenses R600 per lens per person for multifocal lenses R1 650 per lens per beneficiary for contact lenses Eye tests are covered at R460 per person at a preferred provider and at R310 per person at a non-network provider. You ll also get a bonus of R140 for using a preferred provider. Benefits 2015 Page 14

15 Dental benefits to put a smile on your face We cover you and your family for conservative dentistry (such as cleaning and polishing) and specialised dentistry (such as crowns, bridges and orthodontic treatment). This is based on the Bonitas Dental Tariff and clinical protocols. Generous oncology benefits On the Standard Option you get R per family at a preferred provider for the treatment of cancer. This can be used in and out of hospital and must be pre-authorised. 100% cover for chronic renal dialysis We cover renal dialysis at 100% of the Bonitas Rate at a Preferred Provider. Maternity benefits that bring your baby into the world with the best start We cover the following maternity benefits from risk so it won t impact your other benefits: 12 consultations while you re pregnant Two 2D ultrasounds Antenatal classes to the value of R1 000 Unlimited hospitalisation Four consultations with a midwife after you give birth You ll also get the Bonitas baby pack which features a beautiful baby bag and goodies for both mom and baby. Wellness benefits to keep you in tip-top condition The Standard Option offers each member and their dependants one wellness assessment a year. This must be done by a registered provider and includes: A blood pressure test A glucose test A cholesterol test A BMI test A waist to hip ratio measurement Extensive cover for Chronic Conditions The Standard Option offers cover for 43 chronic conditions. 1. Acne 2. Addison s disease 3. Allergic rhinitis 4. Ankylosing spondylitis 5. Asthma 6. Attention Deficit Disorder (5-18yr) 7. Barrett s oesophagus 8. Behcet s disease 9. Bipolar disorder 10. Bronchiectasis 11. Cardiac failure 12. Cardiomyopathy 13. Chronic obstructive pulmonary disease 14. Chronic renal disease 15. Coronary artery disease 16. Crohn s disease 17. Depression 18. Dermatitis 19. Diabetes insipidus 20. Diabetes Type Diabetes Type Dysrhythmias 23. Eczema 24. Epilepsy 25. Gastro-Oesophageal Reflux Disorder 26. Glaucoma 27. Gout 28. Haemophilia 29. Hyperlipidaemia 30. Hypertension 31. Hypothyroidism 32. Multiple sclerosis 33. Narcolepsy 34. Obsessive compulsive disorder 35. Panic disorder 36. Parkinson s disease 37. Post-traumatic stress syndrome 38. Rheumatoid arthritis 39. Schizophrenia 40. Systemic lupus erythematosus 41. Tourette s syndrome 42. Ulcerative colitis 43. Zollinger-Ellison syndrome This is limited to R7 850 per beneficiary and R per family on the Comprehensive Formulary. You will have to pay a 40% co-payment for medicine not listed on the formulary. If you go over these limits you will be covered for Prescribed Minimum Benefit conditions on the Restrictive Formulary using Pharmacy Direct. Benefits 2015 Page 15

16 Elite access to the Centre for Diabetes and Endocrinology Members with diabetes also have access to the Centre for Diabetes and Endocrinology which offers: Consultations with a specialist or accredited diabetes doctor Wide-ranging diabetes education with a registered nurse Dietary advice from a dietician A 24-hour emergency hotline Supplementary benefits Our supplementary benefits are paid from risk so they won t impact your other benefits. They can be used for treatment in and out of hospital and are designed to give you more value. Ensure peace of mind with mental health benefits You get R per family for mental health. This can be used in and out of hospital and must be pre-authorised. Up to R of the benefit can be used for consultations. Get medical cover while you re on holiday The international travel benefit ensures you and your dependants have access to medical care while travelling in a foreign country. Infant Paediatric Benefit for children under 2 This benefit can be used at a GP or paediatrician and offers: 2 consultations per child for children under 1 year old 2 consultations per child for children between 1 and 2 years old Childhood illness benefit to keep your kids healthy This benefit gives each of your children between 2 and 12 years old, 2 GP consultations per year. Benefits for appliances such as wheelchairs and hearing aids We offer the following benefits: R6 550 per family for general appliances such as wheelchairs R per family every two years for hearing aids (a 10% co-payment applies) Cover for stoma products and CPAP machines that may exceed the general appliances limit by R5 300 R3 700 per person for foot orthotics (a 10% co-payment applies) Unlimited cover for oxygen and home ventilation if pre-authorised You also get: R per family for cochlear implants R per family for internal nerve stimulators The benefit of R per family is for out of hospital R for internal and external prostheses 1 HIV test and flu vaccine per person Emergency medical transport from ER24 Get the best of care for you and your loved ones without breaking the bank with the Standard Option. Benefits 2015 Page 16

