2020

INDEX
Why choose Bonitas page 2
Income based option
Overview of our plans page 3
How our plans work page 5 BonCap page 57

Savings options Hospital options

BonComprehensive page 6 Hospital Standard page 62

BonClassic page 11 BonEssential page 66
BonComplete page 17 BonEssential Select page 70
BonSave page 23
BonFit Select page 28 What you need to know page 74

Traditional options

Standard page 33
Standard Select page 39
Primary page 45
Primary Select page 51

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 Fund Rules,
the Fund Rules will prevail. The Fund Rules are available at www.bonitas.co.za or on request. Benefits are subject to approval from the Council for Medical
Schemes.

Page 1 Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
 WHY CHOOSE BONITAS

Affordable, quality healthcare Access to quality service providers

for you and your family and healthcare professionals so you get the
best care

A wide range of plans including Preventative care and wellness

savings, traditional, income based and benefits in addition to savings and day-to-day
hospital plans benefits so you get more value

Cover for up to 60 chronic Benefits for dentistry and optometry

conditions and free medicine delivery in addition to your savings and day-to-day
benefits

Care and support for families Free cover for your fourth
including additional benefits for maternity, and subsequent children so you only pay for a
consultations with a paediatrician and maximum of three children (except on BonCap)
24/7 baby advice line

Managed Care programmes Largest GP network and a specialist

to help you manage chronic conditions network to give you more value for money
including cancer, mental health, HIV/AIDS
and diabetes

Please note:
Claims are Product
paid at therules, limits,
Bonitas Rate.terms and and
Benefits conditions apply.
limits are per Where there
calendar year,isunless
a discrepancy between
otherwise stated.the content
Managed provided
Care in this
protocols brochure,
apply. the
Benefits website
are subjectand the Fundfrom
to approval Rules,the
theCouncil
Fund Rules will prevail.
for Medical The Fund Rules are available on request.
Schemes. Page 2
OVERVIEW OF OUR PLANS

BonComprehensive BonClassic BonComplete BonSave BonFit Select

In-hospital benefits
Unlimited hospital cover ✓ ✓ ✓ ✓ ✓
Bonitas Rate for hospital cover* 150% 100% 100% 100% 100%
Hospital network applies x x x x ✓
Prostheses ✓ ✓ ✓ ✓ x
Cancer treatment ✓ ✓ ✓ ✓ ✓
Mental health ✓ ✓ ✓ ✓ ✓
Out-of-hospital benefits
Day-to-day/GP consultations/Savings ✓ ✓ ✓ ✓ ✓
Chronic conditions covered 60 47 31 27 27
Specialist consultations ✓ ✓ ✓ ✓ ✓
Blood and lab tests ✓ ✓ ✓ ✓ ✓
Specialised radiology (CT scans, MRIs) with no co-payments ✓ ✓ ✓ ✓ ✓
X-rays ✓ ✓ ✓ ✓ ✓
Basic dentistry ✓ ✓ ✓ ✓ ✓
Specialised dentistry ✓ ✓ ✓ x x
Optometry ✓ ✓ ✓ ✓ ✓
Mental health consultations ✓ ✓ ✓ ✓ ✓
Additional benefits
Contraceptives ✓ ✓ ✓ ✓ ✓
Maternity benefits ✓ ✓ ✓ ✓ ✓
24/7 baby advice line for children under 3 ✓ ✓ ✓ ✓ ✓
Childhood immunisations ✓ ✓ ✓ ✓ ✓
Separate benefit for paediatric consultations ✓ x ✓ ✓ ✓
Wellness benefits ✓ ✓ ✓ ✓ ✓
Preventative care ✓ ✓ ✓ ✓ ✓
International travel benefit ✓ ✓ ✓ ✓ ✓

* Please note: Network specialists will be covered in full at the Bonitas Rate.
** Contributions for BonCap are income based. Income will be verified once a year.

Page 3 Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.

Standard Standard Select
✓ ✓
100% 100%
x ✓
✓ ✓
✓ ✓
✓ ✓
✓ ✓
45 45
✓ ✓
✓ ✓
✓ ✓
✓ ✓
✓ ✓
✓ ✓
✓ ✓
✓ ✓
✓ ✓
✓ ✓
✓ ✓
✓ ✓
✓ ✓
✓ ✓
✓ ✓
✓ ✓
Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
OVERVIEW OF OUR PLANS
Primary Primary Select BonCap** Hospital Standard BonEssential BonEssential Select
✓ ✓ ✓ ✓ ✓ ✓
100% 100% 100% 100% 100% 100%
x ✓ ✓ x x ✓
✓ ✓ x ✓ ✓ ✓
✓ ✓ ✓ ✓ ✓ ✓
✓ ✓ ✓ ✓ ✓ ✓
✓ ✓ ✓ x x x
27 27 27 27 27 27
✓ ✓ ✓ x x x
✓ ✓ ✓ x x x
✓ ✓ ✓ ✓ x x
✓ ✓ ✓ x x x
✓ ✓ ✓ x x x
x x x x x x
✓ ✓ ✓ x x x
✓ ✓ ✓ ✓ ✓ ✓
✓ ✓ ✓ ✓ ✓ ✓
✓ ✓ ✓ ✓ ✓ ✓
✓ ✓ ✓ ✓ ✓ ✓
✓ ✓ x x x x
✓ ✓ x ✓ x x
✓ ✓ ✓ ✓ ✓ ✓
✓ ✓ ✓ ✓ ✓ ✓
✓ ✓ x ✓ ✓ ✓
Page 4
HOW OUR PLANS WORK

Comprehensive options
These plans offer you in-hospital and out-of-hospital benefits. Hospital options
Savings plans Traditional plans These plans cover you in-hospital for emergency and planned procedures.

Give you set amount to use as you choose Give you set limits for specific benefits for
for out-of-hospital expenses such as GP example a GP benefit, optical benefit and
visits, optometry and dentistry. dental benefit. HOSPITAL STANDARD
BONESSENTIAL
BONCOMPREHENSIVE STANDARD
BONCLASSIC PRIMARY
BONCOMPLETE
BONSAVE

All plans include benefits for:

Network options Chronic medicine

Contraceptives
These plans use a quality provider network to help you get more value for money.

Maternity
Savings plan Traditional plans Hospital plan
Wellness
BONFIT SELECT STANDARD SELECT BONESSENTIAL SELECT
Preventative care
PRIMARY SELECT
BONCAP INCOME BASED
Managed Care programmes

Page 5 All claims are paid at the Bonitas

Claims
Rate,are
unless
paidotherwise
at the Bonitas
stated.
Rate.
All Benefits
benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
 BONCOMPREHENSIVE

Savings Above-threshold benefit

Main member R16 308
Adult dependant R15 384 Unlimited
Child dependant R3 324

Plus extra benefits for: R28 100 for chronic medicine

for up to 60 conditions
MRIs and CT scans

Mental health
R283 300 cochlear implant benefit

R618 500 cancer benefit Preventative care:

(R245 400 can be used for specialised drugs)
• Bone density screening
• Flu vaccine
• Full lipogram

What you pay R26 300 hearing aid benefit

•
•
HIV test
Mammogram
once every 5 years • Pneumococcal vaccine
• Prostate screening
Main member R7 207
Adult dependant R6 797 R21 190 refractive eye surgery
benefit Managed Care programmes:
Child dependant R1 467 •
•
Back and neck
Cancer
• Diabetes
• Hip and knee replacements
You only pay for a maximum of three children. Full-time Unlimited terminal care benefit • Mental health
students pay child rates up to age 24 years. • HIV/AIDS

All benefits per family unless otherwise stated Page 6

 Out-of-hospital benefits
These benefits provide cover for consultations with your GP or specialist, acute medicine, x-rays,
blood tests and other out-of-hospital medical expenses.
Savings
Self-payment gap
Above threshold benefit
Once your savings for the year are finished, you will need to pay for day-to-day medical expenses
BONCOMPREHENSIVE
yourself until you have paid the full self-payment gap. You will then have access to your above
threshold benefit. Please submit all claims you have paid towards the self-payment gap to us, so
that we can let you know when you have access to your above threshold benefit.
GP consultations
Specialist consultations
Blood tests and other
laboratory tests
X-rays and ultrasounds
Acute medicine
Over-the-counter medicine
Paramedical/Allied medical
professionals
(such as physiotherapists,
occupational therapists,
dieticians and biokineticists)
Specialised dentistry
Basic dentistry
Optometry
General medical appliances
(such as wheelchairs)
Page 7
The following are paid from your unlimited overall annual
benefit (and not from your savings, so you get more value for money):
MRIs and CT scans R31 960 per family, in and out-of-hospital
Main member Adult dependant Child dependant (specialised radiology) Pre-authorisation required
R16 308 R15 384 R3 324 R15 890 per family
R4 080 R3 380 R1 550 In and out-of-hospital consultations (included in the mental
Mental health consultations health hospitalisation benefit)
Unlimited
Cover for educational psychologists for beneficiaries up to the
age of 21 years
R26 300 per family, once every 5 years (based on the date of your
previous claim)
Hearing aids
10% co-payment applies
Paid from available savings or above threshold benefit You must use a preferred supplier
Paid from available savings or above threshold benefit
You must get a referral from your GP
Additional benefits
Paid from available savings or above threshold benefit We believe in giving you more value. The following benefits are in addition to your savings and other
benefits.
Paid from available savings or above threshold benefit
Paid from available savings or above threshold benefit
Formulary and Bonitas Pharmacy Network applies to above Contraceptives
threshold benefit For women aged up to 50 R1 610 per family
20% co-payment for non-network or non-formulary use in above
threshold benefit Maternity care
Paid from available savings or above threshold benefit
Formulary and Bonitas Pharmacy Network applies to above 12 antenatal consultations with a gynaecologist, GP or midwife
threshold benefit 2 2D ultrasound scans
20% co-payment for non-network or non-formulary use in above
R1 240 for antenatal classes
threshold benefit
1 amniocentesis
Per pregnancy
Private ward after delivery
Paid from available savings or above threshold benefit
4 consultations with a midwife after delivery (1 of these can be
used for a consultation with a lactation specialist)
Paid from available savings or above threshold benefit Maternity support for pregnant moms
Dental protocols and limits apply
Pre-authorisation required Childcare
Paid from available savings or above threshold benefit Hearing screening For newborns, in or out-of-hospital
Dental protocols and limits apply
Pre-authorisation required Congenital hypothyroidism
For infants under 1 month old
screening
Paid from available savings or above threshold benefit
Limited to R3 170 per beneficiary, once every 2 years (based on Babyline 24/7 helpline for medical advice for children under 3 years
the date of your previous claim) Paediatrician or GP 3 consultations per child under 1 year
Sublimits apply consultations 2 consultations per child between ages 1 and 2
Each beneficiary can choose glasses or contact lenses
GP consultations 2 consultations per child between ages 2 and 12
Paid from available savings
Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
 Immunisations
According to Expanded Programme on Immunisation in South Chronic benefits
Africa
BonComprehensive offers extensive cover for the 60 chronic conditions listed below. Your chronic
Preventative care medicine benefit is R14 110 per beneficiary and R28 100 per family on the applicable formulary.
If you choose to use medicine that is not on the formulary, you will have to pay a 40% co-payment.
1 HIV test per beneficiary
General health Once the amount above is finished, you will still be covered for the 27 Prescribed Minimum Benefits,
1 flu vaccine per beneficiary listed below. You must get your medicine from the Bonitas Pharmacy Network. If you choose to use
a non-network pharmacy, you will have to pay a 40% co-payment. Pre-authorisation is required.
Cardiac health 1 full lipogram every 5 years, for members aged 20 and over
1 mammogram every 2 years, for women over 40 Prescribed Minimum Benefits covered
Women’s health
1 pap smear every 3 years, for women between ages 21 and 65
1 prostate screening antigen test for men between ages 45 and 1. Addison’s Disease 10. Crohn’s Disease 19. Hyperlipidaemia
Men’s health
69, who are considered to be at high risk for prostate cancer 2. Asthma 11. Diabetes Insipidus 20. Hypertension

BONCOMPREHENSIVE
1 pneumococcal vaccine every 5 years, for members aged 3. Bipolar Mood Disorder 12. Diabetes Type 1 21. Hypothyroidism
65 and over
4. Bronchiectasis 13. Diabetes Type 2 22. Multiple Sclerosis
1 stool test for colon cancer, for members between ages
Elderly health 5. Cardiac Failure 14. Dysrhythmias 23. Parkinson’s Disease
50 and 75
1 bone density screening every 5 years, for women aged 6. Cardiomyopathy 15. Epilepsy 24. Rheumatoid Arthritis
65 and over and men aged 70 and over 7. Chronic Obstructive 16. Glaucoma 25. Schizophrenia
Pulmonary Disease
Wellness benefits
8. Chronic Renal Disease 17. Haemophilia 26. Systemic Lupus
1 wellness screening per beneficiary at a participating pharmacy, Erythematosus
biokineticist or a Bonitas wellness day
9. Coronary Artery Disease 18. HIV/AIDS 27. Ulcerative Colitis
Wellness screening includes the following tests:
Wellness screening • Blood pressure
• Glucose Additional conditions covered
• Cholesterol
• Body mass index 28. Acne 39. Dermatomyositis 50. Obsessive Compulsive
• Waist-to-hip ratio Disorder
29. Allergic Rhinitis 40. Depression 51. Osteoporosis
R2 540 per family which can be used for:
• GP consultations only 30. Alzheimer’s Disease 41. Eczema 52. Paget’s Disease
• Biokineticist consultations and treatment (early onset)
• Dietician consultations and treatment 31. Ankylosing Spondylitis 42. Gastro-Oesophageal 53. Panic Disorder
• Physiotherapist consultations and treatment Reflux Disease
Wellness extender • A programme to stop smoking (GORD)
• X-rays as per formulary
32. Anorexia Nervosa 43. Generalised Anxiety 54. Polyarteritis Nodosa
• Blood tests as per formulary
Disorder
Available after completing a wellness screening
33. Attention Deficit 44. Gout 55. Post-Traumatic Stress
Child dependants can access the wellness extender once an adult Disorder Disorder
beneficiary has completed a wellness screening (in children aged 5-18)

International travel benefit 34. Barrett’s Oesophagus 45. Huntington’s Disease 56. Pulmonary Interstitial
Fibrosis
Cover for medical emergencies when you travel outside South
35. Behcet’s Disease 46. Hyperthyroidism 57. Psoriatic Arthritis
Per trip Africa
36. Bulimia Nervosa 47. Myasthenia Gravis 58. Systemic Sclerosis
You must register for this benefit
37. Cystic Fibrosis 48. Narcolepsy 59. Tourette’s Syndrome
38. Dermatitis 49. Neuropathies 60. Zollinger-Ellison
Syndrome

Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes. Page 8
 Managed Care programmes Provides you with appropriate treatment and tools to live a
normal life
We offer a range of Managed Care programmes to support you and help put you on the path to
good health. These programmes empower you to manage your condition effectively in the most Covers medicine to treat HIV (including drugs to prevent
clinically-proven way, ensuring your benefits last longer. mother-to-child transmission and infection after sexual assault
or needle-stick injury)
You will need to register to join these programmes.
Treatment and prevention of opportunistic infections such as
pneumonia, TB and flu
Helps manage severe back and neck pain
Covers regular blood tests to monitor disease progression,
Offers a personalised treatment plan for up to 6 weeks HIV/AIDS response to therapy and to detect possible side-effects of
Includes assistance from doctors, physiotherapists and treatment
biokineticists Offers HIV-related consultations to visit your doctor to monitor
BONCOMPREHENSIVE

Back and neck Gives access to a home care plan to maintain long-term results your clinical status
We cover the full cost of the programme so it won’t impact your Gives ongoing patient support via a team of trained and
savings or day-to-day benefits experienced counsellors
Highly effective and low-risk, with an excellent success rate Offers access to telephonic support from doctors
Uses the DBC network Helps in finding a registered counsellor for emotional support

Puts you first, offering emotional and medical support
Delivers cost-effective care of the highest quality
Liaises with your doctor to ensure your treatment plan is
clinically appropriate to meet your needs
Cancer Matches the treatment plan to your benefits to ensure you have
the cover you need
Access to a social worker for you and your loved ones
Uses the ICON network of oncology specialists
Uses the Bonitas Oncology Medicine Network
(20% co-payment applies for use of a non-network provider)
Empowers you to make the right decisions to stay healthy
Available to pre-identified members who suffer from depression,
anxiety, post-traumatic stress disorder and alcohol abuse
Access to a Care Manager who will work with you, your
treating doctor and where appropriate, with other healthcare
professionals to assist in improving your condition
Mental wellness Your Care Manager will assist with setting up appointments
with your doctor, obtain authorisation for healthcare services,
understand the importance of preventative care and the use of
wellness benefits or resolve queries related to any other health
condition
Provides educational material about mental health which
empowers you to manage your condition

Offers a personalised care plan for your specific needs

Diabetes management
Hip and knee replacement
Provides cover for the tests required for the management of
diabetes as well as other chronic conditions
Helps you track the results of the required tests
Offers access to diabetes doctors, dieticians and podiatrists
Helps you better understand your condition through diabetes
education
Gives access to a dedicated Health Coach to answer any
questions you may have
Based on the latest international standardised clinical care
pathways
Uses a multidisciplinary team, dedicated to assist with
successful recovery
Doctors evaluate and treat your condition before surgery to give
you the best outcomes
Treatment is covered in full on the ICPS and Joint Care network

Page 9 Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
 In-hospital benefits
This benefit offers cover for major medical events that result in a beneficiary being admitted to
hospital. We negotiate extensively with private hospitals to ensure the best possible value for our
members.
Pre-authorisation is required.
Specialist consultations /
treatment
GP consultations/treatment Unlimited, covered at 100% of the Bonitas Rate
Blood tests and other
laboratory tests
X-rays and ultrasounds
MRIs and CT scans
(specialised radiology)
Paramedical/Allied medical
professionals
(such as physiotherapists,
occupational therapists,
dieticians and biokineticists)
Internal prosthesis
External prosthesis
Internal nerve stimulators
Deep brain stimulation
(excluding prosthesis)
Cochlear implants
Refractive eye surgery
Spinal surgery
Hip and knee replacements
Mental health
hospitalisation
Take-home medicine
Physical rehabilitation
Alternatives to hospital
(hospice, step-down facilities)
Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
Unlimited
Terminal care Including hospice/private nursing, home oxygen,
pain management, psychologist and social worker support
R618 500 per family
R245 400 of this can be used for specialised drugs
Cancer treatment
(including biological drugs)
Sublimit of R44 220 per beneficiary for Brachytherapy
Unlimited, covered at 150% of the Bonitas Rate
Non-cancer specialised
drugs R200 100 per family
(including biological drugs)
Unlimited
Unlimited, covered at 100% of the Bonitas Rate
BONCOMPREHENSIVE
Organ transplants
Sublimit of R32 130 per beneficiary for corneal grafts
Unlimited, covered at 100% of the Bonitas Rate
Unlimited
R31 960 per family, in and out-of-hospital
Kidney dialysis You must use a Designated Service Provider or a 20%
Pre-authorisation required co-payment will apply
Unlimited, if you register on the HIV/AIDS managed care
Unlimited, covered at 100% of the Bonitas Rate HIV/AIDS
programme
Your therapist must get a referral from the doctor treating you
in hospital
R56 200 per family
R56 200 per family
Sublimit of R5 360 per breast prosthesis (limited to 2 per year)
R168 900 per family
R238 000 per beneficiary
R283 300 per family
You must use a preferred supplier
R21 190 per family
Pre-authorisation required
You will have to pay a R10 000 co-payment if you do not go for an
assessment through the back and neck programme
You will have to pay a R10 000 co-payment if you do not use the
preferred provider
R46 880 per family
No cover for physiotherapy for mental health admissions
You must use a Designated Service Provider
R555 per beneficiary, per hospital stay
R50 600 per family
R16 880 per family
Page 10
BONCLASSIC

Savings
Main member R8 484
Adult dependant R7 284
Child dependant R2 100

Plus extra benefits for: R23 910 for chronic medicine

for up to 47 conditions
R5 845 for optometry

R4 790 for basic dentistry

R5 760 for specialised dentistry

Preventative care:
MRIs and CT scans • Bone density screening
• Flu vaccine
• Full lipogram
Mental health • HIV test
• Mammogram
• Pap smear
•
•
Pneumococcal vaccine
Prostate screening What you pay
Unlimited hospital cover
100% Bonitas Rate Main member R5 003

Managed Care programmes: Adult dependant R4 295

Unlimited terminal care benefit • Back and neck
• Cancer Child dependant R1 236
• Diabetes
• Hip and knee replacements
• Mental health
R283 300 cochlear implant benefit • HIV/AIDS
You only pay for a maximum of three children. Full-time
students pay child rates up to age 24 years.

