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Bonitas Medical Fund I 0860 002 108 I www.bonitas.co.za
Product Brochure 2016
You can’t put a price on experience… With a proudly South African heritage spanning over 33 years, Bonitas has an intimate understanding of how the healthcare industry works. Our aim is to make quality healthcare accessible to all South Africans and add value to their lives. Affordable and generous, our benefits are designed to give our members more value for money. We have a wide range of products that are simple to understand so you know exactly what you’re covered for. They’re also easy to use, ensuring you get the support you need when you need it. Our members know that when things get tough, we’re there to support them and take care of the little details so that they can receive the best of care and focus on getting better.
Please note: The information contained in this brochure is subject to approval by the Council for Medical Schemes. Terms, conditions and Scheme rules apply. Version CMS1.
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INDEX Medicine management
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Pharmacy Advised Therapy (PAT) Page 60 Chronic Medicine Page 60
Pharmacy Direct Hospital Management
Page 61 Page 62
Networks Page 63 GP Network Page 63 Specialist Referrals Page 64 Specialist Network Page 64 The Standard Select and BonFit Hospital Network Page 64
Index
Introduction to Bonitas Page 08 Why choose Bonitas Page 10 Standard Page 12 Standard Select Page 18 Primary Page 24 BonComprehensive Page 30 BonClassic Page 36 BonSave Page 42 BonFit Page 48 BonEssential Page 52 Benefit and Process Guides Page 56 YourHealth Portal Page 56 Maternity Page 57 Prescribed Minimum Benefits Page 57 Managed care Page 59
Dental benefits Page 64 Optical benefits Page 66 Diabetic Program Page 67 Hip and Knee Replacement Program Page 68 HIV/Aids Management Page 68 Emergency medical services Page 69 Exclusion List Page 69 How-To Guide Page 76
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A customer-centric approach At Bonitas, we are committed to making quality healthcare accessible to all South Africans. It is this focus that drives our development of affordable, generous and easy-tounderstand benefits that offer excellent value for money.
We strive to give members the best advice when it comes to choosing the right product to suit their specific needs and pride ourselves on superior member support to ensure that every Bonitas experience is a great one.
Free flu vaccines & HIV tests on all options.
The only medical scheme to pay for dental benefits from risk.
The largest GP network in S.A.
Bonitas brings you more More experience: 33 years of experience in the healthcare industry = an intimate understanding of the needs of South Africans.
That’s why we’re the second largest open medical scheme in the country.
More support for customers – your every claim & query is met with superior support & advice. More payouts than any other open medical scheme.
93% More Added Value
Introduction to Bonitas
More & more members trust us to look after their healthcare needs.
What
more reason do you need? Visit our website at www.bonitas.co.za to learn more about our products.
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Why choose Bonitas? Consider these factors when choosing the right medical aid plan to suit your specific needs.
Adult Dependant: Any dependant on your medical aid who is 21 years of age or older.
Assessment of your healthcare needs: How often do you and your family visit the doctor? • • •
Do you and your family often require medication? Do you or your dependants need to visit a specialist? Do you or anyone in your family need extra cover for cancer, HIVAIDS or any other chronic condition?
Broker assistance: •
If you haven’t claimed at all or have had few medical expenses and are unlikely to claim unless a major medical emergency, you will probably require a low level of coverage. If you have had a large amount of medical expenses, it is likely that you require a higher level of cover.
Decision to use network •
Why choose Bonitas
Some plans require that you use a specific GP and hospital network or a selection of preferred providers in order to claim your expenses. This helps to keep your costs as low as possible but sticking to the network can be difficult. If you would prefer to have freedom to use any provider, you may need to opt for a more expensive plan.
Any dependant on your medical aid who is under the age of 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 they turn 24 years of age. You will need to send us valid proof of registration from a recognised tertiary institution for this to apply.
Special dependant: These include other members of your family that are currently financially dependent on you for care and support, such as grandchildren, parents-in-law and siblings. Your application might be subject to underwriting.
Underwriting: Your membership may be subject to underwriting which include late joiner penalties, condition specific or general waiting periods. Underwriting affects your benefit date.
A financial advisor or broker can advise on which plan best suits your needs and your budget.
Cover requirement history:
Child Dependant:
Pro-Ration:
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 June, you will have access to six months’ worth of benefits, which is 50% of the total benefits.
Bonitas rates vs. Private rates
All claims will be paid at the Bonitas Rate. This will vary between 100% and 300%, depending on the option chosen. Some service providers might charge you private rates for services. This means you will have to pay the difference yourself. Please check which rate your provider is charging before you receive treatment.
For more information, contact us on 0860 002 108.