17 BonSave Take total control of your benefits with BonSave, the flexible option that lets you decide how to use your savings. Designed to offer you cover when you need it most, while allowing you to customise your cover according to your needs, BonSave offers extensive hospital cover. What it costs Main member Adult dependant Child dependant R1 711 R1 325 R514 Your fourth and subsequent children will be covered free of charge. Hospital benefits Hospitalisation covered at 150% of the Bonitas Rate Get full cover for hospital stays. We cover all major hospital events including oncology treatment, renal dialysis and organ transplants. You also get the following: Unlimited GP and Specialist consultations while in hospital for network specialists Unlimited pathology covered at 100% of the Bonitas Rate in hospital Unlimited radiology covered at 100% of the Bonitas Rate in hospital Unlimited paramedical services cover at 100% of the Bonitas Rate in hospital Unlimited maxillo-facial surgery covered at 100% of the Bonitas Rate in hospital (excluding orthognathic surgery) Unlimited physical therapy (physiotherapy and biokinetics) while in hospital Unlimited cover for organ transplants while in hospital R cover for HIV immune deficiency (subject to Aid for AIDS registration and protocols) R per family for physical rehabilitation R per family for alternatives to hospitalisation such as nursing and out-patient antibiotic therapy R310 per person per admission for medicine on discharge Benefits 2015 Page 17

18 You will have to pay a deductible for certain procedures as shown in the table below: R1 000 deductible R2 500 deductible R5 000 deductible 1. Colonoscopy 2. Conservative back treatment 3. Cystoscopy 4. Facet joint injections 5. Flexible sigmoidoscopy 6. Functional nasal surgery 7. Gastroscopy 8. Umbilical hernia repair 9. Hysteroscopy (not endometrial ablation) 10. Myringotomy 11. Tonsillectomy and adenoidectomy (not PMBs) 12. Varicose vein surgery 1. Arthroscopy 2. Diagnostic laparoscopy 3. Hysterectomy (except cancer and PMBs) 4. Percutaneous radiofrequency ablations 5. Percutaneous rhizotomies 6. Laparoscopic appendectomy 7. Laparoscopic nephrectomy 1. Nissen fundoplication (reflux surgery) 2. Back surgery including spinal fusion 3. Joint replacement (except PMBs) 4. Laparoscopic pyeloplasty 5. Laparoscopic radical prostatectomy Out-of-hospital benefits Generous savings to use as you choose You and your dependants get savings to use for GP and specialist consultations, pathology, optometry, acute medicine and paramedical services such as speech therapy. Main member Adult dependant Child dependant Savings R3 492 R2 700 R1 056 If you use all your savings for the year, your family will still get a maximum of 6 consultations to use (limited to 3 per person), if illness strikes. We ll cover these at no extra cost to you. Dental benefits to put a smile on your face Basic dentistry is covered from risk. This is subject to DENIS clinical protocols and the Bonitas Dental Tariff. Optical benefits to help you see clearly Optometry including eye tests, frames and lenses, is covered from savings. Paramedical services are also covered Paramedical services such as occupational therapy, podiatry, speech therapy, dietetics and physiotherapy will be covered from your savings. Generous oncology benefits On BonSave you get R per family at a preferred provider for the treatment of cancer. This can be used in and out of hospital and must be pre-authorised. 100% cover for chronic renal dialysis We cover renal dialysis at 100% of the Bonitas Rate at a Preferred Provider. Benefits 2015 Page 18