Page 11 All benefits per family unless otherwise stated

 Out-of-hospital benefits
These benefits provide cover for consultations with your GP or specialist, acute medicine, x-rays,
blood tests and other out-of-hospital medical expenses.
Savings
GP consultations
Specialist consultations
Acute medicine
Over-the-counter medicine
Paramedical/Allied medical
professionals
(such as occupational therapists,
physiotherapists, biokineticists
and dieticians)
General medical appliances
(such as wheelchairs and
crutches)
The following are paid from your unlimited overall annual
benefit (and not from your savings, so you get more value for money):
Blood tests and x-rays
MRIs and CT scans
(specialised radiology)
Mental health consultations
Hearing aids
Optometry
Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
1 per beneficiary, at a network provider
Eye tests OR
R325 per beneficiary, at a non-network provider
Single vision lenses (Clear) 100% towards the cost of lenses at network rates
Main member Adult dependant Child dependant
or R185 per lens, per beneficiary, out of network
R8 484 R7 284 R2 100
Bifocal lenses (Clear) 100% towards the cost of lenses at network rates
Paid from available savings or R420 per lens, per beneficiary, out of network
Paid from available savings 100% towards the cost of lenses at network rates
Multifocal lenses (Clear)
You must get a referral from your GP R745 per lens, per beneficiary, out of network
Paid from available savings
R1 110 per beneficiary at a network provider
BONCLASSIC
Paid from available savings Frames
R777 per beneficiary at a non-network provider
Contact lenses R1 790 per beneficiary, included in family limit
Paid from available savings
R4 790 per family, per year
Basic dentistry
Covered at the Bonitas Dental Tariff
Paid from available savings
Consultations 2 annual check-ups per beneficiary (once every 6 months)
X-rays: Intra-oral Managed Care protocols apply
1 per beneficiary, every 3 years
X-rays: Extra-oral Additional benefits may be considered if specialist dental
treatment is required
R3 170 per beneficiary 2 annual scale and polish treatments per beneficiary
(once every 6 months)
R7 030 per family
Oral hygiene Fissure sealants are only covered for children under 16 years
R29 570 per family, in and out-of-hospital Fluoride treatments are only covered for children from age
Pre-authorisation required 5 and younger than 16 years
R15 890 per family Benefit for fillings is granted once per tooth, every 2 years
In and out-of-hospital consultations (included in the mental Benefit for re-treatment of a tooth is subject to Managed Care
Fillings
health hospitalisation benefit) protocols
Cover for educational psychologists for beneficiaries up to the A treatment plan and x-rays may be required for multiple fillings
age of 21 years
Root canal therapy and
R17 220 per family, once every 5 years Managed Care protocols apply
extractions
(based on the date of your previous claim)
1 set of plastic dentures (an upper and a lower) per beneficiary,
10% co-payment applies once every 4 years
Plastic dentures and
You must use a preferred supplier
associated laboratory costs Managed Care protocols apply
R5 845 per family, once every 2 years (based on the date of your Pre-authorisation required
previous claim)
R5 760 per family, per year
Each beneficiary can choose glasses or contact lenses Specialised dentistry
Covered at the Bonitas Dental Tariff
Page 12

Partial metal frame
dentures and associated
laboratory costs
Crowns, bridges and
associated laboratory costs
BONCLASSIC
Orthodontics and associated Benefit for orthodontic treatment will be granted where
laboratory costs function is impaired (not granted for cosmetic reasons)
Periodontics
Maxillo-facial surgery and oral pathology
Surgery in the dental chair
Hospitalisation
(general anaesthetic)
Laughing gas in dental
rooms
Page 13
2 partial frames (an upper and a lower) per beneficiary, once Limited to extensive dental treatment
every 5 years IV conscious sedation in
Managed Care protocols apply
rooms
Managed Care protocols apply Pre-authorisation required
Pre-authorisation required
1 crown per family, per year
Benefit for crowns will be granted once per tooth, every 5 years
A treatment plan and x-rays may be requested
Pre-authorisation required
Orthodontic treatment is granted once per beneficiary,
per lifetime
Pre-authorisation cases will be clinically assessed by using an
orthodontic needs analysis
Benefit allocation is subject to the outcome of the needs Additional benefits
analysis and funding can be granted up to 100% of the Bonitas
We believe in giving you more value. The following benefits are in addition to your savings and other
Dental Tariff
benefits.
Contraceptives
Only 1 family member may begin orthodontic treatment in a
calendar year R1 610 per family
For women aged up to 50 You must use the Designated Service Provider for
Benefit for fixed comprehensive treatment is limited to
pharmacy-dispensed contraceptives
beneficiaries from age 9 and younger than 18 years
Maternity care
Managed Care protocols apply
12 antenatal consultations with a gynaecologist, GP or midwife
Pre-authorisation required
2 2D ultrasound scans
Benefit is limited to conservative, non-surgical therapy only
and will only be applied to members who are registered on the R1 240 for antenatal classes
Periodontal Programme Per pregnancy 1 amniocentesis
Managed Care protocols apply 4 consultations with a midwife after delivery (1 of these can be
Pre-authorisation required used for a consultation with a lactation specialist)
Maternity support for pregnant moms
Managed Care protocols apply Childcare
A co-payment of R3 500 per hospital admission and admission Hearing screening For newborns, in or out-of-hospital
protocols apply Congenital hypothyroidism
For infants under 1 month old
screening
General anaesthetic is only available to children under the
age of 5 for extensive dental treatment Babyline 24/7 helpline for medical advice for children under 3 years
General anaesthetic benefit is available for the removal of According to Expanded Programme on Immunisation in South
Immunisations
impacted teeth Africa
Managed Care protocols apply Preventative care
Pre-authorisation required 1 HIV test per beneficiary
General health
1 flu vaccine per beneficiary
Managed Care protocols apply
Cardiac health 1 full lipogram every 5 years, for members aged 20 and over
Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
 1 mammogram every 2 years, for women over 40 Chronic benefits
Women’s health
1 pap smear every 3 years, for women between ages 21 and 65 BonClassic offers generous cover for the 47 chronic conditions listed below. Your chronic medicine
1 prostate screening antigen test for men between ages 45 and benefit is R11 560 per beneficiary and R23 910 per family on the applicable formulary. If you choose
Men’s health to use medicine that is not on the formulary, you will have to pay a 40% co-payment. You must get
69, who are considered to be at high risk for prostate cancer
your medicine from the Bonitas Pharmacy Network. If you choose to use a non-network pharmacy,
1 pneumococcal vaccine every 5 years, for members aged you will have to pay a 40% co-payment. Pre-authorisation is required.
65 and over
Once the amount above is finished, you will still be covered for the 27 Prescribed Minimum Benefits,
1 stool test for colon cancer, for members between ages listed below, through Pharmacy Direct our Designated Service Provider. If you choose not to use
Elderly health
50 and 75 Pharmacy Direct, you will have to pay a 40% co-payment.
1 bone density screening every 5 years, for women aged
65 and over and men aged 70 and over Prescribed Minimum Benefits covered
Wellness benefits
1 Addison’s Disease 10. Crohn’s Disease 19. Hyperlipidaemia

BONCLASSIC
1 wellness screening per beneficiary at a participating pharmacy,
2. Asthma 11. Diabetes Insipidus 20. Hypertension
biokineticist or a Bonitas wellness day
3. Bipolar Mood Disorder 12. Diabetes Type 1 21. Hypothyroidism
Wellness screening includes the following tests:
Wellness screening • Blood pressure 4. Bronchiectasis 13. Diabetes Type 2 22. Multiple Sclerosis
• Glucose 5. Cardiac Failure 14. Dysrhythmias 23. Parkinson’s Disease
• Cholesterol
• Body mass index 6. Cardiomyopathy 15. Epilepsy 24. Rheumatoid Arthritis
• Waist-to-hip ratio 7. Chronic Obstructive 16. Glaucoma 25. Schizophrenia
R1 750 per family which can be used for: Pulmonary Disease
• GP consultations only 8. Chronic Renal Disease 17. Haemophilia 26. Systemic Lupus
• Biokineticist consultations and treatment Erythematosus
• Dietician consultations and treatment
• Physiotherapist consultations and treatment 9. Coronary Artery Disease 18. HIV/AIDS 27. Ulcerative Colitis
Wellness extender • A programme to stop smoking
• X-rays as per formulary Additional conditions covered
• Blood tests as per formulary
Available after completing a wellness screening 28. Alzheimer’s Disease 35. Gastro-Oesophageal 42. Polyarteritis Nodosa
(early onset) Reflux Disease (GORD)
Child dependants can access the wellness extender once an adult
beneficiary has completed a wellness screening 29. Ankylosing Spondylitis 36. Generalised Anxiety 43. Pulmonary Interstitial
Disorder Fibrosis
International travel benefit
30. Attention Deficit 37. Gout 44. Post-Traumatic Stress
Cover for medical emergencies when you travel outside South Disorder Disorder
Per trip Africa (in children aged 5-18)
You must register for this benefit 31. Barrett's Oesophagus 38. Obsessive Compulsive 45. Scleroderma
Disorder
32. Benign Prostatic 39. Osteoporosis 46. Tourette's Syndrome
Hypertrophy
33. Depression 40. Paget's Disease 47. Zollinger-Ellison
Syndrome
34. Eczema 41. Panic Disorder

Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes. Page 14
 Managed Care programmes Provides you with appropriate treatment and tools to live a
normal life
We offer a range of Managed Care programmes to support you and help put you on the path to
good health. These programmes empower you to manage your condition effectively in the most Covers medicine to treat HIV (including drugs to prevent
clinically-proven way, ensuring your benefits last longer. mother-to-child transmission and infection after sexual assault
or needle-stick injury)
You will need to register to join these programmes.
Treatment and prevention of opportunistic infections such as
pneumonia, TB and flu
Helps manage severe back and neck pain
Covers regular blood tests to monitor disease progression,
Offers a personalised treatment plan for up to 6 weeks HIV/AIDS response to therapy and to detect possible side-effects of
Includes assistance from doctors, physiotherapists and treatment
biokineticists Offers HIV-related consultations to visit your doctor to monitor
Back and neck Gives access to a home care plan to maintain long-term results your clinical status
BONCLASSIC

We cover the full cost of the programme so it won’t impact your Gives ongoing patient support via a team of trained and
savings or day-to-day benefits experienced counsellors
Highly effective and low-risk, with an excellent success rate Offers access to telephonic support from doctors
Uses the DBC network Helps in finding a registered counsellor for emotional support

Puts you first, offering emotional and medical support
Delivers cost-effective care of the highest quality
Liaises with your doctor to ensure your treatment plan is
clinically appropriate to meet your needs
Cancer Matches the treatment plan to your benefits to ensure you have
the cover you need
Access to a social worker for you and your loved ones
Uses the ICON network of oncology specialists
Uses the Bonitas Oncology Medicine Network
(20% co-payment applies for use of a non-network provider)
Empowers you to make the right decisions to stay healthy
Available to pre-identified members who suffer from depression,
anxiety, post-traumatic stress disorder and alcohol abuse
Access to a Care Manager who will work with you, your
treating doctor and where appropriate, with other healthcare
professionals to assist in improving your condition
Mental wellness Your Care Manager will assist with setting up appointments
with your doctor, obtain authorisation for healthcare services,
understand the importance of preventative care and the use of
wellness benefits or resolve queries related to any other health
condition
Provides educational material about mental health which
empowers you to manage your condition

Offers a personalised care plan for your specific needs

Diabetes management
Hip and knee replacement
Provides cover for the tests required for the management of
diabetes as well as other chronic conditions
Helps you track the results of the required tests
Offers access to diabetes doctors, dieticians and podiatrists
Helps you better understand your condition through diabetes
education
Gives access to a dedicated Health Coach to answer any
questions you may have
Based on the latest international standardised clinical care
pathways
Uses a multidisciplinary team, dedicated to assist with
successful recovery
Doctors evaluate and treat your condition before surgery to give
you the best outcomes
Treatment is covered in full on the ICPS and Joint Care network

Page 15 Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
 In-hospital benefits
This benefit offers cover for major medical events that result in a beneficiary being admitted to
hospital. We negotiate extensively with private hospitals to ensure the best possible value for our
members.
Pre-authorisation is required.
Specialist consultations/
treatment
GP consultations/treatment Unlimited, covered at 100% of the Bonitas Rate
Blood tests and other
laboratory tests
X-rays and ultrasounds
MRIs and CT scans
(specialised radiology)
Paramedical/Allied medical
professionals
(such as physiotherapists,
occupational therapists,
dieticians and biokineticists)
Internal and external
prostheses
Spinal surgery
Hip and knee replacements
Cochlear implants
Mental health
hospitalisation
Take-home medicine
Physical rehabilitation
Alternatives to hospital
(hospice, step-down facilities)
Terminal care
Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
R410 400 per family
Cancer treatment You must use a preferred provider
Sublimit of R44 220 per beneficiary for Brachytherapy
Unlimited
Organ transplants
Sublimit of R32 130 per beneficiary for corneal grafts
Unlimited, network specialists covered in full at the Bonitas Rate Unlimited
Kidney dialysis
Unlimited, non-network specialists paid at 100% of the Bonitas You must use a Designated Service Provider, or a
Rate 20% co-payment will apply
Unlimited, if you register on the HIV/AIDS programme
HIV/AIDS Chronic medicine must be obtained from the Designated Service
Unlimited, covered at 100% of the Bonitas Rate Provider
BONCLASSIC
Unlimited, covered at 100% of the Bonitas Rate
R29 570 per family, in and out-of-hospital
Pre-authorisation required
Unlimited, covered at 100% of the Bonitas Rate
Your therapist must get a referral from the doctor treating you in
hospital
R55 690 per family
Managed Care protocols apply
Sublimit of R5 360 per breast prosthesis (limited to 2 per year)
You must use a preferred supplier
You will have to pay a R10 000 co-payment if you do not go for an
assessment through the back and neck programme
You will have to pay a R10 000 co-payment if you do not use the
preferred provider
R283 300 per family
You must use a preferred supplier
R41 210 per family
No cover for physiotherapy for mental health admissions
You must use a Designated Service Provider
R475 per beneficiary, per hospital stay
R50 600 per family
R16 880 per family
Unlimited
Including hospice/private nursing, home oxygen,
pain management, psychologist and social worker support
Page 16
BONCOMPLETE

Savings Above-threshold benefit

Main member R7 200 R4 700
Adult dependant R5 772 R2 770
Child dependant R1 956 R1 200

Plus extra benefits for: Chronic medicine for

Basic and specialised dentistry 31 conditions
MRIs and CT scans

Mental health Preventative care:

• Flu vaccine
GP consultations for children under 12 • Full lipogram
• HIV test
• Pap smear
• Prostate screening

Unlimited hospital cover

• Mammogram
What you pay
100% Bonitas Rate

Managed Care programmes: Main member R4 009

Unlimited terminal care benefit • Back and neck
Adult dependant R3 211
• Cancer
• Diabetes
• HIV/AIDS
Wellness screening plus R1 750 Extender to
Child dependant R1 089
use for blood tests, x-rays, programme to stop
smoking or consultations with a GP, dietician,
biokineticist and physiotherapist You only pay for a maximum of three children. Full-time
students pay child rates up to age 24 years.

Page 17 All benefits per family unless otherwise stated

 Out-of-hospital benefits Paid from available savings or above threshold benefit, once
Optometry every 2 years (based on the date of your previous claim)
These benefits provide cover for consultations with your GP or specialist, acute medicine, x-rays,
blood tests and other out-of-hospital medical expenses. Each beneficiary can choose glasses or contact lenses

1 per beneficiary, once every 2 years at a network provider

Main member Adult dependant Child dependant
OR
Savings R 7 200 R5 772 R1 956 Eye tests
R325 per beneficiary, once every 2 years at a non-network
Self-payment gap R 1 770 R1 500 R385 provider
Above threshold benefit R 4 700 R2 770 R1 200
Single vision lenses (Clear) 100% towards the cost of clear lenses, limited to R185 per lens,
Once your savings for the year are finished, you will need to pay for day-to-day medical expenses or per beneficiary
yourself, until you have paid the full self-payment gap. You will then have access to your above Bifocal lenses (Clear) 100% towards the cost of clear lenses, limited to R420 per lens,

BONCOMPLETE
threshold benefit. Please submit all claims you have paid towards the self-payment gap to us, so or per beneficiary
that we can let you know when you have access to your above threshold benefit. 100% towards the cost of clear lenses, limited to R745 per lens,
Multifocal lenses (Clear)
per beneficiary
GP consultations Paid from available savings or above threshold benefit Frames R775 per beneficiary
Paid from available savings or above threshold benefit Contact lenses R1 910 per beneficiary
Specialist consultations
You must get a referral from your GP Paid from available savings or above threshold benefit
Blood tests and other Paid from available savings, wellness extender or above threshold Available once every 5 years (based on the date of your previous
laboratory tests benefit Hearing aids
claim)
Paid from available savings, wellness extender or above threshold You must use a preferred supplier
X-rays and ultrasounds
benefit
R23 800 per family, in and out-of-hospital
MRIs and CT scans The following are paid from your unlimited overall annual
(specialised radiology) Pre-authorisation required
benefit (and not from your savings, so you get more value for money):
Paid from available savings or above threshold benefit
Formulary and Bonitas Pharmacy Network applies to above
Acute medicine threshold benefit Basic dentistry Covered at the Bonitas Dental Tariff
20% co-payment for non-network or non-formulary use in above Consultations 2 annual check-ups per beneficiary (once every 6 months)
threshold benefit
X-rays: Intra-oral Managed Care protocols apply
Paid from available savings or above threshold benefit
Formulary and Bonitas Pharmacy Network applies to above 1 per beneficiary, every 3 years
Over-the-counter medicine threshold benefit X-rays: Extra-oral Additional benefits may be considered if specialist dental
20% co-payment for non-network or non-formulary use in above treatment is required
threshold benefit
2 annual scale and polish treatments per beneficiary (once every
Paramedical/Allied medical
professionals 6 months)
(such as physiotherapists, Paid from available savings or above threshold benefit Oral hygiene Fissure sealants are only covered for children under 16 years
occupational therapists, Fluoride treatments are only covered for children from age 5 and
dieticians and biokineticists) younger than 16 years
R15 890 per family
In and out-of-hospital consultations (included in the mental Benefit for fillings is granted once per tooth, every 2 years
Mental health consultations health hospitalisation benefit) Benefit for re-treatment of a tooth is subject to Managed Care
Fillings
Cover for educational psychologists for beneficiaries up to the protocols
age of 21 years A treatment plan and x-rays may be required for multiple fillings
General medical appliances Paid from available savings or above threshold benefit Root canal therapy and
(such as wheelchairs and Managed Care protocols apply
You must use a preferred supplier extractions
crutches)

Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes. Page 18

Plastic dentures and
associated laboratory costs
Specialised dentistry
Partial metal frame
dentures and associated
laboratory costs
Crowns, bridges and
associated laboratory costs
BONCOMPLETE
1 set of plastic dentures (an upper and a lower) per beneficiary, Laughing gas in dental
Managed Care protocols apply
once every 4 years rooms
Pre-authorisation required Limited to extensive dental treatment
IV conscious sedation in
Covered at the Bonitas Dental Tariff Managed Care protocols apply
rooms
1 partial frame (an upper or a lower) per beneficiary, once every Pre-authorisation required
5 years
Managed Care protocols apply
Pre-authorisation required
1 crown per family, per year Additional benefits
Benefit for crowns will be granted once per tooth, every 5 years We believe in giving you more value. The following benefits are in addition to your savings and other
A treatment plan and x-rays may be requested benefits.
Pre-authorisation required

Implants and associated Contraceptives

No benefit
laboratory costs
R1 610 per family
Orthodontic treatment is granted once per beneficiary, per
For women aged up to 50 You must use the Designated Service Provider for
lifetime
pharmacy-dispensed contraceptives
Pre-authorisation cases will be clinically assessed by using an
orthodontic needs analysis Maternity care
Benefit allocation is subject to the outcome of the needs analysis 6 antenatal consultations with a gynaecologist, GP or midwife
and funding can be granted up to 65% of the Bonitas Dental 2 2D ultrasound scans
Tariff
Orthodontics and associated Benefit for orthodontic treatment will be granted where function R1 240 for antenatal classes
laboratory costs Per pregnancy 1 amniocentesis
is impaired (not granted for cosmetic reasons)
Only 1 family member may begin orthodontic treatment in a 4 consultations with a midwife after delivery (1 of these can be
calendar year used for a consultation with a lactation specialist)
Benefit for fixed comprehensive treatment is limited to Maternity support for pregnant moms
beneficiaries from age 9 and younger than 18 years
Childcare
Managed Care protocols apply
Pre-authorisation required Hearing screening For newborns, in or out-of-hospital
Congenital hypothyroidism
Benefit is limited to conservative, non-surgical therapy only For infants under 1 month old
screening
and will only be applied to members who are registered on the
Periodontal Programme Babyline 24/7 helpline for medical advice for children under 3 years
Periodontics
Managed Care protocols apply Paediatrician or GP 2 consultations per child under 1 year
consultations 1 consultation per child between ages 1 and 2
Pre-authorisation required
GP consultations 1 consultation per child between ages 2 and 12
Maxillo-facial surgery and oral pathology
According to Expanded Programme on Immunisation in
Surgery in the dental chair Managed Care protocols apply Immunisations
South Africa
A co-payment of R3 500 per hospital admission and admission Preventative care
protocols apply
1 HIV test per beneficiary
General anaesthetic is only available to children under the age of General health
1 flu vaccine per beneficiary
Hospitalisation 5 for extensive dental treatment once per lifetime
Cardiac health 1 full lipogram every 5 years, for members aged 20 and over
(general anaesthetic) General anaesthetic benefit is available for the removal of
1 mammogram every 2 years, for women over 40
impacted teeth Women’s health
Managed Care protocols apply 1 pap smear every 3 years, for women between ages 21 and 65

Pre-authorisation required 1 prostate screening antigen test for men between ages 45 and
Men’s health
69, who are considered to be at high risk for prostate cancer

Page 19 Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
 1 pneumococcal vaccine every 5 years, for members aged Chronic benefits
65 and over
Elderly health BonComplete offers cover for 31 chronic conditions, using the applicable formulary.
1 stool test for colon cancer, for members between ages
50 and 75 Pre-authorisation is required.