• Dependants: Page 10
If you are single or married with children and wanting peace of mind that your family’s general medical needs are covered, without having to break the bank then this product is perfect for you. Overall annual limit (OAL) - Unlimited MONTHLY CONTRIBUTIONS
Main member
Adult dependant
Child dependant
R2 683
R2 321
R784
Your fourth and subsequent children will be covered free of charge.
IN-HOSPITAL BENEFITS These benefits include major medical events. GP consultations
Unlimited, at 100% of the Bonitas Rate
Specialist consultations
Unlimited, at the Specialist network rate: 130% of Bonitas Rate
Pathology
Unlimited, at 100% of the Bonitas Rate
General radiology
Unlimited, at 100% of the Bonitas Rate
Specialised radiology
Unlimited, subject to pre-authorisation
Paramedical services (Allied medical professions) - speech therapy, occupational therapy, dietetics
Unlimited, at 100% of the Bonitas Rate
Prosthesis internal and external
R37 900 per family, per year ICPS is the **DSP for hip and knee replacements a R5 000 co-payment is payable when not using the DSP.
Standard
Internal nerve stimulators
R142 000 per family, per year
Cochlear implants
R250 000 per family, per year
Mental health hospitalisation
R34 800 per family, per year
Take home medication (TTO)
R400 per beneficiary, per admission
Physical rehabilitation
R42 500 per family, per year
Alternatives to hospitalisation
R14 200 per family, per year
Oncology
R295 400 per family, per year
Organ transplants
Unlimited, subject to treatment protocols
Renal dialysis
Unlimited, subject to treatment protocols
Out-of-hospital claims excluding Network GP consultations will be paid from current available savings first. Once savings are depleted, claims will be paid from the day-to-day benefit .
Savings
Main member
Adult dependant
Child dependant
R1 212
R1 056
R360
The day-to-day benefit covers out-of-hospital general radiology, pathology, paramedical services (such as audiology, physiotherapy, occupational therapy and more) and specialist consultations, if referred by your family doctor. Main member only
R4 020
Main member + 1 dependant
R6 140
Main member + 2 dependants
R6 590
Main member + 3 dependants
R7 110
Main member + 4 or more dependants
R7 600
GP consultations
In network
Out of network
Main member only
R3 580
R1 160
Main member + 1 dependant
R5 260
R1 790
Main member + 2 dependants
R5 790
R1 950
Main member + 3 dependants
R6 100
R2 050
Main member + 4 or more dependants
R6 630
R2 210
*Specialist consultations
Paid from available savings, then covered from day-to-day benefits
Acute medication
Paid from available savings, then covered from day-to-day benefits
General radiology
Paid from available savings, then covered from day-to-day benefits
Pharmacy Advice Therapy (PAT)
Paid from available savings
Pathology
Paid from available savings, then covered from day-to-day benefits
Mental health consultations
R13 600 per family, per year (sub-limit to mental health hospitalisation, in and out of hospital consultations)
Standard
Unlimited, at the Specialist non-network rate: 100% of the Bonitas Rate
OUT-OF-HOSPITAL BENEFITS
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Paramedical services
Paid from available savings, then covered from day-to-day benefits
Specialised radiology
R22 400 per family, per year (subject to pre-authorisation) R6 900 per family, per year Fillings
Benefit for fillings are granted once per tooth in 365 days
Stoma care products
General medical appliances limit may be exceeded by R5 600 per year
Hearing aids
R13 700 per family, per two year cycle (10% co-payment)
Benefit for re-treatment of a tooth is subject to managed care protocols
Foot orthotics
R3 900 per beneficiary, per year (10% co-payment)
A treatment plan and x-rays may be required for multiple fillings
Appliances - wheelchairs, CPAP machines, etc.