19 Maternity benefits that bring your baby into the world with the best start We cover the following maternity benefits from risk so it won t impact your savings: 6 consultations while you re pregnant Two 2D ultrasounds Antenatal classes to the value of R1 000 Unlimited hospitalisation Four consultations with a midwife after you give birth You ll also get the Bonitas baby pack which features a beautiful baby bag and goodies for both mom and baby. Wellness benefits to keep you in tip-top condition BonSave offers each member and their dependants one wellness assessment a year. This must be done by a registered provider and includes: A blood pressure test A glucose test A cholesterol test A BMI test A waist to hip ratio measurement Chronic cover for Prescribed Minimum Benefits at a DSP BonSave gives you and your dependants full cover for 26 chronic conditions and delivers your medicine to you through Pharmacy Direct. 1. Addison s disease 2. Asthma 3. Bipolar disorder 4. Bronchiectasis 5. Cardiac failure 6. Cardiomyopathy 7. Chronic obstructive pulmonary disease 8. Chronic renal disease 9. Coronary artery disease 10. Crohn s disease 11. Diabetes insipidus 12. Diabetes Type Diabetes Type Dysrhythmias 15. Epilepsy 16. Glaucoma 17. Haemophilia 18. Hyperlipidaemia 19. Hypertension 20. Hypothyroidism 21. Multiple sclerosis 22. Parkinson s disease 23. Rheumatoid arthritis 24. Schizophrenia 25. Systemic lupus erythematosus 26. Ulcerative colitis You will have to pay a 40% co-payment for medicine not listed on the formulary or if you do not use Pharmacy Direct. Supplementary benefits Our supplementary benefits are paid from risk so they won t impact your savings or hospital benefits. They can be used for treatment in and out of hospital and are designed to give you more value. Ensure peace of mind with mental health benefits BonSave members get R per family for mental health. This can be used in and out of hospital and must be pre-authorised. Up to R of the benefit can be used for consultations. Get medical cover while you re on holiday The international travel benefit ensures you and your dependants have access to medical care while travelling in a foreign country. Infant Paediatric Benefit for children under 2 This benefit can be used at a GP or paediatrician and offers: 2 consultations per child for children under 1 year old 1 consultation per child for children between 1 and 2 years old Benefits 2015 Page 19

20 Childhood illness benefit to keep your kids healthy This benefit gives each of your children between 2 and 12 years old, 1 GP consultation per year. Benefits for appliances such as wheelchairs We offer the following benefits: R5 950 per family for general appliances such as wheelchairs Cover for stoma products and CPAP machines that may exceed the general appliances limit by R5 300 R3 700 per person for foot orthotics (a 10% co-payment applies) Unlimited cover for oxygen and home ventilation if pre-authorised You also get: R per family for specialised radiology out of hospital Cover for internal and external prostheses for Prescribed Minimum Benefit conditions 1 HIV test and flu vaccine per person Emergency medical transport from ER24 If you re looking for cover that s as adaptable as you are, then BonSave is the option for you. Benefits 2015 Page 20

21 Primary The Primary Option offers simple, fuss-free healthcare that ensures you and your loved ones are covered for emergencies and routine health checks alike. What it costs Main member Adult dependant Child dependant R1 550 R1 213 R494 Your fourth and subsequent children will be covered free of charge. Hospital benefits Unlimited hospitalisation at 100% of the Bonitas Rate Get full cover for hospital stays at any private hospital in South Africa. Hospitalisation is covered at 100% of the Bonitas Rate. We cover all major hospital events including oncology treatment and renal dialysis. You also get the following: Unlimited GP and Specialist consultations while in hospital for network specialists Unlimited pathology covered at 100% of the Bonitas Rate in hospital Unlimited radiology covered at 100% of the Bonitas Rate in hospital Unlimited paramedical services cover at 100% of the Bonitas Rate in hospital Unlimited maxillo-facial surgery covered at 100% of the Bonitas Rate in hospital (excluding orthognathic surgery) Unlimited physical therapy (physiotherapy and biokinetics) while in hospital Cover for organ transplants for Prescribed Minimum Benefit conditions R cover for HIV immune deficiency (subject to Aid for AIDS registration and protocols) R per family for physical rehabilitation R per family for alternatives to hospitalisation such as nursing and out-patient antibiotic therapy R310 per person per admission for medicine on discharge Benefits 2015 Page 21