Wellness benefits You must use Pharmacy Direct, our Designated Service Provider, to get your medicine. If you choose
not to use Pharmacy Direct or if you choose to use medicine that is not on the formulary, you will
1 wellness screening per beneficiary at a participating pharmacy, have to pay a 40% co-payment.
biokineticist or a Bonitas wellness day
Wellness screening includes the following tests:
• Blood pressure Prescribed Minimum Benefits covered
Wellness screening
• Glucose
• Cholesterol 1. Addison’s Disease 10. Crohn’s Disease 19. Hyperlipidaemia
• Body mass index 2. Asthma 11. Diabetes Insipidus 20. Hypertension
• Waist-to-hip ratio

BONCOMPLETE
3. Bipolar Mood Disorder 12. Diabetes Type 1 21. Hypothyroidism
R1 750 per family which can be used for:
• GP consultations only 4. Bronchiectasis 13. Diabetes Type 2 22. Multiple Sclerosis
• Biokineticist consultations and treatment 5. Cardiac Failure 14. Dysrhythmias 23. Parkinson’s Disease
• Dietician consultations and treatment
6. Cardiomyopathy 15. Epilepsy 24. Rheumatoid Arthritis
• Physiotherapist consultations and treatment
Wellness extender • A programme to stop smoking 7. Chronic Obstructive 16. Glaucoma 25. Schizophrenia
• X-rays as per formulary Pulmonary Disease
• Blood tests as per formulary 8. Chronic Renal Disease 17. Haemophilia 26. Systemic Lupus
Available after completing a wellness screening Erythematosus
Child dependants can access the wellness extender once an adult 9. Coronary Artery Disease 18. HIV/AIDS 27. Ulcerative Colitis
beneficiary has completed a wellness screening
International travel benefit Additional conditions covered
Cover for medical emergencies when you travel outside South
28. Acne 30. Allergic Dermatitis/ 31. Attention Deficit
Per trip Africa
(children up to 21 years) Eczema Disorder
You must register for this benefit (children up to 21 years) (in children aged 5-18)

29. Allergic Rhinitis

(children up to 21 years)

Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes. Page 20
 Managed Care programmes Provides you with appropriate treatment and tools to live a
normal life
We offer a range of Managed Care programmes to support you and help put you on the path to
good health. These programmes empower you to manage your condition effectively in the most Covers medicine to treat HIV (including drugs to prevent
clinically-proven way, ensuring your benefits last longer. mother-to-child transmission and infection after sexual assault
or needle-stick injury)
You will need to register to join these programmes.
Treatment and prevention of opportunistic infections such as
pneumonia, TB and flu
Helps manage severe back and neck pain
Covers regular blood tests to monitor disease progression,
Offers a personalised treatment plan for up to 6 weeks HIV/AIDS response to therapy and to detect possible side-effects of
Includes assistance from doctors, physiotherapists and treatment
biokineticists Offers HIV-related consultations to visit your doctor to monitor
Back and neck Gives access to a home care plan to maintain long-term results your clinical status
BONCOMPLETE

We cover the full cost of the programme so it won’t impact your Gives ongoing patient support via a team of trained and
savings or day-to-day benefits experienced counsellors
Highly effective and low-risk, with an excellent success rate Offers access to telephonic support from doctors
Uses the DBC network Helps in finding a registered counsellor for emotional support

Puts you first, offering emotional and medical support

Delivers cost-effective care of the highest quality
Liaises with your doctor to ensure your treatment plan is
clinically appropriate to meet your needs

Cancer
Diabetes management
Hip and knee replacement
Matches the treatment plan to your benefits to ensure you have
the cover you need
Access to a social worker for you and your loved ones
Uses the ICON network of oncology specialists
Uses the Bonitas Oncology Medicine Network
(20% co-payment applies for use of a non-network provider)
Empowers you to make the right decisions to stay healthy
Offers a personalised care plan for your specific needs
Provides cover for the tests required for the management of
diabetes as well as other chronic conditions
Helps you track the results of the required tests
Offers access to diabetes doctors, dieticians and podiatrists
Helps you better understand your condition through diabetes
education
Gives access to a dedicated Health Coach to answer any
questions you may have
Based on the latest international standardised clinical care
pathways
Uses a multidisciplinary team, dedicated to assist with
successful recovery
Doctors evaluate and treat your condition before surgery to give
you the best outcomes
Treatment is covered in full on the ICPS and Joint Care network

Page 21 Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
 In-hospital benefits
This benefit offers cover for major medical events that result in a beneficiary being admitted to
hospital. We negotiate extensively with private hospitals to ensure the best possible value for our
members.
Pre-authorisation is required.
Specialist consultations/
treatment
GP consultations/treatment Unlimited, covered at 100% of the Bonitas Rate
Blood tests and other
laboratory tests
X-rays and ultrasounds
MRIs and CT scans
(specialised radiology)
Paramedical/Allied medical
professionals
(such as physiotherapists,
occupational therapists,
dieticians and biokineticists)
Internal and external
prostheses
Spinal surgery
Hip and knee replacements
Mental health
hospitalisation
Take-home medicine
Physical rehabilitation
Alternatives to hospital
(hospice, step-down facilities)
Terminal care
Cancer treatment
Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
Unlimited
Organ transplants
Sublimit of R32 130 per beneficiary for corneal grafts
Unlimited
Kidney dialysis You must use a Designated Service Provider, or a 20%
co-payment will apply
Unlimited, if you register on the HIV/AIDS programme
Unlimited, network specialists covered in full at the Bonitas Rate HIV/AIDS
Chronic medicine must be obtained from the Designated Service
Unlimited, non-network specialists paid at 100% of the Provider
Bonitas Rate
BONCOMPLETE
Unlimited, covered at 100% of the Bonitas Rate
Unlimited, covered at 100% of the Bonitas Rate
R23 800 per family, in and out-of-hospital
Pre-authorisation required
Unlimited, covered at 100% of the Bonitas Rate
Your therapist must get a referral from the doctor treating you
in hospital
R45 090 per family
Managed Care protocols apply
Sublimit of R5 360 per breast prosthesis (limited to 2 per year)
You must use a preferred supplier
You will have to pay a R10 000 co-payment if you do not go for an
assessment through the back and neck programme
You will have to pay a R10 000 co-payment if you do not use the
preferred provider
R32 210 per family
No cover for physiotherapy for mental health admissions
You must use a Designated Service Provider
R420 per beneficiary, per hospital stay
R50 600 per family
R16 880 per family
Unlimited
Including hospice/private nursing, home oxygen,
pain management, psychologist and social worker support
R344 500 per family
You must use a preferred provider
Sublimit of R44 220 per beneficiary for Brachytherapy
Page 22
BONSAVE What you pay
Main member R2 723

Savings Adult dependant R2 109

Main member R6 372 Child dependant R815
Adult dependant R4 932
Child dependant R1 908
You only pay for a maximum of three children. Full-time
students pay child rates up to age 24 years.

Plus extra benefits for: Maternity benefits:

6 GP consultations when savings are finished • 6 consultations during pregnancy
• 2 x 2D scans
• R1 240 for antenatal classes
Basic dentistry
• 4 consultations with a midwife after delivery
(1 of these can be used for a consultation with
MRIs and CT scans a lactation specialist)
• Maternity support for pregnant moms
Mental health
Childcare benefits:
• Newborn hearing screening
Wellness screening plus R1 270 Extender to • Thyroid screening for infants under 1 month
use for blood tests, x-rays, programme to stop • Childhood immunisations according to the
smoking or consultations with a GP, dietician, Expanded Programme on Immmunisation
biokineticist and physiotherapist • 2 Paediatric or GP consultations for children under 1
• 1 GP consultation for children aged 2 - 12
• 24/7 Babyline for advice for children under 3
R1 610 for contraceptives
Preventative care:
• Flu vaccine
Unlimited hospital cover • HIV test
100% Bonitas Rate • Pap smear
• Prostate screening
• Mammogram
Unlimited terminal care benefit
Managed Care programmes:
Chronic medicine for 27 PMB • Back and neck
• Cancer
conditions • Diabetes
• HIV/AIDS

Page 23 All benefits per family unless otherwise stated

 Out-of-hospital benefits 2 annual scale and polish treatments per beneficiary
These benefits provide cover for consultations with your GP or specialist, acute medicine, x-rays, (once every 6 months)
blood tests and other out-of-hospital medical expenses. Oral hygiene Fissure sealants are only covered for children under 16 years
Fluoride treatments are only covered for children from age 5 and
Main member Adult dependant Child dependant younger than 16 years
Savings R 6 372 R4 932 R1 908 Benefit for fillings is granted once per tooth, every 2 years
Benefit for re-treatment of a tooth is subject to Managed Care
GP consultations Paid from available savings Fillings
protocols
Paid from available savings A treatment plan and x-rays may be required for multiple fillings
Specialist consultations
You must get a referral from your GP Benefit for root canal limited to the shortened dental arch and
Root canal therapy and excludes milk teeth and permanent molars
Acute medicine and
Paid from available savings extractions
over-the-counter medicine Managed Care protocols apply

X-rays and ultrasounds
Blood tests and other
laboratory tests
Paramedical/Allied medical
professionals
(such as physiotherapists,
occupational therapists,
dieticians and biokineticists)
Optometry
General medical appliances
(such as wheelchairs and
crutches)
External prostheses
The following are paid from your unlimited overall annual
benefit (and not from your savings, so you get more value for money):
BONSAVE
Paid from available savings Plastic dentures and
No benefit
associated laboratory costs
Paid from available savings
Maxillo-facial surgery and oral pathology
Managed Care protocols apply
Surgery in the dental chair
Paid from available savings Pre-authorisation required
Hospitalisation PMB only
(general anaesthetic) Pre-authorisation required
Paid from available savings
Laughing gas in dental
Managed Care protocols apply
Paid from available savings rooms
Limited to extensive dental treatment
Paid from available savings IV conscious sedation in
Managed Care protocols apply
rooms
Pre-authorisation required

MRIs and CT scans R23 800 per family, in and out-of-hospital

(specialised radiology) Pre-authorisation required
R15 890 per family
In and out-of-hospital consultations (included in the mental
Mental health consultations health hospitalisation benefit)
Cover for educational psychologists for beneficiaries up to the
age of 21 years
Basic dentistry Covered at the Bonitas Dental Tariff
Consultations 2 annual check-ups per beneficiary (once every 6 months)
X-rays: Intra-oral Managed Care protocols apply
1 per beneficiary, every 3 years
X-rays: Extra-oral Additional benefits may be considered if specialist dental
treatment is required

Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes. Page 24
 Additional benefits Wellness benefits
We believe in giving you more value. The following benefits are in addition to your savings and other 1 wellness screening per beneficiary at a participating pharmacy,
benefits. biokineticist or a Bonitas wellness day
Wellness screening includes the following tests:
If you use all your savings for the year, your family will still get • Blood pressure
Wellness screening
Additional GP consultations a maximum of 6 GP consultations (limited to 3 per beneficiary) • Glucose
paid at the Bonitas Rate • Cholesterol
• Body mass index
Contraceptives • Waist-to-hip ratio
R1 610 per family R1 270 per family which can be used for:
For women aged up to 50 You must use the Designated Service Provider for • GP consultations only
pharmacy-dispensed contraceptives • Biokineticist consultations and treatment
• Dietician consultations and treatment
Maternity care
BONSAVE

• Physiotherapist consultations and treatment

6 antenatal consultations with a gynaecologist, GP or midwife • A programme to stop smoking
Wellness extender
2 2D ultrasound scans • X-rays as per formulary
R1 240 for antenatal classes • Blood tests as per formulary
Per pregnancy 1 amniocentesis Available after completing a wellness screening
4 consultations with a midwife after delivery (1 of these can be Child dependants can access the wellness extender once an adult
used for a consultation with a lactation specialist) beneficiary has completed a wellness screening
Maternity support for pregnant moms International travel benefit
Childcare Cover for medical emergencies when you travel outside South
Hearing screening For newborns, in or out-of-hospital Per trip Africa

Congenital hypothyroidism You must register for this benefit

For infants under 1 month old
screening
Babyline 24/7 helpline for medical advice for children under 3 years

Paediatrician or GP 2 consultations per child under 1 year

consultations 1 consultation per child between ages 1 and 2
GP consultations 1 consultation per child between ages 2 and 12
According to Expanded Programme on Immunisation in South
Immunisations
Africa
Preventative care
1 HIV test per beneficiary
General health
1 flu vaccine per beneficiary
1 mammogram every 2 years, for women over 40
Women’s health
1 pap smear every 3 years, for women between ages 21 and 65

1 prostate screening antigen test for men between ages 45 and

Men’s health
69, who are considered to be at high risk for prostate cancer

1 pneumococcal vaccine every 5 years, for members aged

65 and over
Elderly health
1 stool test for colon cancer, for members between ages
50 and 75

Page 25 Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
 Chronic benefits Puts you first, offering emotional and medical support
BonSave ensures that you are covered for the 27 Prescribed Minimum Benefits listed below. You Delivers cost-effective care of the highest quality
must use Pharmacy Direct, our Designated Service Provider, to get your medicine. If you choose not Liaises with your doctor to ensure your treatment plan is
to use Pharmacy Direct or if you choose to use medicine that is not on the formulary, you will have clinically appropriate to meet your needs
to pay a 40% co-payment.
Cancer Matches the treatment plan to your benefits to ensure you have
the cover you need
Prescribed Minimum Benefits covered
Access to a social worker for you and your loved ones
1. Addison’s Disease 10. Crohn’s Disease 19. Hyperlipidaemia Uses the ICON network of oncology specialists
Uses the Bonitas Oncology Medicine Network
2. Asthma 11. Diabetes Insipidus 20. Hypertension
(20% co-payment applies for use of a non-network provider)
3. Bipolar Mood Disorder 12. Diabetes Type 1 21. Hypothyroidism
Empowers you to make the right decisions to stay healthy
4. Bronchiectasis 13. Diabetes Type 2 22. Multiple Sclerosis
Offers a personalised care plan for your specific needs

BONSAVE
5. Cardiac Failure 14. Dysrhythmias 23. Parkinson’s Disease
Provides cover for the tests required for the management of
6. Cardiomyopathy 15. Epilepsy 24. Rheumatoid Arthritis diabetes as well as other chronic conditions
7. Chronic Obstructive 16. Glaucoma 25. Schizophrenia Helps you track the results of the required tests
Pulmonary Disease Diabetes management
Offers access to diabetes doctors, dieticians and podiatrists
8. Chronic Renal Disease 17. Haemophilia 26. Systemic Lupus
Erythematosus Helps you better understand your condition through diabetes
education
9. Coronary Artery Disease 18. HIV/AIDS 27. Ulcerative Colitis
Gives access to a dedicated Health Coach to answer any
questions you may have
Provides you with appropriate treatment and tools to live a
normal life
Covers medicine to treat HIV (including drugs to prevent
mother-to-child transmission and infection after sexual assault
or needle-stick injury)
Treatment and prevention of opportunistic infections such as
pneumonia, TB and flu
Covers regular blood tests to monitor disease progression,
HIV/AIDS response to therapy and to detect possible side-effects of
Managed Care programmes treatment

We offer a range of Managed Care programmes to support you and help put you on the path to Offers HIV-related consultations to visit your doctor to monitor
good health. These programmes empower you to manage your condition effectively in the most your clinical status
clinically-proven way, ensuring your benefits last longer. Gives ongoing patient support via a team of trained and
You will need to register to join these programmes. experienced counsellors
Helps manage severe back and neck pain Offers access to telephonic support from doctors
Offers a personalised treatment plan for up to 6 weeks Helps in finding a registered counsellor for emotional support
Includes assistance from doctors, physiotherapists and
biokineticists
Back and neck Gives access to a home care plan to maintain long-term results
We cover the full cost of the programme so it won’t impact your
savings or day-to-day benefits
Highly effective and low-risk, with an excellent success rate
Uses the DBC network

Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes. Page 26
 In-hospital benefits
This benefit offers cover for major medical events that result in a beneficiary being admitted to
hospital. We negotiate extensively with private hospitals to ensure the best possible value for our
members.
Pre-authorisation is required.
Specialist consultations/
treatment
GP consultations/treatment Unlimited, covered at 100% of the Bonitas Rate
Blood tests and other
laboratory tests
X-rays and ultrasounds
BONSAVE
MRIs and CT scans
(specialised radiology)
Paramedical/Allied medical
professionals
(such as physiotherapists,
occupational therapists,
dieticians and biokineticists)
Internal prosthesis
Mental health
hospitalisation
Take-home medicine
Physical rehabilitation
Alternatives to hospital
(hospice, step-down facilities)
Terminal care
Cancer treatment
Organ transplants
Kidney dialysis
Page 27
Unlimited, if you register on the HIV/AIDS programme
HIV/AIDS Chronic medicine must be obtained from the
Designated Service Provider
A co-payment will apply to the following procedures in hospital:
R1 520 co-payment R3 850 co-payment R7 580 co-payment
1. Colonoscopy 1. Arthroscopy 1. Back Surgery including
Unlimited, covered at 100% of the Bonitas Rate Spinal Fusion
2. Conservative Back 2. Diagnostic Laparoscopy 2. Joint Replacements
Treatment
Unlimited, covered at 100% of the Bonitas Rate 3. Cystoscopy 3. Laparoscopic 3. Laparoscopic
Hysterectomy Pyeloplasty
Unlimited, covered at 100% of the Bonitas Rate
4. Facet Joint Injections 4. Percutaneous 4. Laparoscopic Radical
R23 800 per family, in and out-of-hospital Radiofrequency Prostatectomy
Pre-authorisation required Ablations
(Percutaneous Rhizotomies)
5. Flexible Sigmoidoscopy 5. Nissen Fundoplication
Paid from available savings (except for PMB) (Reflux Surgery)
6. Functional Nasal Surgery
R32 130 per family (excluding joint replacement prosthesis)
7. Gastroscopy
Managed Care protocols apply
8. Hysteroscopy
You must use a preferred supplier (not Endometrial Ablation)
R32 210 per family 9. Myringotomy
No cover for physiotherapy for mental health admissions 10. Tonsillectomy and
Adenoidectomy
You must use a Designated Service Provider
11. Umbilical Hernia Repair
R390 per beneficiary, per hospital stay
12. Varicose Vein Surgery
R50 600 per family
R16 880 per family
Unlimited
Including hospice/private nursing, home oxygen,
pain management, psychologist and social worker support
R344 500 per family
You must use a preferred provider
Sublimit of R44 220 per beneficiary for Brachytherapy
Unlimited
Sublimit of R32 130 per beneficiary for corneal grafts
Unlimited
You must use a Designated Service Provider, or a 20%
co-payment will apply
Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
 BONFIT SELECT

Savings
Main member R4 128
Adult dependant R3 204
Child dependant R1 236

Plus extra benefits for: Chronic medicine for 27 PMB

2 GP consultations when savings are finished conditions

Basic dentistry

Maternity benefits:
• 6 consultations during pregnancy
• 2 x 2D scans
Unlimited hospital cover • 4 consultations with a midwife after delivery
100% Bonitas Rate (1 of these can be used for a consultation with
a lactation specialist)
• Maternity support for pregnant moms

Wellness screening plus R1 270 Extender to

What you pay use for blood tests, x-rays, programme to stop
smoking or consultations with a GP, dietician, Childcare benefits:
biokineticist and physiotherapist • Newborn hearing screening
• Thyroid screening for infants under 1 month
Main member R2 152 • Childhood immunisations according to the
Expanded Programme on Immmunisation
• 2 Paediatric or GP consultations for children under 1
Adult dependant R1 668 R1 610 for contraceptives • 1 GP consultation for children aged 2 - 12
• 24/7 Babyline for advice for children under 3

Child dependant R645

Managed Care programmes:
• Back and neck
Preventative care:
You only pay for a maximum of three children. Full-time
students pay child rates up to age 24 years. • Cancer • Flu vaccine
• Diabetes • HIV test
• HIV/AIDs • Pap smear

All benefits per family unless otherwise stated Page 28

 Out-of-hospital benefits 2 annual scale and polish treatments per beneficiary
(once every 6 months)
These benefits provide cover for consultations with your GP or specialist, acute medicine, x-rays,
blood tests and other out-of-hospital medical expenses. Oral hygiene Fissure sealants are only covered for children under 16 years
Fluoride treatments are only covered for children from age
5 and younger than 16 years
Main member Adult dependant Child dependant
Fillings No benefit
Savings R 4 128 R3 204 R1 236
Root canal therapy and
No benefit
extractions
GP consultations Paid from available savings
Paid from available savings
Specialist consultations
You must get a referral from your GP
Additional benefits
BONFIT SELECT

Blood tests and other

Paid from available savings We believe in giving you more value. The following benefits are in addition to your savings and other
laboratory tests
benefits.
X-rays and ultrasounds Paid from available savings

MRIs and CT scans
(specialised radiology)
Acute medicine
Over-the-counter medicine
Paramedical/Allied medical
professionals
(such as physiotherapists,
occupational therapists,
dieticians and biokineticists)
Paid from available savings If you use all your savings for the year, your family will still get
Pre-authorisation required Additional GP consultations a maximum of 2 GP consultations (limited to 1 per beneficiary)
paid at the Bonitas Rate
Paid from available savings
Contraceptives
Paid from available savings
R1 610 per family
For women aged up to 50 You must use the Designated Service Provider for
Paid from available savings pharmacy-dispensed contraceptives
Maternity care

General medical appliances Paid from available savings 6 antenatal consultations with a gynaecologist, GP or midwife
2 2D ultrasound scans
Optometry Paid from available savings
1 amniocentesis
Per pregnancy
4 consultations with a midwife after delivery (1 of these can be
The following are paid from your unlimited overall annual used for a consultation with a lactation specialist)
benefit (and not from your savings, so you get more value for money): Maternity support for pregnant moms
Childcare
PMB consultations only
Hearing screening For newborns, in or out-of-hospital
In and out-of-hospital consultations (included in the mental
Mental health consultations health hospitalisation benefit) Congenital hypothyroidism
For infants under 1 month old
screening
Cover for educational psychologists for beneficiaries up to the
age of 21 years Babyline 24/7 helpline for medical advice for children under 3 years
Covered at the Bonitas Dental Tariff Paediatrician or GP 2 consultations per child under 1 year
Basic dentistry consultations
Managed Care protocols apply 1 consultation per child between ages 1 and 2
Consultations 2 annual check-ups per beneficiary (once every 6 months) GP consultations 1 consultation per child between ages 2 and 12
X-rays: Intra-oral No benefit According to Expanded Programme on Immunisation in South
Immunisations
Africa
X-rays: Extra-oral No benefit
Preventative care
1 HIV test per beneficiary
General health
1 flu vaccine per beneficiary