Included in general medical appliances limit
Root canal therapy and extractions
Benefit is subject to managed care protocols
Optometry
R5 270 per family, per two year cycle
Vision examination (Iso-Leso members)
R490 per beneficiary, per two year cycle
Plastic dentures and associated laboratory costs
1 x set of plastic dentures (an upper and a lower) per beneficiary, per four year cycle
Vision examination (Non Iso-Leso members)
R350 per beneficiary, per two year cycle
Specialised dentistry
Covered at the Bonitas Dental Tariff (BDT)
Single vision lenses (glass/plastic)
R160 per beneficiary, per lens, per two year cycle
Partial metal frame dentures and associated laboratory costs
1 x partial frame (an upper or a lower) per beneficiary, per five year cycle
Bifocal lenses (glass/plastic)
R350 per beneficiary, per lens, per two year cycle
Multifocal lenses (glass/plastic)
R700 per beneficiary, per lens, per two year cycle
Frames
R800 per beneficiary, per two year cycle
1 x crown per family, per year
Contact lens materials
R1 750 per beneficiary, per two year cycle
HIV/Aids
R27 800 per beneficiary, per year (if registered on Aid for Aids program)
Benefits for crowns will be granted once per tooth, per five year cycle
Basic dentistry
Covered at the Bonitas Dental Tariff (BDT)
Consultations
2 x annual check-ups per beneficiary (once in 6 months)
X-rays: Intra-oral
Benefit is subject to managed care protocols
X-rays: Extra-oral
1 x per beneficiary, per three year cycle Additional benefit may be considered where specialised dental treatment is required
Oral hygiene
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Benefit for fluoride is limited to beneficiaries between ages 5 & 16 years
2 x annual scale and polish treatments per beneficiary (once in 6 months)
Benefit is subject to managed care protocols Crown and bridge and associated laboratory costs
Periodontics
Maxillo-facial surgery and oral pathology • Surgery in the dental chair Hospitalisation (general anaesthetic)
Subject to a DENIS Designated Service Provider Network Pre-authorisation is required
A treatment plan and x-rays may be requested Implants and associated laboratory costs
No benefit
Orthodontics and associated laboratory costs
Pre-authorisation is required Benefit is subject to managed care protocols Orthodontic treatment is granted once per beneficiary, per lifetime On pre-authorisation cases will be clinically assessed by using an orthodontic needs analysis. Benefit allocation is subject to the outcome of the needs analysis and funding can be granted up to 80% of BDT
Laughing gas in dental rooms IV conscious sedation in rooms
Scheme exclusions
* Subject to the specialist network. **Designated Service Provider
Benefit for Orthodontic treatment will be granted where function is impaired Benefit will not be granted where Orthodontic treatment is required for cosmetic reasons Only one family member may commence Orthodontic treatment in a calendar year Benefit for fixed comprehensive treatment is limited to individuals between ages 9 & 18 years Pre-authorisation is required Benefit is subject to managed care protocols Benefit is limited to conservative, nonsurgical therapy only and will only be applied to members who are registered on the Periodontal Program Benefit is subject to managed care protocols Pre-authorisation is required A co-payment of R2 000 per hospital admission applies Admission protocols apply General anaesthetic benefits are available for children under the age of 5 years for extensive dental treatment General anaesthetic benefits are available for the removal of impacted teeth. Benefit is subject to managed care protocols Benefit is subject to managed care protocols Pre-authorisation is required Benefit is subject to managed care protocols Benefit is limited to extensive dental treatment Please refer to the last section herein for exclusions and www.bonitas.co.za for Scheme rules & exclusions
CHRONIC BENEFITS These offer cover for conditions that require medicine on an ongoing basis. The Standard option offers cover for all of the following 44 chronic conditions. Cover is limited to R8 250 per beneficiary and R16 500 per family, per year on the Comprehensive Formulary. This is subject to pre-authorisation. A 40% co-payment will be required if you decide to use a non-DSP to obtain your medication. Pharmacy Direct is the **DSP for chronic medication. Once this amount is depleted, you will still be covered for the 27 Prescribed Minimum Benefits, highlighted below, subject to the use of in-formulary medicine 1.
Acne
16. Crohn’s Disease
31. Hypertension
2. Addison’s Disease
17. Depression
32. Hypothyroidism
3.
Allergic Rhinitis
18. Dermatitis
33. Multiple Sclerosis
4.
Ankylosing Spondylitis
19. Diabetes Insipidus
34. Narcolepsy
5. Asthma
20. Diabetes Type 1
35. Obsessive Compulsive Disorder
6.
Attention Deficit Disorder (5-18 Year Olds)
21. Diabetes Type 2
36. Panic Disorder
7.
Barrett’s Oesophagus
22. Dysrhythmias
37. Parkinson’s Disease
8.
Behcet’s Disease
23. Eczema
38. Post-Traumatic Stress Syndrome
9. Bipolar Mood Disorder
24. Epilepsy
39. Rheumatoid Arthritis
10. Bronchiectasis
25. Gastro-Oesophageal Reflux Disorder
40. Schizophrenia
11. Cardiac Failure
26. Glaucoma
41. Systemic Lupus Erythematosus
12. Cardiomyopathy
27. Gout
42. Tourette’s Syndrome
13. Chronic Obstructive Pulmonary Disease
28. Haemophilia
43. Ulcerative Colitis
14. Chronic Renal Disease
29. Hyperlipidaemia
44. Zollinger-Ellison Syndrome
15. Coronary Artery Disease
30. Hiv/Aids
Standard
Standard
General medical appliances
Benefit for fissure sealants is limited to beneficiaries younger than 16 years of age
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SUPPLEMENTARY BENEFITS
Glucose test Cholesterol test
At Bonitas we believe in giving you more. These additional benefits provide cover in or out-of-hospital and payable from OAL .