22 You will have to pay a deductible for certain procedures as shown in the table below: R1 000 deductible R2 500 deductible R5 000 deductible 1. Colonoscopy 2. Conservative back treatment 3. Cystoscopy 4. Facet joint injections 5. Flexible sigmoidoscopy 6. Functional nasal surgery 7. Gastroscopy 8. Umbilical hernia repair 9. Hysteroscopy (not endometrial ablation) 10. Myringotomy 11. Tonsillectomy and adenoidectomy (not PMBs) 12. Varicose vein surgery 1. Arthroscopy 2. Diagnostic laparoscopy 3. Hysterectomy (except cancer and PMBs) 4. Percutaneous radiofrequency ablations 5. Percutaneous rhizotomies 6. Laparoscopic appendectomy 7. Laparoscopic nephrectomy 1. Nissen fundoplication (reflux surgery) 2. Back surgery including spinal fusion 3. Joint replacement (except PMBs) 4. Laparoscopic pyeloplasty 5. Laparoscopic radical prostatectomy Out-of-hospital benefits GP benefits that treat you right You and your dependants get savings to use for GPs in and out of the Bonitas network. Main member only Main member + 1 dependant Main member + 2 dependants Main member + 3 dependants Main member + 4 or more dependants GP benefit R1 600 (only R530 can be used at GPs outside our network) R3 000 (only R1 000 can be used at GPs outside our network) R3 500 (only R1 150 can be used at GPs outside our network) R3 800 (only R1 300 can be used at GPs outside our network) R4 300 (only R1 450 can be used at GPs outside our network) Day-to-day benefits to help you stay healthy The day-to-day benefit covers out-of-hospital radiology, pathology, paramedical services (such as audiology, physiotherapy, occupational therapy and so on) and specialist consultations if referred by your doctor. Day-to-day benefit Main member only R1 700 Main member + 1 dependant R3 100 Main member + 2 dependants R3 600 Main member + 3 dependants R3 900 Main member + 4 or more dependants R4 250 Each female member gets one gynaecologist visit a year without referral while each child under 2 can visit the paediatrician without referral. Over-the-counter medicine is covered You get R1 170 per family for pharmacy advised therapy. This is limited to R400 per beneficiary. Dental benefits to put a smile on your face Basic dentistry is covered from risk. This is subject to DENIS clinical protocols and the Bonitas Dental Tariff. Optical benefits to help you see clearly Optical benefits work on a 2-year cycle so you can only access your benefits once every two years. You get: R4 270 per family R300 per person for frames R150 per lens per person for single vision lenses R325 per lens per person for bifocal lenses R600 per lens per person for multifocal lenses R1 150 per lens per beneficiary for contact lenses Eye tests are covered at R460 per person at a preferred provider and at R310 per person at a non-network provider. You ll also get a bonus of R140 for using a preferred provider. Benefits 2015 Page 22

23 Paramedical services are also covered Paramedical services such as occupational therapy, podiatry, speech therapy, dietetics and physiotherapy will be covered from your day-to-day benefit. Generous oncology benefits On the Primary Option you get R per family at a preferred provider for the treatment of cancer. This can be used in and out of hospital and must be pre-authorised. 100% cover for chronic renal dialysis We cover renal dialysis at 100% of the Bonitas Rate for Prescribed Minimum Benefit conditions. Maternity benefits to bring your baby into the world with the best start We cover the following maternity benefits from risk so it won t impact your day-to-day benefits: 6 consultations while you re pregnant Two 2D ultrasounds Unlimited hospitalisation Four consultations with a midwife after you give birth You ll also get the Bonitas baby pack which features a beautiful baby bag and goodies for both mom and baby. Wellness benefits to keep you in tip-top condition The Primary Option offers each member and their dependants one wellness assessment a year. This must be done by a registered provider and includes: A blood pressure test A glucose test A cholesterol test A BMI test A waist to hip ratio measurement Chronic cover for Prescribed Minimum Benefits at a DSP The Primary Option gives you and your dependants full cover for 26 chronic conditions and delivers your medicine to you through Pharmacy Direct. 1. Addison s disease 2. Asthma 3. Bipolar disorder 4. Bronchiectasis 5. Cardiac failure 6. Cardiomyopathy 7. Chronic obstructive pulmonary disease 8. Chronic renal disease 9. Coronary artery disease 10. Crohn s disease 11. Diabetes insipidus 12. Diabetes Type Diabetes Type Dysrhythmias 15. Epilepsy 16. Glaucoma 17. Haemophilia 18. Hyperlipidaemia 19. Hypertension 20. Hypothyroidism 21. Multiple sclerosis 22. Parkinson s disease 23. Rheumatoid arthritis 24. Schizophrenia 25. Systemic lupus erythematosus 26. Ulcerative colitis You will have to pay a 40% co-payment for medicine not listed on the formulary or if you do not use Pharmacy Direct. Benefits 2015 Page 23