Page 29 Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
 1 mammogram every 2 years, for women over 40 Chronic benefits
Women’s health
1 pap smear every 3 years, for women between ages 21 and 65 BonFit Select ensures that you are covered for the 27 Prescribed Minimum Benefits listed below.
You must use Pharmacy Direct, our Designated Service Provider, to get your medicine. If you choose
1 prostate screening antigen test for men between ages 45 and
Men’s health not to use Pharmacy Direct or if you choose to use medicine that is not on the formulary, you will
69, who are considered to be at high risk for prostate cancer
have to pay a 40% co-payment.
1 pneumococcal vaccine every 5 years, for members aged
65 and over Prescribed Minimum Benefits covered
Elderly health
1 stool test for colon cancer, for members between ages
50 and 75 1. Addison’s Disease 10. Crohn’s Disease 19. Hyperlipidaemia
Wellness benefits 2. Asthma 11. Diabetes Insipidus 20. Hypertension
1 wellness screening per beneficiary at a participating pharmacy, 3. Bipolar Mood Disorder 12. Diabetes Type 1 21. Hypothyroidism
biokineticist or a Bonitas wellness day 4. Bronchiectasis 13. Diabetes Type 2 22. Multiple Sclerosis

BONFIT SELECT
Wellness screening includes the following tests: 5. Cardiac Failure 14. Dysrhythmias 23. Parkinson’s Disease
Wellness screening • Blood pressure
• Glucose 6. Cardiomyopathy 15. Epilepsy 24. Rheumatoid Arthritis
• Cholesterol 7. Chronic Obstructive 16. Glaucoma 25. Schizophrenia
• Body mass index Pulmonary Disease
• Waist-to-hip ratio
8. Chronic Renal Disease 17. Haemophilia 26. Systemic Lupus
R1 270 per family which can be used for: Erythematosus
• GP consultations only 9. Coronary Artery Disease 18. HIV/AIDS 27. Ulcerative Colitis
• Biokineticist consultations and treatment
• Dietician consultations and treatment
• Physiotherapist consultations and treatment
Wellness extender • A programme to stop smoking
• X-rays as per formulary
• Blood tests as per formulary
Available after completing a wellness screening
Child dependants can access the wellness extender once an adult
beneficiary has completed a wellness screening
International travel benefit
Cover for medical emergencies when you travel outside South
Per trip Africa
You must register for this benefit

Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes. Page 30
 Managed Care programmes Provides you with appropriate treatment and tools to live a
normal life
We offer a range of Managed Care programmes to support you and help put you on the path to
good health. These programmes empower you to manage your condition effectively in the most Covers medicine to treat HIV (including drugs to prevent
clinically-proven way, ensuring your benefits last longer. mother-to-child transmission and infection after sexual assault
or needle-stick injury)
You will need to register to join these programmes.
Treatment and prevention of opportunistic infections such as
pneumonia, TB and flu
Helps manage severe back and neck pain
Covers regular blood tests to monitor disease progression,
Offers a personalised treatment plan for up to 6 weeks HIV/AIDS response to therapy and to detect possible side-effects of
Includes assistance from doctors, physiotherapists and treatment
biokineticists Offers HIV-related consultations to visit your doctor to monitor
Back and neck Gives access to a home care plan to maintain long-term results your clinical status
BONFIT SELECT

We cover the full cost of the programme so it won’t impact your Gives ongoing patient support via a team of trained and
savings or day-to-day benefits experienced counsellors
Highly effective and low-risk, with an excellent success rate Offers access to telephonic support from doctors
Uses the DBC network Helps in finding a registered counsellor for emotional support

Puts you first, offering emotional and medical support

Delivers cost-effective care of the highest quality
Liaises with your doctor to ensure your treatment plan is
clinically appropriate to meet your needs

Cancer Matches the treatment plan to your benefits to ensure you have
the cover you need
Access to a social worker for you and your loved ones
Uses the ICON network of oncology specialists
Uses the Bonitas Oncology Medicine Network
(20% co-payment applies for use of a non-network provider)
Empowers you to make the right decisions to stay healthy
Offers a personalised care plan for your specific needs
Provides cover for the tests required for the management of
diabetes as well as other chronic conditions
Helps you track the results of the required tests
Diabetes management
Offers access to diabetes doctors, dieticians and podiatrists
Helps you better understand your condition through diabetes
education
Gives access to a dedicated Health Coach to answer any
questions you may have

Page 31 Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
 In-hospital benefits Unlimited, if you register on the HIV/AIDS programme
This benefit offers cover for major medical events that result in a beneficiary being admitted to HIV/AIDS Chronic medicine must be obtained from the Designated Service
hospital. We negotiate extensively with private hospitals to ensure the best possible value for our Provider
members.
Pre-authorisation is required.
A co-payment will apply to the following procedures in hospital:
Please note: You must use a hospital on the BonFit Select network or you will have to pay a
30% co-payment. R1 520 co-payment R3 850 co-payment R7 580 co-payment
1. Colonoscopy 1. Arthroscopy 1. Back Surgery including
Unlimited, network specialists covered in full at the Bonitas Rate Spinal Fusion
Specialist consultations/
treatment Unlimited, non-network specialists paid at 100% of the 2. Conservative Back 2. Diagnostic Laparoscopy 2. Joint Replacements
Bonitas Rate Treatment

BONFIT SELECT
GP consultations/treatment Unlimited, covered at 100% of the Bonitas Rate 3. Cystoscopy 3. Laparoscopic 3. Laparoscopic
Blood tests and other Hysterectomy Pyeloplasty
Unlimited, covered at 100% of the Bonitas Rate
laboratory tests 4. Facet Joint Injections 4. Percutaneous 4. Laparoscopic Radical
X-rays and ultrasounds Unlimited, covered at 100% of the Bonitas Rate Radiofrequency Prostatectomy
Ablations
MRIs and CT scans R16 070 per family (Percutaneous Rhizotomies)
(specialised radiology) Pre-authorisation required 5. Flexible Sigmoidoscopy 5. Nissen Fundoplication
Paramedical/Allied medical (Reflux Surgery)
professionals 6. Functional Nasal Surgery
(such as physiotherapists, Paid from available savings (except for PMB)
occupational therapists,
dieticians and biokineticists) 7. Gastroscopy
PMB only 8. Hysteroscopy
Internal and external (not Endometrial Ablation)
Managed Care protocols apply
prostheses
You must use a preferred supplier 9. Myringotomy

R32 210 per family 10. Tonsillectomy and

Mental health Adenoidectomy
No cover for physiotherapy for mental health admissions
hospitalisation 11. Umbilical Hernia Repair
You must use a Designated Service Provider
12. Varicose Vein Surgery
Take-home medicine R390 per beneficiary, per hospital stay
Physical rehabilitation R50 600 per family
Alternatives to hospital
R16 880 per family
(hospice, step-down facilities)
Unlimited
Terminal care Including hospice/private nursing, home oxygen,
pain management, psychologist and social worker support
R344 500 per family
Cancer treatment You must use a preferred provider
Sublimit of R44 220 per beneficiary for Brachytherapy
Organ transplants Unlimited
Unlimited
Kidney dialysis You must use a Designated Service Provider, or a
20% co-payment will apply

Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes. Page 32
STANDARD

Rich GP benefit up to R7 870 and day-to-day up to R12 420

Plus extra benefits for: Maternity benefits:

General appliances • 12 consultations during pregnancy
(including moonboot and crutches) • 2 x 2D scans
• R1 240 for antenatal classes
MRIs and CT scans • 4 consultations with a midwife after delivery
(1 of these can be used for a consultation with
Mental health a lactation specialist)
• Maternity support for pregnant moms
Basic and specialised dentistry

Optometry
Childcare benefits:
• Newborn hearing screening
• Thyroid screening for infants under 1 month
• Childhood immunisations according to the
Expanded Programme on Immmunisation
• 2 Paediatric or GP consultations for children under 1
Unlimited hospital cover • 2 GP consultations for children aged 2 - 12
100% Bonitas Rate • 24/7 Babyline for advice for children under 3

Wellness screening plus R1 750 Extender to

Preventative care: What you pay
use for blood tests, x-rays, programme to stop • Full lipogram
smoking or consultations with a GP, dietician, • Flu vaccine
biokineticist and physiotherapist • HIV test Main member R3 888
• Mammogram
• Pap smear
• Prostate screening Adult dependant R3 371
R283 300 cochlear implant benefit
Managed Care programmes:
Child dependant R1 140
• Back and neck
• Cancer You only pay for a maximum of three children. Full-time
R19 670 for chronic medicine • Diabetes students pay child rates up to age 24 years.
for up to 45 conditions • Hip and knee replacements
• HIV/AIDS
• Mental health

Page 33 All benefits per family unless otherwise stated

 Out-of-hospital benefits R790 per beneficiary
R2 400 per family
Out-of-hospital claims will be paid from available day-to-day benefits. There is a separate benefit
for GP consultations. Paid from available day-to-day benefits
Over-the-counter medicine
Formulary and Bonitas Pharmacy Network applies
20% co-payment for non-network or non-
GP consultations
formulary use
If you do not use a GP on our network, your benefit for GP consultations will be limited to the
non-network GP consultation benefit. This is shown in the table below. The following are paid from your unlimited overall annual
R4 250 (R1 380 of this can be used for
benefit (and not from your day-to-day benefits, so you get more value for money):
Main member only
non-network GP consultations)
R6 230 (R2 130 of this can be used for MRIs and CT scans R26 620 per family, in and out-of-hospital
Main member + 1 dependant (specialised radiology)
non-network GP consultations) Pre-authorisation required

STANDARD
R6 910 (R2 330 of this can be used for R15 890 per family
Main member + 2 dependants
non-network GP consultations)
In and out-of-hospital consultations (included in the mental
R7 250 (R2 430 of this can be used for Mental health consultations health hospitalisation benefit)
Main member + 3 dependants
non-network GP consultations)
Cover for educational psychologists for beneficiaries up to the
R7 870 (R2 620 of this can be used for age of 21 years
Main member + 4 or more dependants
non-network GP consultations)
R7 820 per family
General medical appliances An additional R6 680 per family will apply should Stoma Care and
Day-to-day benefits (such as wheelchairs and
CPAP machines exceed the general medical appliances limit
crutches)
These benefits provide cover for consultations with your specialist, acute medicine, x-rays, blood You must use a preferred supplier
tests and other out-of-hospital medical expenses.
R16 320 per family, once every 5 years (based on the date of your
previous claim)
There is a separate benefit for tests and consultations for PMB treatment plans (excluding Hearing aids
GP consultations) so this will not affect your day-to-day benefits. 20% co-payment applies
You must use a preferred supplier
Main member only R5 940 R6 115 per family, once every 2 years (based on the date of your
Main member + 1 dependant R9 030 Optometry previous claim)

Main member + 2 dependants R10 440 Each beneficiary can choose glasses or contact lenses

Main member + 3 dependants R11 400 1 per beneficiary, at a network provider

Main member + 4 or more dependants
Specialist consultations
Blood tests and other laboratory tests
X-rays and ultrasounds
Acute medicine
Paramedical/Allied medical professionals
(such as physiotherapists, occupational
therapists, dieticians and biokineticists)
R12 420 Eye tests OR
R325 per beneficiary, at a non-network provider
Paid from available day-to-day benefits
You must get a referral from your GP Single vision lenses (Clear) 100% towards the cost of lenses at network rates
or R185 per lens, per beneficiary, out of network
Paid from available day-to-day benefits
Paid from available day-to-day benefits Bifocal lenses (Clear) 100% towards the cost of lenses at network rates
or R420 per lens, per beneficiary, out of network
Paid from available day-to-day benefits
Formulary and Bonitas Pharmacy Network applies 100% towards the cost of lenses at network rates
Multifocal lenses (Clear)
20% co-payment for non-network or R745 per lens, per beneficiary, out of network
non-formulary use
R1 275 per beneficiary at a network provider
Frames
Paid from available day-to-day benefits R893 per beneficiary at a non-network provider
Contact lenses R1 870 per beneficiary (included in the family limit)

Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes. Page 34
 Basic dentistry Covered at the Bonitas Dental Tariff Benefit is limited to conservative, non-surgical therapy only
Consultations 2 annual check-ups per beneficiary (once every 6 months) and will only be applied to members who are registered on the
Periodontics Periodontal Programme
X-rays: Intra-oral Managed Care protocols apply Managed Care protocols apply
1 per beneficiary, every 3 years Pre-authorisation required
X-rays: Extra-oral Additional benefit may be considered if specialist dental Maxillo-facial surgery and oral pathology
treatment planning/follow up is required
Surgery in the dental chair Managed Care protocols apply
2 annual scale and polish treatments per beneficiary (once every
6 months) A co-payment of R3 500 per hospital admission and admission
protocols apply
Oral hygiene Fissure sealants are only covered for children under 16 years
General anaesthetic is only available to children under the age of
Fluoride treatments are only covered for children from age 5 for extensive dental treatment once per lifetime
Hospitalisation
5 and younger than 16 years
(general anaesthetic) General anaesthetic benefit is available for the removal of
STANDARD

Fillings
Root canal and extractions
Benefit for fillings is granted once per tooth, every 2 years impacted teeth
Benefit for re-treatment of a tooth is subject to Managed Care Managed Care protocols apply
protocols Pre-authorisation required
A treatment plan and x-rays may be required for multiple fillings Laughing gas in dental
Managed Care protocols apply
Managed Care protocols apply rooms

1 set of plastic dentures (an upper and a lower) per beneficiary, Limited to extensive dental treatment
Plastic dentures and IV conscious sedation in
once every 4 years Managed Care protocols apply
associated laboratory costs rooms
Pre-authorisation required Pre-authorisation required

Specialised dentistry Covered at the Bonitas Dental Tariff

1 partial frame (an upper or lower) per beneficiary, once every
Partial metal frame 5 years Additional benefits
dentures and associated We believe in giving you more value. The following benefits are in addition to your day-to-day and
Managed Care protocols apply
laboratory costs
other benefits.
Pre-authorisation required
1 crown per family, per year
Contraceptives
Crowns, bridges and Benefit for crowns will be granted once per tooth, every 5 years
R1 610 per family
associated laboratory costs A treatment plan and x-rays may be requested For women aged up to 50 You must use the Designated Service Provider for
Pre-authorisation required pharmacy-dispensed contraceptives
Orthodontic treatment is granted once per beneficiary, per Maternity care
lifetime
12 antenatal consultations with a gynaecologist, GP or midwife
Pre-authorisation cases will be clinically assessed by using an
orthodontic needs analysis 2 2D ultrasound scans
Benefit allocation is subject to the outcome of the needs analysis R1 240 for antenatal classes
and funding can be granted up to 80% of the Bonitas Dental Per pregnancy 1 amniocentesis
Tariff
Orthodontics and associated Benefit for orthodontic treatment will be granted where function 4 consultations with a midwife after delivery (1 of these can be
laboratory costs used for a consultation with a lactation specialist)
is impaired (not granted for cosmetic reasons)
Only 1 family member may begin orthodontic treatment in a Maternity support for pregnant moms
calendar year Childcare
Benefit for fixed comprehensive treatment is limited to Hearing screening For newborns, in or out-of-hospital
beneficiaries from age 9 and younger than 18 years
Congenital hypothyroidism
Managed Care protocols apply For infants under 1 month old
screening
Pre-authorisation required

Page 35 Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
 Babyline 24/7 helpline for medical advice for children under 3 years Chronic benefits
Paediatrician or GP 2 consultations per child under 1 year Standard offers generous cover for the 45 chronic conditions listed below. Your chronic medicine
consultations 2 consultations per child between ages 1 and 2 benefit is R9 800 per beneficiary and R19 670 per family on the applicable formulary. If you choose
to use medicine that is not on the formulary, you will have to pay a 40% co-payment. You must get
GP consultations 2 consultations per child between ages 2 and 12 your medicine from the Bonitas Pharmacy Network. If you choose to use a non-network pharmacy,
According to Expanded Programme on Immunisation in you will have to pay a 40% co-payment. Pre-authorisation is required.
Immunisations
South Africa Once the amount above is finished, you will still be covered for the 27 Prescribed Minimum Benefits,
Preventative care listed below, through Pharmacy Direct our Designated Service Provider. If you choose not to use
Pharmacy Direct, you will have to pay a 40% co-payment.
1 HIV test per beneficiary
General health
1 flu vaccine per beneficiary Prescribed Minimum Benefits covered
Cardiac health 1 full lipogram every 5 years, for members aged 20 and over
1. Addison’s Disease 10. Crohn’s Disease 19. Hyperlipidaemia

STANDARD
1 mammogram every 2 years, for women over 40
Women’s health 2. Asthma 11. Diabetes Insipidus 20. Hypertension
1 pap smear every 3 years, for women between ages 21 and 65
3. Bipolar Mood Disorder 12. Diabetes Type 1 21. Hypothyroidism
1 prostate screening antigen test for men between ages 45 and
Men’s health 4. Bronchiectasis 13. Diabetes Type 2 22. Multiple Sclerosis
69, who are considered to be at high risk for prostate cancer
5. Cardiac Failure 14. Dysrhythmias 23. Parkinson’s Disease
1 pneumococcal vaccine every 5 years, for members aged
65 and over 6. Cardiomyopathy 15. Epilepsy 24. Rheumatoid Arthritis
Elderly health
1 stool test for colon cancer, for members between ages 7. Chronic Obstructive 16. Glaucoma 25. Schizophrenia
50 and 75 Pulmonary Disease
Wellness benefits 8. Chronic Renal Disease 17. Haemophilia 26. Systemic Lupus
Erythematosus
1 wellness screening per beneficiary at a participating pharmacy,
biokineticist or a Bonitas wellness day 9. Coronary Artery Disease 18. HIV/AIDS 27. Ulcerative Colitis
Wellness screening includes the following tests:
• Blood pressure Additional conditions covered
Wellness screening
• Glucose
• Cholesterol 28. Acne 34. Dermatitis 40. Narcolepsy
• Body mass index 29. Allergic Rhinitis 35. Depression 41. Obsessive Compulsive
• Waist-to-hip ratio Disorder
R1 750 per family which can be used for: 30. Ankylosing Spondylitis 36. Eczema 42. Panic Disorder
• GP consultations only
31. Attention Deficit 37. Gastro-Oesophageal 43. Post-Traumatic Stress
• Biokineticist consultations and treatment
Disorder Reflux Disease Disorder
• Dietician consultations and treatment
(in children aged 5-18) (GORD)
• Physiotherapist consultations and treatment
• A programme to stop smoking 32. Barrett’s Oesophagus 38. Generalised Anxiety 44. Tourette’s Syndrome
Wellness extender
• X-rays as per formulary Disorder
• Blood tests as per formulary 33. Behcet’s Disease 39. Gout 45. Zollinger-Ellison
Available after completing a wellness screening Syndrome
Child dependants can access the wellness extender once an adult
beneficiary has completed a wellness screening
International travel benefit
Cover for medical emergencies when you travel outside South
Per trip Africa
You must register for this benefit

Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes. Page 36
 Managed Care programmes Provides you with appropriate treatment and tools to live a
normal life
We offer a range of Managed Care programmes to support you and help put you on the path to
good health. These programmes empower you to manage your condition effectively in the most Covers medicine to treat HIV (including drugs to prevent
clinically-proven way, ensuring your benefits last longer. mother-to-child transmission and infection after sexual assault
or needle-stick injury)
You will need to register to join these programmes.
Treatment and prevention of opportunistic infections such as
pneumonia, TB and flu
Helps manage severe back and neck pain
Covers regular blood tests to monitor disease progression,
Offers a personalised treatment plan for up to 6 weeks HIV/AIDS response to therapy and to detect possible side-effects of
Includes assistance from doctors, physiotherapists and treatment
biokineticists Offers HIV-related consultations to visit your doctor to monitor
Back and neck Gives access to a home care plan to maintain long-term results your clinical status
STANDARD

We cover the full cost of the programme so it won’t impact your Gives ongoing patient support via a team of trained and
savings or day-to-day benefits experienced counsellors
Highly effective and low-risk, with an excellent success rate Offers access to telephonic support from doctors
Uses the DBC network Helps in finding a registered counsellor for emotional support

Cancer
Diabetes management
Hip and knee replacement
Puts you first, offering emotional and medical support Available to pre-identified members who suffer from depression,
Delivers cost-effective care of the highest quality anxiety, post-traumatic stress disorder and alcohol abuse
Liaises with your doctor to ensure your treatment plan is Access to a Care Manager who will work with you, your
clinically appropriate to meet your needs treating doctor and where appropriate, with other healthcare
professionals to assist in improving your condition
Matches the treatment plan to your benefits to ensure you have
the cover you need Mental wellness Your Care Manager will assist with setting up appointments
Access to a social worker for you and your loved ones with your doctor, obtain authorisation for healthcare services,
understand the importance of preventative care and the use of
Uses the ICON network of oncology specialists
wellness benefits or resolve queries related to any other health
Uses the Bonitas Oncology Medicine Network condition
(20% co-payment applies for use of a non-network provider)
Provides educational material about mental health which
Empowers you to make the right decisions to stay healthy empowers you to manage your condition
Offers a personalised care plan for your specific needs
Provides cover for the tests required for the management of
diabetes as well as other chronic conditions
Helps you track the results of the required tests
Offers access to diabetes doctors, dieticians and podiatrists
Helps you better understand your condition through diabetes
education
Gives access to a dedicated Health Coach to answer any
questions you may have
Based on the latest international standardised clinical care
pathways
Uses a multidisciplinary team, dedicated to assist with
successful recovery
Doctors evaluate and treat your condition before surgery to give
you the best outcomes
Treatment is covered in full on the ICPS and Joint Care network