Waist to hip ratio assessment
Maternity care Per event
Body mass index
12 x ante-natal consultations
Wellness extender
R1 400 per family per year
2 x 2D scans
Subject to registration and completion of health risk assessment per beneficiary
4 x post-natal consultations with a midwife
Beneficiary may then choose from the following:
R1 100 for ante-natal classes
GP consultation
1 x amniocentesis
Biokineticist consultation
Infant paediatric benefit
Notes
Dietician consultation 2 x consultations per beneficiary under 1 year of age 2 x consultations per beneficiary between ages 1 and 2
Childhood illness benefit
Physiotherapy consultation Wearable devices (subject to approval) Smoking cessation program (subject to approval)
Standard
Preventative care
Subject to DSP
Women's health
1 x mammogram female members – between ages 50 & 74 years, per two year cycle
Standard
2 x GP consultations per beneficiary between ages 2 and 12
1 x pap smear - female members between ages 21 & 65 years, per three year cycle General health
1 x annual HIV test per beneficiary, per year 1 x annual Flu vaccine per beneficiary, per year
Cardiac health
1 x full Lipogram - members 20+ years of age, per five year cycle
Elderly health
1 x lifetime Pneumococcal vaccine members 65+years of age 1 x annual Faecal Occult blood test members between ages 50 & 75 years
Wellness screening benefit
1 x assessment per beneficiary, per year at a **DSP Limited to: Blood pressure test
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If you are married or single with children and looking for an affordable medical aid product that offers a wide range of benefits, the Standard Select is perfect for you. This option makes use of our extensive, high-quality Designated Service Provider network of medical professionals. Overall annual limit (OAL) - Unlimited
OUT-OF-HOSPITAL BENEFITS Out of hospital claims excluding Nominated GP consultations will be paid from current available savings first. Once savings are depleted, claims will be paid from the day-to-day benefit. The GP consultation benefit is subject to nomination of a GP for each beneficiary from the Bonitas GP network.
MONTHLY CONTRIBUTIONS
Main member
Adult dependant
Child dependant
R2 321
R2 007
R678
Consultations to non-nominated GP will be paid from available savings first and after depletion the Non Nominated GP benefit.
Your fourth and subsequent children will be covered free of charge.
IN-HOSPITAL BENEFITS
Savings
These benefits include major medical events and are unlimited subject to network hospitals. Non network hospitals admissions will attract a 30% co-payment.
Pathology General radiology Specialised radiology Paramedical services (Allied medical professions) - speech therapy, occupational therapy, dietetics Prosthesis internal and external Internal nerve stimulators Cochlear implants Mental health hospitalisation Take home medication (TTO) Physical rehabilitation Alternatives to hospitalisation Oncology Organ transplants Renal dialysis HIV/Aids
Standard Select
Unlimited, at 100% of the Bonitas Rate Unlimited, at the Specialist network rate: 130% of the Bonitas Rate Unlimited, at the Specialist non-network rate: 100% of the Bonitas Rate Unlimited, at 100% of the Bonitas Rate Unlimited, at 100% of the Bonitas Rate Unlimited, subject to pre-authorisation Unlimited, at 100% of the Bonitas Rate
R37 900 per family, per year R142 000 per family, per year R250 000 per family, per year R34 800 per family, per year R400 per beneficiary, per admission R42 500 per family, per year R14 200 per family, per year R295 400 per family, per year Unlimited, subject to treatment protocols Unlimited, subject to treatment protocols R27 800 per beneficiary, per year (if registered on Aid for Aids program)
Adult dependant
Child dependant
R1 056
R900
R300
Day-to-day benefits to help you stay healthy The day-to-day benefit covers out-of-hospital general radiology, pathology, paramedical services (such as audiology, physiotherapy, occupational therapy and more) and specialist consultations, if referred by your family doctor. Main member only
R4 020
Main member + 1 dependant
R6 140
Main member + 2 dependants
R6 590
Main member + 3 dependants
R7 110
Main member + 4 or more dependants
R7 600
GP consultations
Nominated GP
Non-Nominated GP
Main member only
R3 580
R1 160
Main member + 1 dependant
R5 260
R1 790
Main member + 2 dependants
R5 790
R1 950
Main member + 3 dependants
R6 100
R2 050
Main member + 4 or more dependants
R6 630
R2 210
Standard Select
GP consultations Specialist consultations
Main member
Please note: Each beneficiary must have a nominated GP *Specialist consultations
Paid from available savings, then covered from day-to-day benefits
Acute medication
Paid from available savings, then covered from day-to-day benefits
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Standard Select
General radiology
Paid from available savings, then covered from day-to-day benefits
Pathology
Paid from available savings, then covered from day-to-day benefits
Additional benefit may be considered where specialised dental treatment is required Oral hygiene
2 x annual scale and polish treatments per beneficiary (once in 6 months)
Mental health consultations
R13 600 per family, per year (sub-limit to Mental health hospitalisation)
Paramedical services
Paid from available savings, then covered from day-to-day benefits
Benefit for fissure sealants is limited to beneficiaries younger than 16 years of age
Specialised radiology
R22 400 per family, per year (subject to pre-authorisation)
Benefit for fluoride is limited to beneficiaries between ages 5 and 16 years
General medical appliances
R6 900 per family, per year
Stoma care products
General medical appliances limit may be exceeded by R5 600 per year
Hearing aids
R13 700 per family, per two year cycle (10% co-payment)
Foot orthotics
R3 900 per beneficiary, per year (10% co-payment)
Appliances - wheelchairs, CPAP machines, etc.