24 Supplementary benefits Our supplementary benefits are paid from risk so they won t impact your other benefits. They can be used for treatment in and out of hospital and are designed to give you more value for money. Ensure peace of mind with mental health benefits Primary Option members get R per family for mental health. This can be used in and out of hospital and must be preauthorised. Up to R7 800 of the benefit can be used for consultations. Get medical cover while you re on holiday The international travel benefit ensures you and your dependants have access to medical care while travelling in a foreign country. Infant Paediatric Benefit for children under 2 This benefit can be used at a GP or paediatrician and offers: 1 consultation per child for children under 1 year old 1 consultation per child for children between 1 and 2 years old Childhood illness benefit to keep your kids healthy This benefit gives each of your children between 2 and 12 years old, 1 GP consultation per year. Benefits for appliances such as wheelchairs and hearing aids We offer the following benefits: R5 900 per family for general appliances such as wheelchairs R7 400 per family for hearing aids once every two years (a 10% co-payment applies) Cover for stoma products and CPAP machines that may exceed the general appliances limit by R5 300 R3 700 per person for foot orthotics (a 10% co-payment applies) Unlimited cover for oxygen and home ventilation if pre-authorised You also get: R per family for specialised radiology in and out of hospital Cover for internal and external prostheses for Prescribed Minimum Benefit conditions 1 HIV test and flu vaccine per person Emergency medical transport from ER24 If you like keeping things simple but want to ensure your loved ones have access to affordable healthcare, then the Primary Option is perfect for you. Benefits 2015 Page 24

25 BonEssential BonEssential is the ideal plan for healthier families and individuals who only really need cover for emergencies. BonEssential offers top-quality hospital cover at affordable prices with added Prescribed Minimum Benefits when you really need them. What it costs Main member Adult dependant Child dependant R1 191 R911 R349 Your fourth and subsequent children will be covered free of charge. Hospital benefits Unlimited hospitalisation at 100% of the Bonitas Rate Get full cover for hospital stays at any private hospital in South Africa. Hospitalisation is covered at 100% of the Bonitas Rate. We cover all major hospital events including oncology treatment and renal dialysis. You also get the following: Unlimited GP and Specialist consultations while in hospital Unlimited pathology covered at 100% of the Bonitas Rate in hospital Unlimited general and specialised radiology covered at 100% of the Bonitas Rate in hospital Unlimited paramedical services covered at 100% of the Bonitas Rate in hospital Unlimited maxillo-facial surgery covered at 100% of the Bonitas Rate in hospital (excluding orthognathic surgery) Unlimited physical therapy (physiotherapy and biokinetics) while in hospital Unlimited cover for organ transplants while in hospital R cover for HIV immune deficiency (subject to Aid for AIDS registration and protocols) R in hospital for mental health benefits R per family for physical rehabilitation R per family for alternatives to hospitalisation such as nursing and out-patient antibiotic therapy R310 per person per admission for medicine on discharge Benefits 2015 Page 25