Page 37 Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
 In-hospital benefits
This benefit offers cover for major medical events that result in a beneficiary being admitted to
hospital. We negotiate extensively with private hospitals to ensure the best possible value for our
members.
Pre-authorisation is required.
Specialist consultations/
treatment
GP consultations/treatment Unlimited, covered at 100% of the Bonitas Rate
Blood and other laboratory
tests
X-rays and ultrasounds
MRIs and CT scans
(specialised radiology)
Paramedical/Allied medical
professionals
(such as physiotherapists,
occupational therapists,
dieticians and biokineticists)
Internal and external
prostheses
Spinal surgery
Hip and knee replacements
Internal nerve stimulators
Cochlear implants
Mental health
hospitalisation
Take-home medicine
Physical rehabilitation
Alternatives to hospital
(hospice, step-down facilities)
Terminal care
Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
R344 500 per family
Cancer treatment You must use a preferred provider
Sublimit of R44 220 per beneficiary for Brachytherapy
Unlimited
Organ transplants
Sublimit of R32 130 per beneficiary for corneal grafts
Unlimited, network specialists covered in full at the Bonitas Rate Unlimited
Kidney dialysis
Unlimited, non-network specialists paid at 100% of the Bonitas You must use a Designated Service Provider, or a 20%
Rate co-payment will apply
Unlimited, if you register on the HIV/AIDS programme
HIV/AIDS Chronic medicine must be obtained from the Designated Service
Unlimited, covered at 100% of the Bonitas Rate Provider
STANDARD
Unlimited, covered at 100% of the Bonitas Rate
R26 620 per family, in and out-of-hospital
Pre-authorisation required
Unlimited, covered at 100% of the Bonitas Rate
Your therapist must get a referral from the doctor treating you
in hospital
R45 090 per family
Managed Care protocols apply
Sublimit of R5 360 per breast prosthesis (limited to 2 per year)
You must use a preferred supplier
You will have to pay a R10 000 co-payment if you do not go for an
assessment through the back and neck programme
You will have to pay a R10 000 co-payment if you do not use the
preferred provider
R168 900 per family
R283 300 per family
You must use a preferred supplier
R40 600 per family
No cover for physiotherapy for mental health admissions
You must use a Designated Service Provider
R475 per beneficiary, per hospital stay
R50 600 per family
R16 880 per family
Unlimited
Including hospice/private nursing, home oxygen,
pain management, psychologist and social worker support
Page 38
STANDARD SELECT

Approximately 15% cheaper using a quality network

Plus extra benefits for: Maternity benefits:

General appliances • 12 consultations during pregnancy
(including moonboot and crutches) • 2 x 2D scans
• R1 240 for antenatal classes
MRIs and CT scans
• 4 consultations with a midwife after delivery
(1 of these can be used for a consultation with
Mental health a lactation specialist)
• Maternity support for pregnant moms
Basic and specialised dentistry
Childcare benefits:
Optometry
• Newborn hearing screening
• Thyroid screening for infants under 1 month
• Childhood immunisations according to the
Expanded Programme on Immmunisation
• 2 Paediatric or GP consultations for children under 1
Unlimited hospital cover • 2 GP consultations for children aged 2 - 12
100% Bonitas Rate • 24/7 Babyline for advice for children under 3

Preventative care:
Wellness screening plus R1 750 Extender to
use for blood tests, x-rays, programme to stop
• Full lipogram What you pay
• Flu vaccine
smoking or consultations with a GP, dietician, • HIV test
biokineticist and physiotherapist • Mammogram Main member R3 368
• Pap smear
• Prostate screening
Adult dependant R2 914
R283 300 cochlear implant benefit
Managed Care programmes:
Child dependant R986
• Back and neck
• Cancer
• Diabetes
R19 670 for chronic medicine • Hip and knee replacements You only pay for a maximum of three children. Full-time
for up to 45 conditions • HIV/AIDS students pay child rates up to age 24 years.
• Mental health

Page 39 All benefits per family unless otherwise stated

 Out-of-hospital benefits R790 per beneficiary
Out-of-hospital claims will be paid from available day-to-day benefits. There is a separate benefit R2 400 per family
for GP consultations. Over-the-counter medicine Paid from available day-to-day benefits
Formulary and Bonitas Pharmacy Network applies
20% co-payment for non-network or
GP consultations non-formulary use
You must choose 1 GP on our network for each beneficiary. This is your nominated GP for the
year. If you do not use your nominated GP, your benefit will be limited to the non-nominated GP
consultation benefit as indicated in the table below.
The following are paid from your unlimited overall annual
benefit (and not from your day-to-day benefits, so you get more value for money):
R4 250 (R1 380 of this can be used for
Main member only MRIs and CT scans R26 620 per family, in and out-of-hospital
non-nominated GP consultations)
(specialised radiology) Pre-authorisation required

STANDARD SELECT
R6 230 (R2 130 of this can be used for
Main member + 1 dependant
non-nominated GP consultations) R15 890 per family
R6 910 (R2 330 of this can be used for
Main member + 2 dependants In and out-of-hospital consultations (included in the mental
non-nominated GP consultations) Mental health consultations health hospitalisation benefit)
R7 250 (R2 430 of this can be used for
Main member + 3 dependants Cover for educational psychologists for beneficiaries up to the
non-nominated GP consultations)
age of 21 years
R7 870 (R2 620 of this can be used for
Main member + 4 or more dependants R7 820 per family
non-nominated GP consultations)
General medical appliances An additional R6 680 per family will apply should Stoma Care and
(such as wheelchairs and
CPAP machines exceed the general medical appliances limit
Day-to-day benefits crutches)
You must use a preferred supplier
These benefits provide cover for consultations with your specialist, acute medicine, x-rays, blood
R16 320 per family, once every 5 years (based on the date of your
tests and other out-of-hospital medical expenses.
previous claim)
There is a separate benefit for tests and consultations for PMB treatment plans (excluding GP Hearing aids
20% co-payment applies
consultations) so this will not affect your day-to-day benefits.
You must use a preferred supplier
Main member only R5 940 R6 115 per family, once every 2 years (based on the date of your
Optometry previous claim)
Main member + 1 dependant R9 030
Each beneficiary can choose glasses or contact lenses
Main member + 2 dependants R10 440
Main member + 3 dependants R11 400 1 per beneficiary, at a network provider
Eye tests OR
Main member + 4 or more dependants R12 420
R325 per beneficiary, at a non-network provider
Paid from available day-to-day benefits
Specialist consultations Single vision lenses (Clear) 100% towards the cost of lenses at network rates
You must get a referral from your GP
or R185 per lens, per beneficiary, out of network
Blood tests and other laboratory tests Paid from available day-to-day benefits
Bifocal lenses (Clear) 100% towards the cost of lenses at network rates
X-rays and ultrasounds Paid from available day-to-day benefits
or R420 per lens, per beneficiary, out of network
Paid from available day-to-day benefits
100% towards the cost of lenses at network rates
Formulary and Bonitas Pharmacy Network applies Multifocal lenses (Clear)
Acute medicine
20% co-payment for non-network or R745 per lens, per beneficiary, out of network
non-formulary use
R1 275 per beneficiary at a network provider
Frames
Paramedical/Allied medical professionals R893 per beneficiary at a non-network provider
(such as physiotherapists, occupational therapists, Paid from available day-to-day benefits
dieticians and biokineticists) Contact lenses R1 870 per beneficiary (included in the family limit)

Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes. Page 40
 Basic dentistry
Consultations
X-rays: Intra-oral
X-rays: Extra-oral
Oral hygiene
STANDARD SELECT
Covered at the Bonitas Dental Tariff Benefit is limited to conservative, non-surgical therapy only
and will only be applied to members who are registered on the
2 annual check-ups per beneficiary (once every 6 months)
Periodontics Periodontal Programme
Managed Care protocols apply Managed Care protocols apply
1 per beneficiary, every 3 years Pre-authorisation required
Additional benefit may be considered if specialist dental Maxillo-facial surgery and oral pathology
treatment planning/follow up is required
Surgery in the dental chair Managed Care protocols apply
2 annual scale and polish treatments per beneficiary (once every
6 months) A co-payment of R3 500 per hospital admission and admission
protocols apply
Fissure sealants are only covered for children under 16 years
General anaesthetic is only available to children under the age of
Fluoride treatments are only covered for children from age 5 and 5 for extensive dental treatment once per lifetime
Hospitalisation

younger than 16 years

Fillings
Root canal and extractions
Plastic dentures and
associated laboratory costs
Specialised dentistry
Partial metal frame
dentures and associated
laboratory costs
(general anaesthetic) General anaesthetic benefit is available for the removal of
Benefit for fillings is granted once per tooth, every 2 years
impacted teeth
Benefit for re-treatment of a tooth is subject to Managed Care
Managed Care protocols apply
protocols
Pre-authorisation required
A treatment plan and x-rays may be required for multiple fillings
Laughing gas in dental
Managed Care protocols apply Managed Care protocols apply
rooms
1 set of plastic dentures (an upper and a lower) per beneficiary, Limited to extensive dental treatment
once every 4 years IV conscious sedation in
Managed Care protocols apply
Pre-authorisation required rooms
Pre-authorisation required
Covered at the Bonitas Dental Tariff
1 partial frame (an upper or lower) per beneficiary, once every
5 years
Managed Care protocols apply
Additional benefits
Pre-authorisation required We believe in giving you more value. The following benefits are in addition to your day-to-day and
other benefits.
1 crown per family, per year

Crowns, bridges and Benefit for crowns will be granted once per tooth, every 5 years
Contraceptives
associated laboratory costs A treatment plan and x-rays may be requested
R1 610 per family
Pre-authorisation required For women aged up to 50 You must use the Designated Service Provider for
Orthodontic treatment is granted once per beneficiary, per pharmacy-dispensed contraceptives
lifetime Maternity care
Pre-authorisation cases will be clinically assessed by using an
orthodontic needs analysis 12 antenatal consultations with a gynaecologist, GP or midwife
Benefit allocation is subject to the outcome of the needs analysis 2 2D ultrasound scans
and funding can be granted up to 80% of the Bonitas Dental
R1 240 for antenatal classes
Tariff
Orthodontics and associated Per pregnancy 1 amniocentesis
Benefit for orthodontic treatment will be granted where function
laboratory costs
is impaired (not granted for cosmetic reasons) 4 consultations with a midwife after delivery (1 of these can be
Only 1 family member may begin orthodontic treatment in a used for a consultation with a lactation specialist)
calendar year
Maternity support for pregnant moms
Benefit for fixed comprehensive treatment is limited to
beneficiaries from age 9 and younger than 18 years Childcare
Managed Care protocols apply Hearing screening For newborns, in or out-of-hospital
Pre-authorisation required

Page 41 Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
 Congenital hypothyroidism
For infants under 1 month old
Chronic benefits
screening
Standard Select offers generous cover for the 45 chronic conditions listed below. Your chronic
Babyline 24/7 helpline for medical advice for children under 3 years medicine benefit is R9 800 per beneficiary and R19 670 per family on the applicable formulary. You
2 consultations per child under 1 year must use Pharmacy Direct, our Designated Service Provider, to get your medicine. If you choose not
Paediatrician or GP
consultations to use Pharmacy Direct or if you choose to use medicine that is not on the formulary, you will have
2 consultations per child between ages 1 and 2 to pay a 40% co-payment.
GP consultations 2 consultations per child between ages 2 and 12 Once the amount above is finished, you will still be covered for the 27 Prescribed Minimum Benefits,
According to Expanded Programme on Immunisation in South listed below.
Immunisations
Africa
Preventative care Prescribed Minimum Benefits covered
1 HIV test per beneficiary
General health 1. Addison’s Disease 10. Crohn’s Disease 19. Hyperlipidaemia

STANDARD SELECT
1 flu vaccine per beneficiary
2. Asthma 11. Diabetes Insipidus 20. Hypertension
Cardiac health 1 full lipogram every 5 years, for members aged 20 and over
3. Bipolar Mood Disorder 12. Diabetes Type 1 21. Hypothyroidism
1 mammogram every 2 years, for women over 40
Women’s health 4. Bronchiectasis 13. Diabetes Type 2 22. Multiple Sclerosis
1 pap smear every 3 years, for women between ages 21 and 65
5. Cardiac Failure 14. Dysrhythmias 23. Parkinson’s Disease
1 prostate screening antigen test for men between ages 45 and
Men’s health 6. Cardiomyopathy 15. Epilepsy 24. Rheumatoid Arthritis
69, who are considered to be at high risk for prostate cancer
7. Chronic Obstructive 16. Glaucoma 25. Schizophrenia
1 pneumococcal vaccine every 5 years, for members aged
Pulmonary Disease
65 and over
Elderly health 8. Chronic Renal Disease 17. Haemophilia 26. Systemic Lupus
1 stool test for colon cancer, for members between ages Erythematosus
50 and 75
9. Coronary Artery Disease 18. HIV/AIDS 27. Ulcerative Colitis
Wellness benefits
1 wellness screening per beneficiary at a participating pharmacy, Additional conditions covered
biokineticist or a Bonitas wellness day
Wellness screening includes the following tests: 28. Acne 34. Dermatitis 40. Narcolepsy
Wellness screening • Blood pressure 29. Allergic Rhinitis 35. Depression 41. Obsessive Compulsive
• Glucose Disorder
• Cholesterol
30. Ankylosing Spondylitis 36. Eczema 42. Panic Disorder
• Body mass index
• Waist-to-hip ratio 31. Attention Deficit 37. Gastro-Oesophageal 43. Post-Traumatic Stress
Disorder Reflux Disease Disorder
R1 750 per family which can be used for:
(in children aged 5-18) (GORD)
• GP consultations only
• Biokineticist consultations and treatment 32. Barrett’s Oesophagus 38. Generalised Anxiety 44. Tourette’s Syndrome
• Dietician consultations and treatment Disorder
• Physiotherapist consultations and treatment 33. Behcet’s Disease 39. Gout 45. Zollinger-Ellison
Wellness extender • A programme to stop smoking Syndrome
• X-rays as per formulary
• Blood tests as per formulary
Available after completing a wellness screening
Child dependants can access the wellness extender once an adult
beneficiary has completed a wellness screening
International travel benefit
Cover for medical emergencies when you travel outside South
Per trip Africa
You must register for this benefit

Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes. Page 42
 Managed Care programmes Provides you with appropriate treatment and tools to live a
normal life
We offer a range of Managed Care programmes to support you and help put you on the path to
good health. These programmes empower you to manage your condition effectively in the most Covers medicine to treat HIV (including drugs to prevent
clinically-proven way, ensuring your benefits last longer. mother-to-child transmission and infection after sexual assault
or needle-stick injury)
You will need to register to join these programmes.
Treatment and prevention of opportunistic infections such as
pneumonia, TB and flu
Helps manage severe back and neck pain
Covers regular blood tests to monitor disease progression,
Offers a personalised treatment plan for up to 6 weeks HIV/AIDS response to therapy and to detect possible side-effects of
Includes assistance from doctors, physiotherapists and treatment
biokineticists Offers HIV-related consultations to visit your doctor to monitor
your clinical status
STANDARD SELECT

Back and neck Gives access to a home care plan to maintain long-term results
We cover the full cost of the programme so it won’t impact your Gives ongoing patient support via a team of trained and
savings or day-to-day benefits experienced counsellors
Highly effective and low-risk, with an excellent success rate Offers access to telephonic support from doctors
Uses the DBC network Helps in finding a registered counsellor for emotional support

Cancer
Diabetes management
Hip and knee replacement
Puts you first, offering emotional and medical support Available to pre-identified members who suffer from depression,
Delivers cost-effective care of the highest quality anxiety, post-traumatic stress disorder and alcohol abuse
Liaises with your doctor to ensure your treatment plan is Access to a Care Manager who will work with you, your
clinically appropriate to meet your needs treating doctor and where appropriate, with other healthcare
professionals to assist in improving your condition
Matches the treatment plan to your benefits to ensure you have
the cover you need Mental wellness Your Care Manager will assist with setting up appointments
Access to a social worker for you and your loved ones with your doctor, obtain authorisation for healthcare services,
understand the importance of preventative care and the use of
Uses the ICON network of oncology specialists wellness benefits or resolve queries related to any other health
Uses the Bonitas Oncology Medicine Network condition
(20% co-payment applies for use of a non-network provider)
Provides educational material about mental health which
Empowers you to make the right decisions to stay healthy empowers you to manage your condition
Offers a personalised care plan for your specific needs
Provides cover for the tests required for the management of
diabetes as well as other chronic conditions
Helps you track the results of the required tests
Offers access to diabetes doctors, dieticians and podiatrists
Helps you better understand your condition through diabetes
education
Gives access to a dedicated Health Coach to answer any
questions you may have
Based on the latest international standardised clinical care
pathways
Uses a multidisciplinary team, dedicated to assist with
successful recovery
Doctors evaluate and treat your condition before surgery to give
you the best outcomes
Treatment is covered in full on the ICPS and Joint Care network

Page 43 Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
 In-hospital benefits
This benefit offers cover for major medical events that result in a beneficiary being admitted to
hospital. We negotiate extensively with private hospitals to ensure the best possible value for our
members.
Pre-authorisation is required.
Please note: You must use a hospital on the Standard Select network or you will have to pay a
30% co-payment.
Specialist consultations/
treatment
GP consultations/treatment Unlimited, covered at 100% of the Bonitas Rate
Blood and other laboratory
tests
X-rays and ultrasounds
MRIs and CT scans
(specialised radiology)
Paramedical/Allied medical
professionals
(such as physiotherapists,
occupational therapists,
dieticians and biokineticists)
Internal and external
prostheses
Spinal surgery
Hip and knee replacements
Internal nerve stimulators
Cochlear implants
Mental health
hospitalisation
Take-home medicine
Physical rehabilitation
Alternatives to hospital
(hospice, step-down facilities)
Terminal care
Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
R344 500 per family
Cancer treatment You must use a preferred provider
Sublimit of R44 220 per beneficiary for Brachytherapy
Unlimited
Organ transplants
Sublimit of R32 130 per beneficiary for corneal grafts
Unlimited
Kidney dialysis You must use a Designated Service Provider, or a 20%
Unlimited, network specialists covered in full at the Bonitas Rate co-payment will apply
Unlimited, non-network specialists paid at 100% of the Bonitas Unlimited, if you register on the HIV/AIDS programme
Rate HIV/AIDS
Chronic medicine must be obtained from Pharmacy Direct
STANDARD SELECT
Unlimited, covered at 100% of the Bonitas Rate
Unlimited, covered at 100% of the Bonitas Rate
R26 620 per family, in and out-of-hospital
Pre-authorisation required
Unlimited, covered at 100% of the Bonitas Rate
Your therapist must get a referral from the doctor treating you
in hospital
R45 090 per family
Managed Care protocols apply
Sublimit of R5 360 per breast prosthesis (limited to 2 per year)
You must use a preferred supplier
You will have to pay a R10 000 co-payment if you do not go for an
assessment through the back and neck programme
You must use the Designated Service Provider
R168 900 per family
R283 300 per family
You must use a preferred supplier
R40 600 per family
No cover for physiotherapy for mental health admissions
You must use a Designated Service Provider
R475 per beneficiary, per hospital stay
R50 600 per family
R16 880 per family
Unlimited
Including hospice/private nursing, home oxygen,
pain management, psychologist and social worker support
Page 44
PRIMARY

Rich GP benefit up to R5 030 and day-to-day up to R6 510

Plus extra benefits for: Maternity benefits:

General appliances • 6 consultations during pregnancy
(including moonboot and crutches) • 2 x 2D scans
• 4 consultations with a midwife after delivery
MRIs and CT scans (1 of these can be used for a consultation with
a lactation specialist)
Mental health • Maternity support for pregnant moms

Basic dentistry
Childcare benefits:
Optometry • Newborn hearing screening
• Thyroid screening for infants under 1 month
• Childhood immunisations according to the
Expanded Programme on Immmunisation
• 1 Paediatric or GP consultation for children under 1
Unlimited hospital cover • 1 GP consultation for children aged 2 - 12
100% Bonitas Rate
• 24/7 Babyline for advice for children under 3

Unlimited terminal care benefit

Preventative care: What you pay
• Flu vaccine
Wellness screening plus R1 270 Extender to • HIV test
use for blood tests, x-rays, programme to stop • Mammogram Main member R2 429
smoking or consultations with a GP, dietician, • Pap smear
biokineticist and physiotherapist • Pneumococcal vaccine
• Prostate screening Adult dependant R1 900

R1 610 for contraceptives Child dependant R773

Managed Care programmes:
• Back and neck
Chronic medicine for 27 PMB • Cancer You only pay for a maximum of three children. Full-time
• Diabetes students pay child rates up to age 24 years.
conditions • HIV/AIDS

Page 45 All benefits per family unless otherwise stated

 Out-of-hospital benefits Paramedical/Allied medical
professionals
Out-of-hospital claims will be paid from available day-to-day benefits. There is a separate benefit Paid from available day-to-day benefits
(such as physiotherapists, occupational
for GP consultations.
therapists, dieticians and biokineticists)

GP consultations
The following are paid from your unlimited overall annual
If you do not use a GP on our network, your benefit for GP consultations will be limited to the
non-network GP consultation benefit. This is shown in the table below.
benefit (and not from your day-to-day benefits, so you get more value for money):
MRIs and CT scans R13 260 per family, in and out-of-hospital
Main member only R1 900 (R615 of this may be used for (specialised radiology)
non-network GP consultations) Pre-authorisation required
Main member + 1 dependant R3 490 (R1 160 of this may be used for R9 560 per family
non-network GP consultations)
In and out-of-hospital consultations (included in the

PRIMARY
Main member + 2 dependants R4 130 (R1 320 of this may be used for Mental health consultations mental health hospitalisation benefit)
non-network GP consultations)
Cover for educational psychologists for beneficiaries
Main member + 3 dependants R4 440 (R1 480 of this may be used for up to the age of 21 years
non-network GP consultations)
R7 030 per family
Main member + 4 or more dependants R5 030 (R1 750 of this may be used for
non-network GP consultations) An additional R6 680 per family will apply should Stoma
General medical appliances
(such as wheelchairs and crutches)
Care and CPAP machines exceed the general medical
Day-to-day benefits appliances limit
These benefits provide cover for consultations with your specialist, acute medicine, x-rays, blood You must use a preferred supplier
tests and other out-of-hospital medical expenses. R4 710 per family, once every 2 years (based on the
Optometry date of your previous claim)
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. Each beneficiary can choose glasses or contact lenses
1 per beneficiary, at a network provider
Main member only R2 660 Eye tests OR
Main member + 1 dependant R4 760 R325 per beneficiary, at a non-network provider
Main member + 2 dependants R5 590 100% towards the cost of lenses at network rates
Single vision lenses (Clear) or
Main member + 3 dependants R6 010 R185 per lens, per beneficiary, out of network
Main member + 4 or more dependants R6 510 Bifocal lenses (Clear) 100% towards the cost of lenses at network rates
or R420 per lens, per beneficiary, out of network
Paid from available day-to-day benefits
Specialist consultations
You must get a referral from your GP 100% towards the cost of lenses at network rates
Multifocal lenses (Clear)
Blood tests and other laboratory tests Paid from available day-to-day benefits R745 per lens, per beneficiary, out of network
X-rays and ultrasounds Paid from available day-to-day benefits
R525 per beneficiary at a network provider
Paid from available day-to-day benefits Frames
R368 per beneficiary at a non-network provider
Formulary and Bonitas Pharmacy Network applies
Acute medicine
20% co-payment for non-network or non-formulary Contact lenses R1 295 per beneficiary (included in the family limit)
use
Covered at the Bonitas Dental Tariff
R500 per beneficiary Basic dentistry
You must use a provider on the DENIS network
R1 460 per family
Paid from available day-to-day benefits 2 annual check-ups per beneficiary (once every 6
Over-the-counter medicine Consultations
months)
Formulary and Bonitas Pharmacy Network applies
20% co-payment for non-network or non-formulary X-rays: Intra-oral Managed Care protocols apply
use

Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes. Page 46
 X-rays: Extra-oral 1 per beneficiary, every 3 years Additional benefits
2 annual scale and polish treatments per beneficiary We believe in giving you more value. The following benefits are in addition to your day-to-day and
(once every 6 months) other benefits.