Included in general medical appliances limit
Optometry
R5 270 per family, per two year cycle
Vision examination (Iso-Leso members)
R490 per beneficiary, per two year cycle
Vision examination (Non Iso-Leso members)
R350 per beneficiary, per two year cycle
Single vision lenses (glass/plastic)
R160 per beneficiary, per lens, per two year cycle
Bifocal lenses (glass/plastic)
R350 per beneficiary, per lens, per two year cycle
Multifocal lenses (glass/plastic)
R700 per beneficiary, per lens, per two year cycle
Frames
R800 per beneficiary, per two year cycle
Contact lens materials
R1 750 per beneficiary, per two year cycle
Basic dentistry
Covered at the Bonitas Dental Tariff (BDT)
Consultations
2 x annual check-ups per beneficiary (once in 6 months)
X-rays: Intra-oral
Benefit is subject to managed care protocols
X-rays: Extra-oral
1 x per beneficiary, per three year cycle
Fillings
Benefit will not be granted where Orthodontic treatment is required for cosmetic reasons
Benefit for re-treatment of a tooth is subject to managed care protocols A treatment plan and x-rays may be required for multiple fillings Root canal therapy and extractions
Benefit is subject to managed care protocols
Plastic dentures and associated laboratory costs
1 x set of plastic dentures (an upper and a lower) per beneficiary, per four year cycle
Specialised dentistry
Covered at the Bonitas Dental Tariff (BDT)
Partial metal frame dentures and associated laboratory costs
1 x partial frame (an upper or a lower) per beneficiary, per five year cycle
Crown and bridge and associated laboratory costs
Periodontics
Benefit is limited to extensive dental treatment Scheme exclusions
Please refer to the last section herein for exclusions and www.bonitas.co.za for Scheme rules & exclusions
Pre-authorisation is required
The Standard Select option offers cover for all of the following 44 chronic conditions.
Benefit is subject to managed care protocols
Cover is limited to R8 250 per beneficiary and R16 500 per family, per year on the Restrictive Formulary. This is subject to pre-authorisation. A 40% co-payment will be required if you decide to use a non-DSP to obtain your medication. Pharmacy Direct is the **DSP for chronic medication.
Benefit is limited to conservative, nonsurgical therapy only and will only be applied to members who are registered on the Periodontal Program
Benefit is subject to managed care protocols
Pre-authorisation is required
Hospitalisation (general anaesthetic)
1 x crown per family, per year
Subject to Bonitas hospital network (Preauthorisation is required)
Benefits for crowns will be granted once per tooth, per five year cycle
A co-payment of R2 000 per hospital admission applies
A treatment plan and x-rays may be requested
Admission protocols apply
Benefit is subject to managed care protocols
Benefit is subject to managed care protocols
CHRONIC BENEFITS
• Surgery in the dental chair
Pre-authorisation is required
Pre-authorisation is required
Benefit for fixed comprehensive treatment is limited to individuals between ages 9 & 18 years
Subject to a DENIS Designated Service Provider Network
No benefit
IV conscious sedation in rooms
* Subject to the specialist network and specialist referral from the Nominated GP.
Maxillo-facial surgery and oral pathology
Orthodontics and associated laboratory costs
Benefit is subject to managed care protocols
Only one family member may commence Orthodontic treatment in a calendar year
Benefit is subject to managed care protocols
Implants and associated laboratory costs
Laughing gas in dental rooms
Benefit for Orthodontic treatment will be granted where function is impaired
Benefit for fillings are granted once per tooth in 365 days
Orthodontic treatment is granted once per beneficiary, per lifetime
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All pre-authorisation cases will be clinically assessed by using an orthodontic needs analysis. Benefit allocation is subject to the outcome of the needs analysis and funding can be granted up to 80% of BDT
General anaesthetic benefits are available for children under the age of 5 years for extensive dental treatment General anaesthetic benefits are available for the removal of impacted teeth. Benefit is subject to managed care protocols
These offer cover for conditions that require medicine on an ongoing basis.