26 You will have to pay a deductible for certain procedures as shown in the table below: R1 000 deductible R2 500 deductible R5 000 deductible 1. Colonoscopy 2. Conservative back treatment 3. Cystoscopy 4. Facet joint injections 5. Flexible sigmoidoscopy 6. Functional nasal surgery 7. Gastroscopy 8. Umbilical hernia repair 9. Hysteroscopy (not endometrial ablation) 10. Myringotomy 11. Tonsillectomy and adenoidectomy (not PMBs) 12. Varicose vein surgery 1. Arthroscopy 2. Diagnostic laparoscopy 3. Hysterectomy (except cancer and PMBs) 4. Percutaneous radiofrequency ablations 5. Percutaneous rhizotomies 6. Laparoscopic appendectomy 7. Laparoscopic nephrectomy 1. Nissen fundoplication (reflux surgery) 2. Back surgery including spinal fusion 3. Joint replacement (except PMBs) 4. Laparoscopic pyeloplasty 5. Laparoscopic radical prostatectomy Generous oncology benefits On BonEssential you get R per family at a preferred provider for the treatment of cancer. This can be used in and out of hospital and must be pre-authorised. 100% cover for chronic renal dialysis We cover renal dialysis at 100% of the Bonitas Rate at a Preferred Provider. Maternity benefits that bring your baby into the world with the best start We cover the following maternity benefits from risk: 6 consultations while you re pregnant Two 2D ultrasounds Unlimited hospitalisation Four consultations with a midwife after you give birth You ll also get the Bonitas baby pack which features a beautiful baby bag and goodies for both mom and baby. Wellness benefits to keep you in tip-top condition BonEssential offers each member and their dependants one wellness assessment a year. This must be done by a registered provider and includes: A blood pressure test A glucose test A cholesterol test A BMI test A waist to hip ratio measurement Benefits 2015 Page 26

27 Chronic cover for Prescribed Minimum Benefits at a DSP BonEssential gives you and your dependants full cover for 26 chronic conditions and delivers your medicine to you through Pharmacy Direct. 1. Addison s disease 2. Asthma 3. Bipolar disorder 4. Bronchiectasis 5. Cardiac failure 6. Cardiomyopathy 7. Chronic obstructive pulmonary disease 8. Chronic renal disease 9. Coronary artery disease 10. Crohn s disease 11. Diabetes insipidus 12. Diabetes Type Diabetes Type Dysrhythmias 15. Epilepsy 16. Glaucoma 17. Haemophilia 18. Hyperlipidaemia 19. Hypertension 20. Hypothyroidism 21. Multiple sclerosis 22. Parkinson s disease 23. Rheumatoid arthritis 24. Schizophrenia 25. Systemic lupus erythematosus 26. Ulcerative colitis You will have to pay a 40% co-payment for medicine not listed on the formulary or if you do not use Pharmacy Direct. Supplementary benefits Our supplementary benefits are paid from risk so they won t impact your other benefits. They can be used for treatment in and out of hospital and are designed to give you more value for money. Ensure peace of mind with mental health benefits Mental health is covered for Prescribed Minimum Benefit conditions. Get medical cover while you re on holiday The international travel benefit ensures you and your dependants have access to medical care while travelling in a foreign country. Childhood illness benefit to keep your kids healthy This benefit gives each of your children between 2 and 12 years old, 1 GP consultation per year. You also get: Cover for internal and external prostheses for Prescribed Minimum Benefit conditions 1 HIV test and flu vaccine per person Emergency medical transport from ER24 If you want excellent medical care when you need it most, then BonEssential is the option for you. Benefits 2015 Page 27

28 BonCap BonCap is our entry-level product that offers access to network providers and hospitals. Designed to help us achieve our aim of making private healthcare more affordable for all South Africans, BonCap offers basic day-to-day benefits and hospital cover. What it costs You earn Main member Adult dependant Child dependant R500 or less R330 R313 R155 R501 to R6 100 R675 R640 R318 R6 101 to R9 950 R821 R776 R376 R9 951 to R R1 338 R1 192 R507 R or more R1 643 R1 463 R623 In-hospital benefits Unlimited hospitalisation in the BonCap hospital network at 100% of the Bonitas Rate Hospitalisation is covered at 100% of the Bonitas Rate at all hospitals on the BonCap Network. You must pre-authorise your stay (except for emergencies). A R5 350 co-payment must be paid if you use a non-network hospital (except for emergencies) or you do not get pre-authorisation. Benefits 2015 Page 28