Fissure sealants are only covered for children under 16

Oral hygiene Contraceptives
years
Fluoride treatments are only covered for children from R1 610 per family
age 5 and younger than 16 years For women aged up to 50 You must use the Designated Service Provider for
pharmacy-dispensed contraceptives
Benefit for fillings is granted once per tooth, every 2
Maternity care
years
6 antenatal consultations with a gynaecologist, GP or midwife
Benefit for re-treatment of a tooth is subject to
Fillings 2 2D ultrasound scans
Managed Care protocols
1 amniocentesis
PRIMARY

A treatment plan and x-rays may be required for Per pregnancy

Root canal therapy and extractions
Plastic dentures and associated
laboratory costs
Maxillo-facial surgery and oral pathology
Surgery in the dental chair
Hospitalisation
(general anaesthetic)
4 consultations with a midwife after delivery (1 of these can be
multiple fillings
used for a consultation with a lactation specialist)
Managed Care protocols apply Maternity support for pregnant moms
Benefit for root canal includes all teeth except primary Childcare
teeth and permanent molars
Hearing screening For newborns, in or out-of-hospital
1 set of plastic dentures (an upper and a lower) per
beneficiary, once every 4 years Congenital hypothyroidism
For infants under 1 month old
screening
Pre-authorisation required
Babyline 24/7 helpline for medical advice for children under 3 years
Paediatrician or GP 1 consultation per child under 1 year
Managed Care protocols apply consultations 1 consultation per child between ages 1 and 2
A co-payment of R3 500 per hospital admission and GP consultations 1 consultation per child between ages 2 and 12
admission protocols apply
According to Expanded Programme on Immunisation in
General anaesthetic is only available to children under Immunisations
South Africa
the age of 5 for extensive dental treatment once per Preventative care
lifetime
1 HIV test per beneficiary
General anaesthetic benefit is available for the removal General health
of impacted teeth 1 flu vaccine per beneficiary

Laughing gas in dental rooms
IV conscious sedation in rooms
Managed Care protocols apply 1 mammogram every 2 years, for women over 40
Women’s health
1 pap smear every 3 years, for women between ages 21 and 65
Pre-authorisation required
1 prostate screening antigen test for men between ages 45 and
Men’s health
Managed Care protocols apply 69, who are considered to be at high risk for prostate cancer
1 pneumococcal vaccine every 5 years, for members aged
Limited to extensive dental treatment
65 and over
Managed Care protocols apply Elderly health
1 stool test for colon cancer, for members between ages
Pre-authorisation required 50 and 75

Page 47 Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
 Wellness benefits Chronic benefits
1 wellness screening per beneficiary at a participating pharmacy, Primary ensures that you are covered for the 27 Prescribed Minimum Benefits listed below. You
biokineticist or a Bonitas wellness day must use Pharmacy Direct, our Designated Service Provider, to get your medicine. If you choose not
to use Pharmacy Direct or if you choose to use medicine that is not on the formulary, you will have
Wellness screening includes the following tests:
to pay a 40% co-payment.
Wellness screening • Blood pressure
• Glucose
• Cholesterol Prescribed Minimum Benefits covered
• Body mass index
• Waist-to-hip ratio 1. Addison’s Disease 10. Crohn’s Disease 19. Hyperlipidaemia
2. Asthma 11. Diabetes Insipidus 20. Hypertension
R1 270 per family which can be used for:
• GP consultations only 3. Bipolar Mood Disorder 12. Diabetes Type 1 21. Hypothyroidism
• Biokineticist consultations and treatment
4. Bronchiectasis 13. Diabetes Type 2 22. Multiple Sclerosis
• Dietician consultations and treatment

PRIMARY
• Physiotherapist consultations and treatment 5. Cardiac Failure 14. Dysrhythmias 23. Parkinson’s Disease
Wellness extender • A programme to stop smoking 6. Cardiomyopathy 15. Epilepsy 24. Rheumatoid Arthritis
• X-rays as per formulary
• Blood tests as per formulary 7. Chronic Obstructive 16. Glaucoma 25. Schizophrenia
Pulmonary Disease
Available after completing a wellness screening
8. Chronic Renal Disease 17. Haemophilia 26. Systemic Lupus
Child dependants can access the wellness extender once an adult Erythematosus
beneficiary has completed a wellness screening
9. Coronary Artery Disease 18. HIV/AIDS 27. Ulcerative Colitis
International travel benefit
Cover for medical emergencies when you travel outside South
Per trip Africa
You must register for this benefit

Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes. Page 48
 Managed Care programmes Provides you with appropriate treatment and tools to live a
We offer a range of Managed Care programmes to support you and help put you on the path to normal life
good health. These programmes empower you to manage your condition effectively in the most Covers medicine to treat HIV (including drugs to prevent
clinically-proven way, ensuring your benefits last longer. mother-to-child transmission and infection after sexual assault
You will need to register to join these programmes. or needle-stick injury)
Treatment and prevention of opportunistic infections such as
pneumonia, TB and flu
Helps manage severe back and neck pain
Covers regular blood tests to monitor disease progression,
Offers a personalised treatment plan for up to 6 weeks HIV/AIDS response to therapy and to detect possible side-effects of
Includes assistance from doctors, physiotherapists and treatment
biokineticists
Offers HIV-related consultations to visit your doctor to monitor
Back and neck Gives access to a home care plan to maintain long-term results your clinical status
PRIMARY

We cover the full cost of the programme so it won’t impact your Gives ongoing patient support via a team of trained and
savings or day-to-day benefits experienced counsellors
Highly effective and low-risk, with an excellent success rate Offers access to telephonic support from doctors
Uses the DBC network Helps in finding a registered counsellor for emotional support

Puts you first, offering emotional and medical support

Delivers cost-effective care of the highest quality
Liaises with your doctor to ensure your treatment plan is
clinically appropriate to meet your needs

Cancer Matches the treatment plan to your benefits to ensure you have
the cover you need
Access to a social worker for you and your loved ones
Uses the ICON network of oncology specialists
Uses the Bonitas Oncology Medicine Network
(20% co-payment applies for use of a non-network provider)

Empowers you to make the right decisions to stay healthy

Offers a personalised care plan for your specific needs
Provides cover for the tests required for the management of
diabetes as well as other chronic conditions
Helps you track the results of the required tests
Diabetes management
Offers access to diabetes doctors, dieticians and podiatrists
Helps you better understand your condition through diabetes
education
Gives access to a dedicated Health Coach to answer any
questions you may have

Page 49 Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
 In-hospital benefits Unlimited, if you register on the HIV/AIDS programme
HIV/AIDS
This benefit offers cover for major medical events that result in a beneficiary being admitted to Chronic medicine must be obtained from Pharmacy Direct
hospital. We negotiate extensively with private hospitals to ensure the best possible value for our
members. A co-payment will apply to the following procedures in hospital:
Pre-authorisation is required.
R1 520 co-payment R3 850 co-payment R7 580 co-payment
Unlimited, network specialists covered in full at the Bonitas Rate 1. Colonoscopy 1. Arthroscopy 1. Back Surgery including
Specialist consultations/ Spinal Fusion
treatment Unlimited, non-network specialists paid at 100% of the Bonitas
Rate 2. Conservative Back 2. Diagnostic Laparoscopy 2. Joint Replacements
GP consultations/treatment Unlimited, covered at 100% of the Bonitas Rate Treatment

Blood tests and other 3. Cystoscopy 3. Laparoscopic 3. Laparoscopic

Unlimited, covered at 100% of the Bonitas Rate Hysterectomy Pyeloplasty
laboratory tests

PRIMARY
X-rays and ultrasounds Unlimited, covered at 100% of the Bonitas Rate 4. Facet Joint Injections 4. Percutaneous 4. Laparoscopic Radical
R13 260 per family, in and out-of-hospital Radiofrequency Prostatectomy
MRIs and CT scans Ablations
(specialised radiology) Pre-authorisation required (Percutaneous Rhizotomies)
Paramedical/Allied medical 5. Flexible Sigmoidoscopy 5. Nissen Fundoplication
professionals (Reflux Surgery)
(such as physiotherapists, Paid from available day-to-day benefits (except for PMB)
occupational therapists, 6. Functional Nasal Surgery
dieticians and biokineticists)
7. Gastroscopy
R32 130 per family (excluding joint replacement prosthesis)
8. Hysteroscopy
Internal prosthesis Managed Care protocols apply (not Endometrial Ablation)
You must use a preferred supplier 9. Myringotomy
R15 830 per family 10. Tonsillectomy and
Mental health Adenoidectomy
No cover for physiotherapy for mental health admissions
hospitalisation
You must use a Designated Service Provider 11. Umbilical Hernia Repair

Take-home medicine R390 per beneficiary, per hospital stay 12. Varicose Vein Surgery

Physical rehabilitation R50 600 per family

Alternatives to hospital
R16 880 per family
(hospice, step-down facilities)
Unlimited
Terminal care Including hospice/private nursing, home oxygen,
pain management, psychologist and social worker support
R165 500 per family
Cancer treatment You must use a preferred provider
Sublimit of R44 220 per beneficiary for Brachytherapy
Organ transplants PMB only
Unlimited
Kidney dialysis You must use a Designated Service Provider, or a 20%
co-payment will apply

Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes. Page 50
PRIMARY SELECT

Approximately 15% cheaper using a quality network

Plus extra benefits for: Maternity benefits:

General appliances • 6 consultations during pregnancy
(including moonboot and crutches) • 2 x 2D scans
• 4 consultations with a midwife after delivery
MRIs and CT scans
(1 of these can be used for a consultation with
a lactation specialist)
Mental health • Maternity support for pregnant moms

Basic dentistry
Childcare benefits:
Optometry • Newborn hearing screening
• Thyroid screening for infants under 1 month
• Childhood immunisations according to the
Expanded Programme on Immmunisation
• 1 Paediatric or GP consultation for children under 1
Unlimited hospital cover • 1 GP consultation for children aged 2 - 12
100% Bonitas Rate • 24/7 Babyline for advice for children under 3

Unlimited terminal care benefit Preventative care: What you pay

• Flu vaccine
• HIV test
Wellness screening plus R1 270 Extender to • Mammogram Main member R2 065
use for blood tests, x-rays, programme to stop • Pap smear
smoking or consultations with a GP, dietician, • Pneumococcal vaccine
biokineticist and physiotherapist • Prostate screening Adult dependant R1 615

Child dependant R657

R1 610 for contraceptives Managed Care programmes:
• Back and neck
• Cancer You only pay for a maximum of three children. Full-time
Chronic medicine for 27 PMB • Diabetes students pay child rates up to age 24 years.
• HIV/AIDS
conditions

Page 51 All benefits per family unless otherwise stated

 Out-of-hospital benefits R500 per beneficiary
Out-of-hospital claims will be paid from available day-to-day benefits. There is a separate benefit R1 460 per family
for GP consultations. Over-the-counter medicine Paid from available day-to-day benefits
Formulary and Bonitas Pharmacy Network applies
GP consultations 20% co-payment for non-network or non-formulary
use
You must choose 1 GP on our network for each beneficiary. This is your nominated GP for the
year. If you do not use your nominated GP, your benefit will be limited to the non-nominated GP
consultation benefit as indicated in the table below. The following are paid from your unlimited overall annual
benefit (and not from your day-to-day benefits, so you get more value for money):
Main member only R1 900 (R615 of this may be used for
non-nominated GP consultations) MRIs and CT scans R13 260 per family, in and out-of-hospital
(specialised radiology) Pre-authorisation required

PRIMARY SELECT
Main member + 1 dependant R3 490 (R1 160 of this may be used for
non-nominated GP consultations)
R9 560 per family
Main member + 2 dependants R4 130 (R1 320 of this may be used for
non-nominated GP consultations) In and out-of-hospital consultations (included in the
Mental health consultations mental health hospitalisation benefit)
Main member + 3 dependants R4 440 (R1 480 of this may be used for
non-nominated GP consultations) Cover for educational psychologists for beneficiaries
Main member + 4 or more dependants R5 030 (R1 750 of this may be used for up to the age of 21 years
non-nominated GP consultations)
R7 030 per family
An additional R6 680 per family will apply should Stoma
Day-to-day benefits General medical appliances
(such as wheelchairs and crutches)
Care and CPAP machines exceed the general medical
These benefits provide cover for consultations with your specialist, acute medicine, x-rays, blood appliances limit
tests and other out-of-hospital medical expenses.
You must use a preferred supplier
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. R4 710 per family, once every 2 years (based on the
Optometry date of your previous claim)

Main member only R2 660 Each beneficiary can choose glasses or contact lenses

Main member + 1 dependant R4 760 1 per beneficiary, at a network provider

Main member + 2 dependants R5 590 Eye tests OR

Main member + 3 dependants R6 010 R325 per beneficiary, at a non-network provider

Main member + 4 or more dependants R6 510 100% towards the cost of lenses at network rates
Single vision lenses (Clear) or
R185 per lens, per beneficiary, out of network
Paid from available day-to-day benefits Bifocal lenses (Clear) 100% towards the cost of lenses at network rates
Specialist consultations
You must get a referral from your GP or R420 per lens, per beneficiary, out of network
Blood tests and other laboratory tests Paid from available day-to-day benefits
100% towards the cost of lenses at network rates
X-rays and ultrasounds Paid from available day-to-day benefits Multifocal lenses (Clear)
R745 per lens, per beneficiary, out of network
Paid from available day-to-day benefits
R525 per beneficiary at a network provider
Formulary and Bonitas Pharmacy Network applies Frames
Acute medicine R368 per beneficiary at a non-network provider
20% co-payment for non-network or non-formulary
use Contact lenses R1 295 per beneficiary (included in the family limit)
Paramedical/Allied medical Covered at the Bonitas Dental Tariff
Basic dentistry
professionals You must use a provider on the DENIS network
Paid from available day-to-day benefits
(such as physiotherapists, occupational
therapists, dieticians and biokineticists)

Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes. Page 52
 2 annual check-ups per beneficiary (once every 6 Additional benefits
Consultations
months) We believe in giving you more value. The following benefits are in addition to your day-to-day and
X-rays: Intra-oral Managed Care protocols apply other benefits.
X-rays: Extra-oral 1 per beneficiary, every 3 years
Contraceptives
2 annual scale and polish treatments per beneficiary
(once every 6 months) R1 610 per family
For women aged up to 50 You must use the Designated Service Provider for
Fissure sealants are only covered for children under
Oral hygiene pharmacy-dispensed contraceptives
16 years
Maternity care
Fluoride treatments are only covered for children from
age 5 and younger than 16 years 6 antenatal consultations with a gynaecologist, GP or midwife
2 2D ultrasound scans
PRIMARY SELECT

Benefit for fillings is granted once per tooth, every 2

years 1 amniocentesis
Per pregnancy
Benefit for re-treatment of a tooth is subject to 4 consultations with a midwife after delivery (1 of these can be
Fillings used for a consultation with a lactation specialist)
Managed Care protocols
Maternity support for pregnant moms
A treatment plan and x-rays may be required for
multiple fillings Childcare

Managed Care protocols apply Hearing screening For newborns, in or out-of-hospital

Root canal therapy and extractions
Plastic dentures and associated
laboratory costs
Benefit for root canal includes all teeth except primary Congenital hypothyroidism
For infants under 1 month old
teeth and permanent molars screening
Babyline 24/7 helpline for medical advice for children under 3 years
1 set of plastic dentures (an upper and a lower) per
beneficiary, once every 4 years Paediatrician or GP 1 consultation per child under 1 year
consultations
Pre-authorisation required 1 consultation per child between ages 1 and 2

Maxillo-facial surgery and oral pathology GP consultations 1 consultation per child between ages 2 and 12

Surgery in the dental chair
Hospitalisation
(general anaesthetic)
Managed Care protocols apply According to Expanded Programme on Immunisation in
Immunisations
South Africa
A co-payment of R3 500 per hospital admission and
admission protocols apply Preventative care
General anaesthetic is only available to children under 1 HIV test per beneficiary
General health
the age of 5 for extensive dental treatment once per 1 flu vaccine per beneficiary
lifetime 1 mammogram every 2 years, for women over 40
Women’s health
General anaesthetic benefit is available for the removal 1 pap smear every 3 years, for women between ages 21 and 65

Laughing gas in dental rooms
IV conscious sedation in rooms
of impacted teeth 1 prostate screening antigen test for men between ages 45 and
Men’s health
69, who are considered to be at high risk for prostate cancer
Managed Care protocols apply
1 pneumococcal vaccine every 5 years, for members aged
Pre-authorisation required
65 and over
Elderly health
Managed Care protocols apply 1 stool test for colon cancer, for members between ages
50 and 75
Limited to extensive dental treatment
Managed Care protocols apply
Pre-authorisation required

Page 53 Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
 Wellness benefits Chronic benefits
1 wellness screening per beneficiary at a participating pharmacy, Primary Select ensures that you are covered for the 27 Prescribed Minimum Benefits listed below
biokineticist or a Bonitas wellness day on the applicable formulary. You must use Pharmacy Direct, our Designated Service Provider, to get
Wellness screening includes the following tests: your medicine. If you choose not to use Pharmacy Direct or if you choose to use medicine that is not
• Blood pressure on the formulary, you will have to pay a 40% co-payment.
Wellness screening
• Glucose
• Cholesterol Prescribed Minimum Benefits covered
• Body mass index
• Waist-to-hip ratio 1. Addison’s Disease 10. Crohn’s Disease 19. Hyperlipidaemia
R1 270 per family which can be used for: 2. Asthma 11. Diabetes Insipidus 20. Hypertension
• GP consultations only
• Biokineticist consultations and treatment 3. Bipolar Mood Disorder 12. Diabetes Type 1 21. Hypothyroidism

PRIMARY SELECT
• Dietician consultations and treatment 4. Bronchiectasis 13. Diabetes Type 2 22. Multiple Sclerosis
• Physiotherapist consultations and treatment
5. Cardiac Failure 14. Dysrhythmias 23. Parkinson’s Disease
Wellness extender • A programme to stop smoking
• X-rays as per formulary 6. Cardiomyopathy 15. Epilepsy 24. Rheumatoid Arthritis
• Blood tests as per formulary 7. Chronic Obstructive 16. Glaucoma 25. Schizophrenia
Available after completing a wellness screening Pulmonary Disease

Child dependants can access the wellness extender once an adult 8. Chronic Renal Disease 17. Haemophilia 26. Systemic Lupus
beneficiary has completed a wellness screening Erythematosus
9. Coronary Artery Disease 18. HIV/AIDS 27. Ulcerative Colitis
International travel benefit
Cover for medical emergencies when you travel outside South
Per trip Africa
You must register for this benefit

Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes. Page 54
 Managed Care programmes Provides you with appropriate treatment and tools to live a
normal life
We offer a range of Managed Care programmes to support you and help put you on the path to
good health. These programmes empower you to manage your condition effectively in the most Covers medicine to treat HIV (including drugs to prevent
clinically-proven way, ensuring your benefits last longer. mother-to-child transmission and infection after sexual assault
or needle-stick injury)
You will need to register to join these programmes.
Treatment and prevention of opportunistic infections such as
pneumonia, TB and flu
Helps manage severe back and neck pain
Covers regular blood tests to monitor disease progression,
Offers a personalised treatment plan for up to 6 weeks HIV/AIDS response to therapy and to detect possible side-effects of
Includes assistance from doctors, physiotherapists and treatment
biokineticists Offers HIV-related consultations to visit your doctor to monitor
Back and neck Gives access to a home care plan to maintain long-term results your clinical status
PRIMARY SELECT

We cover the full cost of the programme so it won’t impact your Gives ongoing patient support via a team of trained and
savings or day-to-day benefits experienced counsellors
Highly effective and low-risk, with an excellent success rate Offers access to telephonic support from doctors
Uses the DBC network Helps in finding a registered counsellor for emotional support

Puts you first, offering emotional and medical support

Delivers cost-effective care of the highest quality
Liaises with your doctor to ensure your treatment plan is
clinically appropriate to meet your needs

Cancer Matches the treatment plan to your benefits to ensure you have
the cover you need
Access to a social worker for you and your loved ones
Uses the ICON network of oncology specialists
Uses the Bonitas Oncology Medicine Network
(20% co-payment applies for use of a non-network provider)
Empowers you to make the right decisions to stay healthy
Offers a personalised care plan for your specific needs
Provides cover for the tests required for the management of
diabetes as well as other chronic conditions
Helps you track the results of the required tests
Diabetes management
Offers access to diabetes doctors, dieticians and podiatrists
Helps you better understand your condition through diabetes
education
Gives access to a dedicated Health Coach to answer any
questions you may have

Page 55 Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
 In-hospital benefits Unlimited, if you register on the HIV/AIDS programme
HIV/AIDS
This benefit offers cover for major medical events that result in a beneficiary being admitted to Chronic medicine must be obtained from Pharmacy Direct
hospital. We negotiate extensively with private hospitals to ensure the best possible value for our
members.
Pre-authorisation is required. A co-payment will apply to the following procedures in hospital:
Please note: You must use a hospital on the Primary Select network or you will have to pay a
R1 520 co-payment R3 850 co-payment R7 580 co-payment
30% co-payment.
1. Colonoscopy 1. Arthroscopy 1. Back Surgery including
Spinal Fusion
Unlimited, network specialists covered in full at the Bonitas Rate
Specialist consultations/ 2. Conservative Back 2. Diagnostic Laparoscopy 2. Joint Replacements
treatment Unlimited, non-network specialists paid at 100% of the Bonitas Treatment
Rate
3. Cystoscopy 3. Laparoscopic 3. Laparoscopic