Once this amount is depleted, you will still be covered for the 27 Prescribed Minimum Benefits, highlighted below, subject to the use of in-formulary medicine. 1. 2.
Acne Addison’s Disease
3. 4. 5.
Allergic Rhinitis 18. Dermatitis Ankylosing Spondylitis 19. Diabetes Insipidus Asthma 20. Diabetes Type 1
6.
Attention Deficit Disorder (5-18 Yr Olds) Barrett’s Oesophagus Behcet’s Disease
7. 8.
16. Crohn’s Disease 17. Depression
21. Diabetes Type 2
31. Hypertension 32. Hypothyroidism 33. Multiple Sclerosis 34. Narcolepsy 35. Obsessive Compulsive Disorder 36. Panic Disorder
22. Dysrhythmias 23. Eczema
37. Parkinson’s Disease 38. Post-Traumatic Stress Syndrome
9. Bipolar Mood Disorder
24. Epilepsy
39. Rheumatoid Arthritis
10. Bronchiectasis
25. Gastro-Oesophageal Reflux Disorder 26. Glaucoma
40. Schizophrenia
11. Cardiac Failure
41. Systemic Lupus Erythematosus
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12. Cardiomyopathy 27. Gout 13. Chronic Obstructive 28. Haemophilia Pulmonary Disease 14. Chronic Renal Disease 29. Hyperlipidaemia 15. Coronary Artery Disease
42. Tourette’s Syndrome 43. Ulcerative Colitis 44. Zollinger-Ellison Syndrome
30. Hiv/Aids
Elderly health
1 x annual Faecal Occult blood test members between ages 50 & 75 years Wellness screening benefit
1 x assessment per beneficiary, per year at **DSP Limited to: Blood pressure test
SUPPLEMENTARY BENEFITS
Glucose test
At Bonitas we believe in giving you more. These additional benefits provide cover in or out-of-hospital, and payable from OAL.
Cholesterol test Body mass index Waist to hip ratio assessment
Maternity care Per event
1 x lifetime Pneumococcal vaccine members 65+years of age
12 x ante-natal consultations 2 x 2D scans 4 x post-natal consultations with a midwife R1 100 for ante-natal classes
Infant paediatric benefit 2 x consultations per beneficiary under 1 year of age 2 x consultations per beneficiary between ages 1 and 2 Childhood illness benefit
R1 400 per family per year Subject to registration and completion of health risk assessment per beneficiary Beneficiary may then choose from the following: GP consultation
Standard Select
1 x amniocentesis
Wellness extender
Biokineticist consultation Dietician consultation Physiotherapy consultation Wearable devices (subject to approval) Smoking cessation program (subject to approval)
2 x GP consultations per beneficiary between ages 2 and 12 Preventative care
Subject to DSP
Women's health
1 x mammogram female members between ages 50 & 74 years, per two year cycle 1 x pap smear - female members between ages 21 & 65 years, per three year cycle
General health
1 x annual HIV test per beneficiary, per year 1 x annual Flu vaccine per beneficiary, per year
Cardiac health
1 x full Lipogram - members 20+ years of age, per five year cycle
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Standard Select
Notes
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Notes
If you’re looking for a simple medical aid plan that offers affordable healthcare for you and your loved ones when you need it, then this product is perfect for you.
HIV/Aids
R21 250 per beneficiary, per year (if registered on Aid for Aids program)
Overall annual limit (OAL) - Unlimited A co-payment will apply to the following procedures in hospital.
MONTHLY CONTRIBUTIONS
Main member
Adult dependant
Child dependant
R1 719
R1 345
R548
Your fourth and subsequent children will be covered free of charge.
IN-HOSPITAL BENEFITS
R2 650 Co-Payment
R5 250 Co-Payment
1. Colonoscopy
1. Arthroscopy
1. Back surgery including spinal fusion
2. Conservative back treatment
2. Diagnostic laparoscopy
2. Joint replacements for example Hip and knee replacements (except PMBs)
3. Cystoscopy
3. Hysterectomy (except cancer and PMBs)
3. Laparoscopic pyeloplasty
4. Facet joint injections
4. Laparoscopic appendectomy
4. Laparoscopic radical prostatectomy
5. Flexible sigmoidoscopy
5. Percutaneous radiofrequency ablations
5. Nissen fundoplication (reflux surgery)
6. Percutaneous rhizotomies
These benefits include major medical events. GP consultations
Unlimited, at 100% of the Bonitas Rate
Specialist consultations
Unlimited, at the Specialist network rate:130% of the Bonitas Rate Unlimited, at the Specialist non-network rate: 100% of Bonitas Rate
Pathology
Unlimited, at 100% of the Bonitas Rate
6. Functional nasal surgery
General radiology
Unlimited, at 100% of the Bonitas Rate
7. Gastroscopy
Specialised radiology
R11 150 per family, per year (in & out-ofhospital)
8. Hyseteroscopy (not endometrial ablation)
Subject to pre-authorisation
9. Myringotomy
Paramedical services (Allied medical professions) - speech therapy, occupational therapy, audiology, dietetics
Unlimited, at 100% of the Bonitas Rate
Prosthesis internal and external
PMB only
Mental health hospitalisation
R13 550 per family, per year
Take home medication (TTO)
R325 per beneficiary, per admission
Physical rehabilitation
R42 500 per family, per year
Alternatives to hospitalisation
R14 200 per family, per year
OUT-OF-HOSPITAL BENEFITS
Oncology
R142 000 per family, per year
Organ transplants
PMB only
These benefits cover your day-to-day medical expenses, such as GP and specialist consultations, dentistry, optometry and more.
Renal dialysis
PMB only
Day-to-day benefits to help you stay healthy
Primary
R1 050 Co-Payment
10. Tonsillectomy and adenoidectomy (except PMBs) 11. Umbilical hernia repair 12. Varicose vein surgery
The day-to-day benefit covers out-of-hospital general radiology, pathology, paramedical
Primary
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Main member only
R1 800
Main member + 1 dependant
R3 250
Main member + 2 dependants
R3 800
Main member + 3 dependants
R4 100
Main member + 4 or more dependants
R4 450
GP consultations
In network
Out of network
Main member only
R1 700
R560
Main member + 1 dependant
R3 150
R1 050
Main member + 2 dependants
R3 700
R1 200
Main member + 3 dependants
R4 000
R1 350
Main member + 4 or more dependants
R4 500
R1 550
*Specialist consultations
Covered from day-to-day benefit
Acute medication
Covered from day-to-day benefit
General radiology
Covered from day-to-day benefit
Pathology
Covered from day-to-day benefit
Mental health consultations
R8 200 per family, per year (sub-limit to Mental health hospitalisation, in and out of hospital consultations)
Paramedical services
Covered from day-to-day benefit
Specialised radiology
R11 150 per family, per year (in & out-ofhospital)
General medical appliances
R6 200 per family, per year
Stoma care products
General medical appliances limit may be exceeded by R5 600 per year
Hearing aids
Page 25
R7 800 per family, per two year cycle (10% co-payment)
Foot orthotics
R3 900 per beneficiary, per year (10% co-payment)
Appliances - wheelchairs, CPAP machines, etc.
Included in general medical appliances limit
Optometry
R4 270 per family, per two year cycle
Vision examination (Iso-Leso members)
R490 per beneficiary, per two year cycle
Vision examination (Non Iso-Leso members)
R350 per beneficiary, per two year cycle
Single vision lenses (glass/plastic)
R160 per beneficiary, per lens, per two year cycle
Crown and bridge and associated laboratory costs
No benefit
Bifocal lenses (glass/plastic)
R350 per beneficiary, per lens per two year cycle
Implants and associated laboratory costs
No benefit
Orthodontics and associated laboratory costs
No benefit
Periodontics
No benefit
CHRONIC BENEFITS These offer cover for conditions that require medicine on an ongoing basis. The Primary option ensures that you are covered for the following 27 Prescribed Minimum Benefits, subject to the use of in-formulary medicine. A 40% co-payment will be required if you decide to use a non-DSP to obtain your medication. Pharmacy Direct is the **DSP for chronic medication.