PRIMARY SELECT
GP consultations/treatment Unlimited, covered at 100% of the Bonitas Rate Hysterectomy Pyeloplasty
Blood tests and other 4. Facet Joint Injections 4. Percutaneous 4. Laparoscopic Radical
Unlimited, covered at 100% of the Bonitas Rate
laboratory tests Radiofrequency Prostatectomy
X-rays and ultrasounds Unlimited, covered at 100% of the Bonitas Rate Ablations
(Percutaneous Rhizotomies)
MRIs and CT scans R13 260 per family, in and out-of-hospital
5. Flexible Sigmoidoscopy 5. Nissen Fundoplication
(specialised radiology) Pre-authorisation required (Reflux Surgery)
Paramedical/Allied medical 6. Functional Nasal Surgery
professionals
(such as physiotherapists, Paid from available day-to-day benefits (except for PMB)
occupational therapists, 7. Gastroscopy
dieticians and biokineticists)
8. Hysteroscopy
R32 130 per family (excluding joint replacement prosthesis) (not Endometrial Ablation)
Internal prosthesis Managed Care protocols apply 9. Myringotomy
You must use a preferred supplier 10. Tonsillectomy and
R15 830 per family Adenoidectomy
Mental health 11. Umbilical Hernia Repair
No cover for physiotherapy for mental health admissions
hospitalisation
You must use a Designated Service Provider 12. Varicose Vein Surgery

Take-home medicine R390 per beneficiary, per hospital stay

Physical rehabilitation R50 600 per family
Alternatives to hospital
R16 880 per family
(hospice, step-down facilities)
Unlimited
Terminal care Including hospice/private nursing, home oxygen,
pain management, psychologist and social worker support
R165 500 per family
Cancer treatment You must use a preferred provider
Sublimit of R44 220 per beneficiary for Brachytherapy
Organ transplants PMB only
Unlimited
Kidney dialysis You must use a Designated Service Provider, or a
20% co-payment will apply

Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes. Page 56
BONCAP

Basic day-to-day benefits with GP consultations at a network provider

Unlimited hospital cover Preventative care:

100% Bonitas Rate
• Flu vaccine
• HIV test
• Mammogram
• Pap smear
Unlimited terminal care benefit • Pneumococcal vaccine
• Prostate screening

R1 070 for contraceptives Managed care programmes:

• Cancer
• HIV/AIDS

Chronic medicine for 27 PMB

conditions

What you pay if your Main Adult Child

monthly income is: member dependant dependant
R0 to R8 520 R1 159 R1 098 R546
R8 521 to R13 840 R1 372 R1 297 R630
R13 841 to R18 900 R2 210 R1 967 R836
R18 901 + R2 714 R2 417 R1 029

Page 57 All benefits per family unless otherwise stated

 Out-of-hospital benefits
These benefits cover your day-to-day medical expenses at of 100% of the Bonitas Rate.
Network GP consultations
Non-network GP
consultations
GP-referred acute
medicine, x-rays and blood
tests
Specialist consultations
(this benefit includes prescribed
acute medicine, blood tests,
x-rays, MRIs and CT scans)
Maternity care
Over-the-counter medicine
Paramedical/Allied medical
professionals
(such as physiotherapists,
occupational therapists,
dieticians and biokineticists)
General medical appliances
(such as wheelchairs and
crutches)
Optometry
Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
1 per beneficiary, at a network provider
Eye tests OR
R325 per beneficiary, at a non-network provider
Unlimited consultations, using a maximum of 2 nominated
network GPs Single vision lenses (Clear) 100% towards the cost of lenses at network rates
or
Approval is required from the 8th GP consultation per R185 per lens, per beneficiary, out of network
beneficiary Bifocal lenses (Clear) 100% towards the cost of lenses at network rates
1 out-of-network consultation per beneficiary or R420 per lens, per beneficiary, out of network
Maximum of 2 consultations per family, limited to R1 070 100% towards the cost of lenses at network rates
Multifocal lenses (Clear)
20% co-payment applies R745 per lens, per beneficiary, out of network
Main member only R1 880 R225 per beneficiary at a network provider
Frames
Main member + 1 dependant R3 120 R158 per beneficiary at a non-network provider
Main member + 2 dependants R3 730
Contact lenses R1 085 per beneficiary (included in the family limit)
Main member + 3 dependants R4 080
You must use a provider on the DENIS network
Main member + 4 or more dependants R4 530
Basic dentistry Covered at the Bonitas Dental Tariff
Formulary and Bonitas Pharmacy Network applies for acute
Managed Care protocols apply
medicine (20% co-payment for non-network or
non-formulary use) Consultations 1 consultation per beneficiary, per year
1 specific (emergency) consultation for pain and sepsis
BONCAP
Limited to 3 visits or R3 170 per beneficiary Emergency consultation
per beneficiary
Limited to 5 visits or R4 710 per family X-rays: Intra-oral 4 x-rays per beneficiary
Subject to referral from a network GP
1 per beneficiary, in a lifetime
Pre-authorisation required for MRIs and CT scans X-rays: Extra-oral
X-rays must be submitted to DENIS for review
Antenatal consultations are subject to the GP consultations 1 polish
and specialist consultations benefits
Scaling and polishing OR
4 consultations with a midwife after delivery (1 of these can be
used for a consultation with a lactation specialist) 1 scaling and polishing per beneficiary
Limited to R95 per event Fluoride treatments 1 treatment for beneficiaries under 16 years
Maximum of R270 per beneficiary, per year 1 per tooth, once every 3 years for beneficiaries under
Fissure sealants
16 years
Formulary and Bonitas Pharmacy Network applies
Infection control,
(20% co-payment for non-network or non-formulary use) instrument sterilisation and 1 set per beneficiary, per visit
local anaesthetic
Laughing gas in dental Inhalation sedation limited to extensive dental treatment
PMB only rooms only
Emergency root canal For emergency treatment only
therapy Subject to DENIS treatment protocols
R5 550 per family
You must use a preferred supplier Pulp treatments For amputation of pulp of primary teeth
You must use the contracted service provider Extractions Subject to DENIS treatment protocols
(removal of teeth)
Managed Care protocols apply Extractions and treatment of septic sockets
Page 58

Dental fillings
Plastic dentures
Maxillo-facial surgery in
dental chair
4 fillings per beneficiary Additional benefits
Benefit for fillings is granted once per tooth, every 2 years We believe in giving you more value. These additional benefits will not affect your other benefit
Benefit for retreatment of a tooth is subject to Managed Care limits.
protocols
1 set of plastic dentures (an upper and a lower) per family, Contraceptives
once every 2 years for beneficiaries 21 years and over R1 070 per family
20% co-payment applies For women aged up to 50 You must use the Designated Service Provider for
pharmacy-dispensed contraceptives
Pre-authorisation required
A further 20% co-payment will apply if authorisation is Childcare
applied for after the treatment has been done Hearing screening For newborns, in or out-of-hospital
PMB only Congenital hypothyroidism
For infants under 1 month old
screening
Please note: No benefit for Osseo-integrated implants and
Orthognathic surgery Babyline 24/7 helpline for medical advice for children under 3 years
Access to a maxillo-facial specialist by DENIS Preventative care
pre-authorisation only 1 HIV test per beneficiary
Pre-authorisation from DENIS required General health
1 flu vaccine per beneficiary

IV conscious sedation in the Limited to extensive dental treatment 1 mammogram every 2 years, for women over 40
rooms Women’s health
Pre-authorisation from DENIS required 1 pap smear every 3 years, for women between ages 21 and 65

PMB only 1 prostate screening antigen test for men between ages 45 and
BONCAP

Hospitalisation Men’s health

(general anaesthetic)
69, who are considered to be at high risk for prostate cancer
Pre-authorisation from DENIS required
1 pneumococcal vaccine every 5 years, for members aged
65 and over
Elderly health
1 stool test for colon cancer, for members between ages
50 and 75
Wellness benefits
1 wellness screening per beneficiary at a participating pharmacy,
biokineticist or a Bonitas wellness day
Wellness screening includes the following tests:
Wellness screening • Blood pressure
• Glucose
• Cholesterol
• Body mass index
• Waist-to-hip ratio

Page 59 Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
 Chronic benefits Managed Care programmes
BonCap ensures that you are covered for the 27 Prescribed Minimum Benefits listed below. You We offer a range of Managed Care programmes to support you and help put you on the path to
must use Pharmacy Direct, our Designated Service Provider, to get your medicine. If you choose not good health. These programmes empower you to manage your condition effectively in the most
to use Pharmacy Direct or if you choose to use medicine that is not on the formulary, you will have clinically-proven way, ensuring your benefits last longer.
to pay a 40% co-payment.
You will need to register to join these programmes.

Prescribed Minimum Benefits covered

Puts you first, offering emotional and medical support
1. Addison’s Disease 10. Crohn’s Disease 19. Hyperlipidaemia Delivers cost-effective care of the highest quality
2. Asthma 11. Diabetes Insipidus 20. Hypertension Liaises with your doctor to ensure your treatment plan is
clinically appropriate to meet your needs
3. Bipolar Mood Disorder 12. Diabetes Type 1 21. Hypothyroidism
Cancer Matches the treatment plan to your benefits to ensure you have
4. Bronchiectasis 13. Diabetes Type 2 22. Multiple Sclerosis the cover you need
5. Cardiac Failure 14. Dysrhythmias 23. Parkinson’s Disease Access to a social worker for you and your loved ones
6. Cardiomyopathy 15. Epilepsy 24. Rheumatoid Arthritis Uses the ICON network of oncology specialists
7. Chronic Obstructive 16. Glaucoma 25. Schizophrenia Uses the Bonitas Oncology Medicine Network
Pulmonary Disease (20% co-payment applies for use of a non-network provider)

8. Chronic Renal Disease 17. Haemophilia 26. Systemic Lupus Provides you with appropriate treatment and tools to live a
Erythematosus normal life
9. Coronary Artery Disease 18. HIV/AIDS 27. Ulcerative Colitis Covers medicine to treat HIV (including drugs to prevent
mother-to-child transmission and infection after sexual assault
or needle-stick injury)

BONCAP
Treatment and prevention of opportunistic infections such as
pneumonia, TB and flu
Covers regular blood tests to monitor disease progression,
HIV/AIDS response to therapy and to detect possible side-effects of
treatment
Offers HIV-related consultations to visit your doctor to monitor
your clinical status
Gives ongoing patient support via a team of trained and
experienced counsellors
Offers access to telephonic support from doctors
Helps in finding a registered counsellor for emotional support

Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes. Page 60
 In-hospital benefits
Hospitalisation is covered at 100% of the Bonitas Rate at all hospitals on the BonCap Network. You
must get pre-authorisation for your hospital admission. You will have to pay a R10 000 co-payment
if you use a non-network hospital (except for emergencies) or if you do not get pre-authorisation
within 48 hours of admission.
GP consultations
Specialist consultations
Blood tests and other
laboratory tests
Blood transfusions
X-rays and ultrasounds
MRIs and CT scans
(specialised radiology)
Paramedical/Allied medical
professionals
(such as physiotherapists,
occupational therapists)
BONCAP
Surgical procedures that are Varicose vein surgery
not covered Hernia repair surgery
Internal and external
prostheses
Mental health
hospitalisation
Neonatal care
Take-home medicine
Physical rehabilitation
Page 61
Alternatives to hospital R14 570 per family
(hospice, step-down facilities) Pre-authorisation required
Unlimited
Terminal care Including hospice/private nursing, home oxygen, pain
management, psychologist and social worker support
Unlimited, covered at 100% of the Bonitas Rate PMB only
Cancer treatment
Unlimited, covered at 100% of the Bonitas Rate Subject to using the Designated Service Provider
Unlimited
R25 950 per family Organ transplants
Pre-authorisation required
R18 850 per family Unlimited
Unlimited, covered at 100% of the Bonitas Rate You must use a Designated Service Provider, or a
Kidney dialysis
R11 840 per family 20% co-payment will apply
Pre-authorisation required Pre-authorisation required
Unlimited, if you register on the HIV/AIDS programme
PMB only HIV/AIDS
Chronic medicine must be obtained from Pharmacy Direct
Your therapist must have a referral from the doctor treating you
Back and neck surgery
Joint replacement surgery
Caesarean sections done for non-medical reasons
Functional nasal and sinus surgery
Laparoscopic or keyhole surgery
Gastroscopies, colonoscopies and all other endoscopies
Bunion surgery
In-hospital dental surgery
PMB only
Managed Care protocols apply
Pre-authorisation required
You must use a preferred supplier
PMB only
No cover for physiotherapy for mental health admissions
Subject to using the Designated Service Provider
Limited to R46 290 per family, except for PMB
R390 per beneficiary, per hospital stay
R50 600 per family
Pre-authorisation required
Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
 HOSPITAL STANDARD

Plus extra benefits for: Maternity benefits:

MRIs and CT scans • 6 consultations during pregnancy
• 2 x 2D scans
• 4 consultations with a midwife after delivery
Mental health
(1 of these can be used for a consultation with
a lactation specialist)
• Maternity support for pregnant moms

Unlimited hospital cover

100% Bonitas Rate
Childcare benefits:
• Newborn hearing screening
• Thyroid screening for infants under 1 month
Wellness screening plus R1 270 Extender to
• 2 Paediatric or GP consultations for children under 1
use for blood tests, x-rays, programme to stop
• 1 GP consultation for children aged 2 - 12
smoking or consultations with a GP, dietician,
• 24/7 Babyline for advice for children under 3
biokineticist and physiotherapist

Preventative care:
R1 610 for contraceptives
• Flu vaccine
• HIV test

What you pay Chronic medicine for 27 PMB

•
•
Mammogram
Pap smear
• Pneumococcal vaccine
conditions • Prostate screening
Main member R2 284
Adult dependant R1 925 Unlimited terminal care benefit Managed Care programmes:
• Back and neck
Child dependant R869 • Cancer
• Diabetes
• HIV/AIDS

You only pay for a maximum of three children. Full-time

students pay child rates up to age 24 years.

All benefits per family unless otherwise stated Page 62

 Additional benefits Wellness benefits
We believe in giving you more value. These additional benefits will not affect your other benefit 1 wellness screening per beneficiary at a participating pharmacy,
limits. biokineticist or a Bonitas wellness day
Wellness screening includes the following tests:
Contraceptives • Blood pressure
Wellness screening
R1 610 per family • Glucose
For women aged up to 50 • Cholesterol
You must use the Designated Service Provider for
• Body mass index
pharmacy-dispensed contraceptives
• Waist-to-hip ratio
Maternity care
R1 270 per family which can be used for:
6 antenatal consultations with a gynaecologist, GP or midwife
• GP consultations only
2 2D ultrasound scans • Biokineticist consultations and treatment
1 amniocentesis • Dietician consultations and treatment
Per pregnancy • Physiotherapist consultations and treatment
4 consultations with a midwife after delivery (1 of these can be
used for a consultation with a lactation specialist) Wellness extender • A programme to stop smoking
• X-rays as per formulary
Maternity support for pregnant moms • Blood tests as per formulary
Childcare Available after completing a wellness screening
Hearing screening For newborns, in or out-of-hospital Child dependants can access the wellness extender once an adult
Congenital hypothyroidism beneficiary has completed a wellness screening
For infants under 1 month old
screening
International travel benefit
Babyline 24/7 helpline for medical advice for children under 3 years
Cover for medical emergencies when you travel outside South
Paediatrician or GP 2 consultations per child under 1 year Per trip Africa
consultations 1 consultation per child between ages 1 and 2 You must register for this benefit
GP consultations 1 consultation per child between ages 2 and 12
Preventative care
1 HIV test per beneficiary
General health
1 flu vaccine per beneficiary
HOSPITAL STANDARD

1 mammogram every 2 years, for women over 40

Women’s health
1 pap smear every 3 years, for women between ages 21 and 65
1 prostate screening antigen test for men between ages 45 and
Men’s health
69, who are considered to be at high risk for prostate cancer
1 pneumococcal vaccine every 5 years, for members aged
65 and over
Elderly health
1 stool test for colon cancer, for members between ages
50 and 75

Page 63 Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
 Chronic benefits Puts you first, offering emotional and medical support
Hospital Standard ensures that you are covered for the 27 Prescribed Minimum Benefits listed Delivers cost-effective care of the highest quality
below on the applicable formulary. You must use Pharmacy Direct, our Designated Service Provider, Liaises with your doctor to ensure your treatment plan is
to get your medicine. If you choose not to use Pharmacy Direct or if you choose to use medicine clinically appropriate to meet your needs
that is not on the formulary, you will have to pay a 40% co-payment.
Cancer Matches the treatment plan to your benefits to ensure you have
the cover you need
Prescribed Minimum Benefits covered
Access to a social worker for you and your loved ones
1. Addison’s Disease 10. Crohn’s Disease 19. Hyperlipidaemia Uses the ICON network of oncology specialists
2. Asthma 11. Diabetes Insipidus 20. Hypertension Uses the Bonitas Oncology Medicine Network
(20% co-payment applies for use of a non-network provider)
3. Bipolar Mood Disorder 12. Diabetes Type 1 21. Hypothyroidism
Empowers you to make the right decisions to stay healthy
4. Bronchiectasis 13. Diabetes Type 2 22. Multiple Sclerosis
Offers a personalised care plan for your specific needs
5. Cardiac Failure 14. Dysrhythmias 23. Parkinson’s Disease
Provides cover for the tests required for the management of
6. Cardiomyopathy 15. Epilepsy 24. Rheumatoid Arthritis diabetes as well as other chronic conditions
7. Chronic Obstructive 16. Glaucoma 25. Schizophrenia Helps you track the results of the required tests
Pulmonary Disease Diabetes management
Offers access to diabetes doctors, dieticians and podiatrists
8. Chronic Renal Disease 17. Haemophilia 26. Systemic Lupus
Erythematosus Helps you better understand your condition through diabetes
education
9. Coronary Artery Disease 18. HIV/AIDS 27. Ulcerative Colitis
Gives access to a dedicated Health Coach to answer any
questions you may have
Provides you with appropriate treatment and tools to live a
normal life
Covers medicine to treat HIV (including drugs to prevent
mother-to-child transmission and infection after sexual assault
or needle-stick injury)
Treatment and prevention of opportunistic infections such as
pneumonia, TB and flu

HOSPITAL STANDARD
Covers regular blood tests to monitor disease progression,
HIV/AIDS response to therapy and to detect possible side-effects of
Managed Care programmes treatment

We offer a range of Managed Care programmes to support you and help put you on the path to Offers HIV-related consultations to visit your doctor to monitor
good health. These programmes empower you to manage your condition effectively in the most your clinical status
clinically-proven way, ensuring your benefits last longer. Gives ongoing patient support via a team of trained and
You will need to register to join these programmes. experienced counsellors
Offers access to telephonic support from doctors
Helps manage severe back and neck pain Helps in finding a registered counsellor for emotional support
Offers a personalised treatment plan for up to 6 weeks
Includes assistance from doctors, physiotherapists and
biokineticists
Back and neck
Gives access to a home care plan to maintain long-term results
We cover the full cost of the programme so it won’t impact your
savings or day-to-day benefits
Highly effective and low-risk, with an excellent success rate
Uses the DBC network
Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes. Page 64
 In-hospital benefits
This benefit offers cover for major medical events that result in a beneficiary being admitted to
hospital. We negotiate extensively with private hospitals to ensure the best possible value for our
members.
Pre-authorisation is required.
Specialist consultations/
treatment
GP consultations/treatment Unlimited, covered at 100% of the Bonitas Rate
Blood tests and other
laboratory tests
X-rays and ultrasounds
MRIs and CT scans
(specialised radiology)
Paramedical/Allied medical
professionals
(such as physiotherapists,
occupational therapists,
dieticians and biokineticists)
Internal prosthesis
External prosthesis
HOSPITAL STANDARD
Hospitalisation for
basic dentistry
(general anaesthetic)
IV conscious sedation
in rooms
Mental health
hospitalisation
Take-home medicine
Physical rehabilitation
Alternatives to hospital
(hospice, step-down facilities)
Page 65
Unlimited
Terminal care Including hospice/private nursing, home oxygen,
pain management, psychologist and social worker support
R344 500 per family
Cancer treatment You must use a preferred provider
Unlimited, network specialists covered in full at the Bonitas Rate Sublimit of R44 220 per beneficiary for Brachytherapy
Unlimited
Unlimited, non-network specialists paid at 100% of the Bonitas
Organ transplants
Rate Sublimit of R32 130 per beneficiary for corneal grafts
Unlimited
Kidney dialysis You must use a Designated Service Provider, or a
Unlimited, covered at 100% of the Bonitas Rate
20% co-payment will apply
Unlimited, covered at 100% of the Bonitas Rate Unlimited, if you register on the HIV/AIDS programme
HIV/AIDS
R26 620 per family, in and out-of-hospital Chronic medicine must be obtained from Pharmacy Direct
Pre-authorisation required
A co-payment will apply to the following procedures in hospital:
PMB only
Your therapist must get a referral from the doctor treating you R1 520 co-payment R3 850 co-payment R7 580 co-payment
in hospital 1. Colonoscopy 1. Arthroscopy 1. Back Surgery including
Spinal Fusion
R45 090 per family (excluding joint replacements) 2. Conservative Back 2. Diagnostic Laparoscopy 2. Joint Replacements
Managed Care protocols apply Treatment
You must use a preferred supplier 3. Cystoscopy 3. Laparoscopic 3. Laparoscopic
Hysterectomy Pyeloplasty
PMB only
4. Facet Joint Injections 4. Percutaneous 4. Laparoscopic Radical
Managed Care protocols apply Radiofrequency Prostatectomy
General anaesthetic is only available to children under the age of Ablations
(Percutaneous Rhizotomies)
5 years for extensive dental treatment once per lifetime
5. Flexible Sigmoidoscopy 5. Nissen Fundoplication
General anaesthetic benefits are available for the removal of
(Reflux Surgery)
impacted teeth
6. Functional Nasal Surgery
R3 500 co-payment for hospital admissions
7. Gastroscopy
Managed Care protocols apply
8. Hysteroscopy
Pre-authorisation required (not Endometrial Ablation)
Managed Care protocols apply 9. Myringotomy
Pre-authorisation required 10. Tonsillectomy and
R32 210 per family Adenoidectomy
11. Umbilical Hernia Repair
Physiotherapy will be excluded for all mental health admissions
You must use a Designated Service Provider 12. Varicose Vein Surgery
R475 per beneficiary, per hospital stay
R50 600 per family
R16 880 per family
Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
 BONESSENTIAL

Plus extra benefits for: Maternity benefits:

MRIs and CT scans • 6 consultations during pregnancy
• 2 x 2D scans
• 4 consultations with a midwife after delivery
Mental health
(1 of these can be used for a consultation with
a lactation specialist)
• Maternity support for pregnant moms

Unlimited hospital cover

100% Bonitas Rate
Wellness screening plus R910 Extender to
use for blood tests, x-rays, programme to stop
smoking or consultations with a GP, dietician,
biokineticist and physiotherapist
Childcare benefits:
• Newborn hearing screening
• Thyroid screening for infants under 1 month
• 1 GP consultation for children aged 2 - 12
• 24/7 Babyline for advice for children under 3

Preventative care:
R1 290 for contraceptives • Flu vaccine
• HIV test

What you pay Chronic medicine for 27 PMB

•
•
Mammogram
Pap smear
• Pneumococcal vaccine
conditions • Prostate screening
Main member R1 877
Adult dependant R1 436 Unlimited terminal care benefit Managed Care programmes:
• Back and neck
Child dependant R550 • Cancer
• Diabetes
• HIV/AIDS
You only pay for a maximum of three children. Full-time
students pay child rates up to age 24 years.

All benefits per family unless otherwise stated Page 66

 Additional benefits R910 per family which can be used for:
We believe in giving you more value. These additional benefits will not affect your other benefit • GP consultations only
limits. • Biokineticist consultations and treatment
• Dietician consultations and treatment
• Physiotherapist consultations and treatment
Contraceptives
Wellness extender • A programme to stop smoking
R1 290 per family • X-rays as per formulary
For women aged up to 50 You must use the Designated Service Provider for • Blood tests as per formulary
pharmacy-dispensed contraceptives Available after completing a wellness screening
Maternity care Child dependants can access the wellness extender once an adult
6 antenatal consultations with a gynaecologist, GP or midwife beneficiary has completed a wellness screening
2 2D ultrasound scans International travel benefit
1 amniocentesis Cover for medical emergencies when you travel outside South
Per pregnancy
4 consultations with a midwife after delivery (1 of these can be Per trip Africa
used for a consultation with a lactation specialist) You must register for this benefit
Maternity support for pregnant moms
Childcare
Hearing screening For newborns, in or out-of-hospital
Congenital hypothyroidism
screening
For infants under 1 month old Chronic benefits
Babyline 24/7 helpline for medical advice for children under 3 years BonEssential ensures that you are covered for the 27 Prescribed Minimum Benefits listed below. You
must use Pharmacy Direct, our Designated Service Provider, to get your medicine. If you choose not
GP consultations 1 consultation per child between ages 2 and 12
to use Pharmacy Direct or if you choose to use medicine that is not on the formulary, you will have
Preventative care to pay a 40% co-payment.
1 HIV test per beneficiary
General health Prescribed Minimum Benefits covered
1 flu vaccine per beneficiary
1 mammogram every 2 years, for women over 40 1. Addison’s Disease 10. Crohn’s Disease 19. Hyperlipidaemia
Women’s health
1 pap smear every 3 years, for women between ages 21 and 65 2. Asthma 11. Diabetes Insipidus 20. Hypertension
BONESSENTIAL

1 prostate screening antigen test for men between ages 45 and 3. Bipolar Mood Disorder 12. Diabetes Type 1 21. Hypothyroidism
Men’s health
69, who are considered to be at high risk for prostate cancer
4. Bronchiectasis 13. Diabetes Type 2 22. Multiple Sclerosis
1 pneumococcal vaccine every 5 years, for members aged
5. Cardiac Failure 14. Dysrhythmias 23. Parkinson’s Disease
65 and over
Elderly health 6. Cardiomyopathy 15. Epilepsy 24. Rheumatoid Arthritis
1 stool test for colon cancer, for members between ages
50 and 75 7. Chronic Obstructive 16. Glaucoma 25. Schizophrenia
Pulmonary Disease
Wellness benefits
8. Chronic Renal Disease 17. Haemophilia 26. Systemic Lupus
1 wellness screening per beneficiary at a participating pharmacy,
Erythematosus
biokineticist or a Bonitas wellness day
9. Coronary Artery Disease 18. HIV/AIDS 27. Ulcerative Colitis
Wellness screening includes the following tests:
Wellness screening • Blood pressure
• Glucose
• Cholesterol
• Body mass index
• Waist-to-hip ratio

Page 67 Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
 Managed Care programmes Provides you with appropriate treatment and tools to live a
normal life
We offer a range of Managed Care programmes to support you and help put you on the path to
good health. These programmes empower you to manage your condition effectively in the most Covers medicine to treat HIV (including drugs to prevent
clinically-proven way, ensuring your benefits last longer. mother-to-child transmission and infection after sexual assault
or needle-stick injury)
You will need to register to join these programmes.
Treatment and prevention of opportunistic infections such as
pneumonia, TB and flu
Helps manage severe back and neck pain
Covers regular blood tests to monitor disease progression,
Offers a personalised treatment plan for up to 6 weeks HIV/AIDS response to therapy and to detect possible side-effects of
Includes assistance from doctors, physiotherapists and treatment
biokineticists
Offers HIV-related consultations to visit your doctor to monitor
Back and neck Gives access to a home care plan to maintain long-term results your clinical status
We cover the full cost of the programme so it won’t impact your Gives ongoing patient support via a team of trained and
savings or day-to-day benefits experienced counsellors
Highly effective and low-risk, with an excellent success rate Offers access to telephonic support from doctors
Uses the DBC network Helps in finding a registered counsellor for emotional support

Puts you first, offering emotional and medical support

Delivers cost-effective care of the highest quality
Liaises with your doctor to ensure your treatment plan is
clinically appropriate to meet your needs

Cancer Matches the treatment plan to your benefits to ensure you have
the cover you need
Access to a social worker for you and your loved ones
Uses the ICON network of oncology specialists
Uses the Bonitas Oncology Medicine Network
(20% co-payment applies for use of a non-network provider)

Empowers you to make the right decisions to stay healthy

Offers a personalised care plan for your specific needs

BONESSENTIAL
Provides cover for the tests required for the management of
diabetes as well as other chronic conditions
Helps you track the results of the required tests
Diabetes management
Offers access to diabetes doctors, dieticians and podiatrists
Helps you better understand your condition through diabetes
education
Gives access to a dedicated Health Coach to answer any
questions you may have

Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes. Page 68
 In-hospital benefits Kidney dialysis
You must use a Designated Service Provider, or a
20% co-payment will apply
This benefit offers cover for major medical events that result in a beneficiary being admitted to
hospital. We negotiate extensively with private hospitals to ensure the best possible value for our Unlimited, if you register on the HIV/AIDS programme
members. HIV/AIDS
Chronic medicine must be obtained from Pharmacy Direct
Pre-authorisation is required.

Unlimited, network specialists covered in full at the Bonitas Rate A co-payment will apply to the following procedures in hospital:
Specialist consultations/
treatment Unlimited, non-network specialists paid at 100% of the Bonitas
Rate R1 520 co-payment R3 850 co-payment R7 580 co-payment

GP consultations/treatment Unlimited, covered at 100% of the Bonitas Rate 1. Colonoscopy 1. Arthroscopy 1. Back Surgery including
Spinal Fusion
Blood tests and other
Unlimited, covered at 100% of the Bonitas Rate 2. Conservative Back 2. Diagnostic Laparoscopy 2. Joint Replacements
laboratory tests
Treatment
X-rays and ultrasounds Unlimited, covered at 100% of the Bonitas Rate
3. Cystoscopy 3. Laparoscopic 3. Laparoscopic
MRIs and CT scans R16 070 per family, in and out-of-hospital Hysterectomy Pyeloplasty
(specialised radiology) Pre-authorisation required 4. Facet Joint Injections 4. Percutaneous 4. Laparoscopic Radical
Paramedical/Allied medical Radiofrequency Prostatectomy
professionals PMB only Ablations
(such as physiotherapists, (Percutaneous Rhizotomies)
Your therapist must get a referral from the doctor treating you
occupational therapists, in hospital 5. Flexible Sigmoidoscopy 5. Nissen Fundoplication
dieticians and biokineticists) (Reflux Surgery)
R32 130 per family (excluding joint replacement prosthesis) 6. Functional Nasal Surgery
Internal prosthesis Managed Care protocols apply
You must use a preferred supplier 7. Gastroscopy
PMB only 8. Hysteroscopy
(not Endometrial Ablation)
External prosthesis Managed Care protocols apply
9. Myringotomy
You must use a preferred supplier
10. Tonsillectomy and
R32 210 per family Adenoidectomy
Mental health
BONESSENTIAL

hospitalisation
Take-home medicine
Physical rehabilitation
Alternatives to hospital
(hospice, step-down facilities)
Terminal care
Cancer treatment
Organ transplants
(excluding corneal grafts)
Physiotherapy will be excluded for all mental health admissions 11. Umbilical Hernia Repair
You must use a Designated Service Provider 12. Varicose Vein Surgery
R390 per beneficiary, per hospital stay
R50 600 per family
R16 880 per family
Unlimited
Including hospice/private nursing, home oxygen,
pain management, psychologist and social worker support
R344 500 per family
You must use a preferred provider
Sublimit of R44 220 per beneficiary for Brachytherapy
Unlimited

Page 69 Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
 BONESSENTIAL SELECT

Approximately 15% cheaper using a quality network

Plus extra benefits for: Maternity benefits:

MRIs and CT scans • 6 consultations during pregnancy
• 2 x 2D scans
• 4 consultations with a midwife after delivery
Mental health
(1 of these can be used for a consultation with
a lactation specialist)
• Maternity support for pregnant moms

Unlimited hospital cover

100% Bonitas Rate
Wellness screening plus R910 Extender to
use for blood tests, x-rays, programme to stop
smoking or consultations with a GP, dietician,
biokineticist and physiotherapist
Childcare benefits:
• Newborn hearing screening
• Thyroid screening for infants under 1 month
• 1 GP consultation for children aged 2 - 12
• 24/7 Babyline for advice for children under 3

Preventative care:
R1 290 for contraceptives
What you pay •
•
Flu vaccine
HIV test
• Mammogram
• Pap smear
Main member R1 602 Chronic medicine for 27 PMB • Pneumococcal vaccine
conditions • Prostate screening

Adult dependant R1 225

Child dependant R470 Unlimited terminal care benefit Managed Care programmes:
• Back and neck
• Cancer
You only pay for a maximum of three children. Full-time • Diabetes
students pay child rates up to age 24 years. • HIV/AIDS

All benefits per family unless otherwise stated Page 70

 Additional benefits R910 per family which can be used for:
We believe in giving you more value. These additional benefits will not affect your other benefit • GP consultations only
limits. • Biokineticist consultations and treatment
• Dietician consultations and treatment
• Physiotherapist consultations and treatment
Contraceptives
Wellness extender • A programme to stop smoking
R1 290 per family • X-rays as per formulary
For women aged up to 50 You must use the Designated Service Provider for • Blood tests as per formulary
pharmacy-dispensed contraceptives Available after completing a wellness screening
Maternity care Child dependants can access the wellness extender once an adult
6 antenatal consultations with a gynaecologist, GP or midwife beneficiary has completed a wellness screening
2 2D ultrasound scans International travel benefit
1 amniocentesis Cover for medical emergencies when you travel outside South
Per pregnancy
4 consultations with a midwife after delivery (1 of these can be Per trip Africa
used for a consultation with a lactation specialist) You must register for this benefit
Maternity support for pregnant moms
Childcare
Hearing screening For newborns, in or out-of-hospital
Congenital hypothyroidism
screening
For infants under 1 month old Chronic benefits
Babyline 24/7 helpline for medical advice for children under 3 years BonEssential Select ensures that you are covered for the 27 Prescribed Minimum Benefits listed
below. You must use Pharmacy Direct, our Designated Service Provider, to get your medicine. If you
GP consultations 1 consultation per child between ages 2 and 12 choose not to use Pharmacy Direct or if you choose to use medicine that is not on the formulary,
Preventative care you will have to pay a 40% co-payment.
1 HIV test per beneficiary
General health Prescribed Minimum Benefits covered
1 flu vaccine per beneficiary
1 mammogram every 2 years, for women over 40 1. Addison’s Disease 10. Crohn’s Disease 19. Hyperlipidaemia
Women’s health
BONESSENTIAL SELECT

1 pap smear every 3 years, for women between ages 21 and 65 2. Asthma 11. Diabetes Insipidus 20. Hypertension
1 prostate screening antigen test for men between ages 45 and 3. Bipolar Mood Disorder 12. Diabetes Type 1 21. Hypothyroidism
Men’s health
69, who are considered to be at high risk for prostate cancer 4. Bronchiectasis 13. Diabetes Type 2 22. Multiple Sclerosis
1 pneumococcal vaccine every 5 years, for members aged 5. Cardiac Failure 14. Dysrhythmias 23. Parkinson’s Disease
65 and over
Elderly health 6. Cardiomyopathy 15. Epilepsy 24. Rheumatoid Arthritis
1 stool test for colon cancer, for members between ages
50 and 75 7. Chronic Obstructive 16. Glaucoma 25. Schizophrenia
Pulmonary Disease
Wellness benefits
8. Chronic Renal Disease 17. Haemophilia 26. Systemic Lupus
1 wellness screening per beneficiary at a participating pharmacy, Erythematosus
biokineticist or a Bonitas wellness day
9. Coronary Artery Disease 18. HIV/AIDS 27. Ulcerative Colitis
Wellness screening includes the following tests:
Wellness screening • Blood pressure
• Glucose
• Cholesterol
• Body mass index
• Waist-to-hip ratio

Page 71 Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
 Managed Care programmes Provides you with appropriate treatment and tools to live a
normal life
We offer a range of Managed Care programmes to support you and help put you on the path to
good health. These programmes empower you to manage your condition effectively in the most Covers medicine to treat HIV (including drugs to prevent
clinically-proven way, ensuring your benefits last longer. mother-to-child transmission and infection after sexual assault
or needle-stick injury)
You will need to register to join these programmes.
Treatment and prevention of opportunistic infections such as
pneumonia, TB and flu
Helps manage severe back and neck pain
Covers regular blood tests to monitor disease progression,
Offers a personalised treatment plan for up to 6 weeks HIV/AIDS response to therapy and to detect possible side-effects of
Includes assistance from doctors, physiotherapists and treatment
biokineticists Offers HIV-related consultations to visit your doctor to monitor
Back and neck Gives access to a home care plan to maintain long-term results your clinical status
We cover the full cost of the programme so it won’t impact your Gives ongoing patient support via a team of trained and
savings or day-to-day benefits experienced counsellors
Highly effective and low-risk, with an excellent success rate Offers access to telephonic support from doctors
Uses the DBC network Helps in finding a registered counsellor for emotional support

Puts you first, offering emotional and medical support

Delivers cost-effective care of the highest quality
Liaises with your doctor to ensure your treatment plan is
clinically appropriate to meet your needs

Cancer Matches the treatment plan to your benefits to ensure you have
the cover you need
Access to a social worker for you and your loved ones
Uses the ICON network of oncology specialists
Uses the Bonitas Oncology Medicine Network
(20% co-payment applies for use of a non-network provider)

Empowers you to make the right decisions to stay healthy

BONESSENTIAL SELECT
Offers a personalised care plan for your specific needs
Provides cover for the tests required for the management of
diabetes as well as other chronic conditions
Helps you track the results of the required tests
Diabetes management
Offers access to diabetes doctors, dieticians and podiatrists
Helps you better understand your condition through diabetes
education
Gives access to a dedicated Health Coach to answer any
questions you may have

Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes. Page 72
 In-hospital benefits
This benefit offers cover for major medical events that result in a beneficiary being admitted to
hospital. We negotiate extensively with private hospitals to ensure the best possible value for our
members.
Pre-authorisation is required.
Please note: You must use a hospital on the BonEssential Select network or you will have to pay a
30% co-payment.
Specialist consultations/
treatment
GP consultations/treatment Unlimited, covered at 100% of the Bonitas Rate
Blood tests and other
laboratory tests
X-rays and ultrasounds
Internal prosthesis
External prosthesis
MRIs and CT scans
(specialised radiology)
Paramedical/Allied medical
professionals
(such as physiotherapists,
BONESSENTIAL SELECT
occupational therapists,
dieticians and biokineticists)
Mental health
hospitalisation
Take-home medicine
Physical rehabilitation
Alternatives to hospital
(hospice, step-down facilities)
Terminal care
Cancer treatment
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Organ transplants
Unlimited
(excluding corneal grafts)
You must use a Designated Service Provider, or a
Kidney dialysis
20% co-payment will apply
Unlimited, if you register on the HIV/AIDS programme
HIV/AIDS
Chronic medicine must be obtained from Pharmacy Direct
Unlimited, network specialists covered in full at the Bonitas Rate A co-payment will apply to the following procedures in hospital:
Unlimited, non-network specialists paid at 100% of the Bonitas
Rate R1 520 co-payment R3 850 co-payment R7 580 co-payment
1. Colonoscopy 1. Arthroscopy 1. Back Surgery including
Spinal Fusion
Unlimited, covered at 100% of the Bonitas Rate 2. Conservative Back 2. Diagnostic Laparoscopy 2. Joint Replacements
Treatment
Unlimited, covered at 100% of the Bonitas Rate
3. Cystoscopy 3. Laparoscopic 3. Laparoscopic
R32 130 per family (excluding joint replacement prosthesis) Hysterectomy Pyeloplasty
Managed Care protocols apply 4. Facet Joint Injections 4. Percutaneous 4. Laparoscopic Radical
You must use a preferred supplier Radiofrequency Prostatectomy
Ablations
PMB only (Percutaneous Rhizotomies)
Managed Care protocols apply 5. Flexible Sigmoidoscopy 5. Nissen Fundoplication
(Reflux Surgery)
You must use a preferred supplier
6. Functional Nasal Surgery
R16 070 per family, in and out-of-hospital
Pre-authorisation required
7. Gastroscopy
PMB only 8. Hysteroscopy
(not Endometrial Ablation)
Your therapist must get a referral from the doctor treating you
in hospital 9. Myringotomy
10. Tonsillectomy and
R32 210 per family Adenoidectomy
Physiotherapy will be excluded for all mental health admissions 11. Umbilical Hernia Repair
You must use a Designated Service Provider 12. Varicose Vein Surgery
R390 per beneficiary, per hospital stay
R50 600 per family
R16 880 per family
Unlimited
Including hospice/private nursing, home oxygen,
pain management, psychologist and social worker support
R344 500 per family
You must use a preferred provider
Sublimit of R44 220 per beneficiary for Brachytherapy
Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.

Designated Service Providers
We negotiate rates with 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.
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 0860 002 108 or log in to www.bonitas.co.za to view the list of Designated Service
Providers.
Understanding the Bonitas Rate
The Bonitas Rate is the rate at which we reimburse healthcare providers.
Where we pay 100% of the Bonitas Rate and your healthcare provider charges more than this, you
will have to pay the outstanding amount. For example, if you visit a healthcare provider who charges
200% of the medical aid rate and you receive a bill of R1 000, we will only pay R500.
If you visit a healthcare provider who charges the Bonitas Rate, we will pay the bill in full (provided
that you have benefits available). On some options we pay more than 100% of the Bonitas Rate.
Dependants
An adult dependant is any dependant on your medical aid who is 21 years or older. A child dependant
is any dependant on your medical aid who is under 21 years.
If your child is a student and is registered on your medical aid, child rates will apply up to and
including the last day of the month in which he/she turns 24 years old. We will require valid proof of
registration from a recognised tertiary institution for child rates to apply to a student.
Please note:
Some exclusions may apply. These exclusions are included in the Fund Rules which are available at www.bonitas.co.za or on request.
Claims are paid at the Bonitas Rate. Benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are subject to approval from the Council for Medical Schemes.
WHAT YOU NEED TO KNOW
Underwriting
Late-joiner penalties and waiting periods may apply to your membership as permitted by the
Medical Schemes Act No. 131 of 1998.
A late-joiner penalty applies to members over 35 years of age or older, who have had a break in
medical aid membership for more than 3 months from 1 April 2001. Late-joiner penalties will result
in your premium being increased. This is based on a specific calculation considering the number of
years you have not been a member of a medical aid.
A general waiting period lasts 3 months. During this period, you and your dependants are not
entitled to claim any benefits, except, in some circumstances, Prescribed Minimum Benefits.
A condition-specific waiting period lasts 12 months. During this period, you and/or your dependants
are not entitled to claim benefits related to a specific condition.
Please refer to Annexure D of the Fund Rules for more information. Visit www.bonitas.co.za for the
latest version.
Providers on the network will be paid in full
We encourage all our members to use providers on our network, as this will ensure that providers
are paid in full (provided that you have benefits available).
Pro-rated benefits
If you join Bonitas during the year, benefits will automatically be pro-rated. This means that you will
only have access to a percentage of your benefits, based on the month you join us, until the next
benefit year begins. For example, if you join in July, you will have access to six months’ worth of
benefits, which is 50% of the total benefits.
Page 74
 0860 002 108

www.bonitas.co.za

Bonitas Medical Fund

@BonitasMedical

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 Fund Rules, the Fund Rules will prevail. The Fund Rules are available at www.bonitas.co.za or on
request. Benefits are subject to approval from the Council for Medical Schemes.