Multifocal lenses (glass/plastic)
R700 per beneficiary, per lens, per two year cycle
Frames
R300 per beneficiary, per two year cycle
Maxillo-facial surgery and oral pathology
Contact lens materials
R1 225 per beneficiary, per two year cycle
Surgery in the dental chair
1. Addison’s Disease
11. Diabetes Insipidus
21. Hypothyroidism
Basic dentistry
Covered at the Bonitas Dental Tariff (BDT) Subject to a DENIS Designated Service Provider Network
Benefit is subject to managed care protocols
2. Asthma
12. Diabetes Type 1
22. Multiple Sclerosis
Hospitalisation (general anaesthetic)
Pre-authorisation is required
3. Bipolar Mood Disorder
13. Diabetes Type 2
23. Parkinson’s Disease
A co-payment of R2 000 per hospital admission applies
4. Bronchiectasis
14. Dysrhythmias
24. Rheumatoid Arthritis
5. Cardiac Failure
15. Epilepsy
25. Schizophrenia
6. Cardiomyopathy
16. Glaucoma
26. Systemic Lupus Erythematosus
7. Chronic Obstructive Pulmonary Disease
17. Haemophilia
27. Ulcerative Colitis
8. Chronic Renal Disease
18. HIV/Aids
Consultations
2 x annual check-ups per beneficiary (once in 6 months)
X-rays: Intra-oral
Benefit is subject to managed care protocols
X-rays: Extra-oral
1 x per beneficiary, per three year cycle
Oral hygiene
2 annual scale and polish treatments per beneficiary (once in 6 months)
Fillings
General anaesthetic benefits are available for children under the age of 5 years for extensive dental treatment General anaesthetic benefits are available for the removal of impacted teeth. Benefit is subject to managed care protocols
Benefit for fissure sealants is limited to beneficiaries younger than 16 years of age
Laughing gas in dental rooms
Benefit is subject to managed care protocols
Benefit for fluoride is limited to beneficiaries between ages 5 & 16 years
IV conscious sedation in rooms
Pre-authorisation is required Benefit is subject to managed care protocols
Benefit for fillings are granted once per tooth in 365 days Benefit for re-treatment of a tooth is subject to managed care protocols A treatment plan and x-rays may be required for multiple fillings
Root canal therapy and extractions
Admission protocols apply
Benefit is subject to managed care protocols
Benefit is limited to extensive dental treatment Scheme exclusions
Please refer to last section herein for exclusions and to www.bonitas.co.za for Scheme rules & exclusions
9. Coronary Artery Disease 19. Hyperlipidaemia 10. Crohn’s Disease
SUPPLEMENTARY BENEFITS At Bonitas we believe in giving you more. These additional benefits provide cover in or out-of-hospital, and payable from OAL.
Maternity care Per event
* Subject to the specialist network.
1 x set of plastic dentures (an upper and a lower) per beneficiary, per four year cycle
Specialised dentistry
Covered at the Bonitas Dental Tariff (BDT)
Partial metal frame dentures and associated laboratory costs
No benefit
6 x ante-natal consultations 2 x 2D scans 4 x post-natal consultations with a midwife
Benefit for root canal includes all teeth except primary teeth and permanent molars Plastic dentures and associated laboratory costs
20. Hypertension
Primary
Primary
services (such as audiology, physiotherapy, occupational therapy and more) and specialist consultations, if referred by your family doctor.
1 x amniocentesis Infant paediatric benefit 1 x Peadiatric consultations per beneficiary under 1 year of age
Page 26
1 x consultations per beneficiary between ages 1 and 2 years Childhood illness benefit
Notes
1 x GP consultations per beneficiary between ages 2 and 12 years Preventative care
Subject to DSP
Women's health
1 x pap smear - female members between ages 21 & 65 years, per three year cycle
General health
1 x annual HIV test per beneficiary, per year 1 x annual Flu vaccine per beneficiary, per year
Elderly health
1 x lifetime Pneumococcal vaccine members 65+years of age 1 x annual Faecal Occult blood test members between ages 50 & 75 years 1 x assessment per beneficiary, per year at a DSP
Primary
Primary
Wellness screening benefit
Limited to : Blood pressure test Glucose test Cholesterol test Body mass index Waist to hip ratio assessment Wellness extender
R1 000 per family, per year Subject to registration and completion of health risk assessment per beneficiary Beneficiary may then choose from the following: GP consultation Biokineticist consultation Dietician consultation Physiotherapy consultation Wearable devices (subject to approval) Smoking cessation program (subject to approval)
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Page 28
Our premium product, BonComprehensive, is designed to meet the most arduous healthcare needs. It features extensive and exclusive benefits that cater for young and old alike. This elite option is perfect for those who appreciate high-quality and superior benefits.
OUT-OF-HOSPITAL BENEFITS These benefits cover your day-to-day medical expenses, such as GP and specialist consultations, dentistry, optometry and more.
Overall annual limit (OAL) – Unlimited MONTHLY CONTRIBUTIONS
Main member
Adult dependant
Child dependant
R4 696
R4 428
R956
Your fourth and subsequent children will be covered free of charge.
Adult dependant
Child dependant
Savings
R10 632
R10 020
R2 172
Self-payment gap
R3 428
R2 840
R1 308
*Threshold level
R14 060
R12 860
R3 480
Above threshold benefit
Unlimited
Unlimited
Unlimited
*Not all claims accumulate to the threshold level
IN-HOSPITAL BENEFITS These benefits include major medical events.
GP consultations
Subject to available savings and threshold
Specialist consultations
Subject to available savings and threshold
GP consultations
Unlimited, at 300% of the Bonitas Rate
Acute medication
Subject to available savings and threshold
Specialist consultations
Unlimited, at 300% of the Bonitas Rate
General radiology
Subject to available savings and threshold
Pathology
Unlimited, at 100% of the Bonitas Rate
Specialised radiology
R26 850 per family, per year
General radiology
Unlimited, at 100% of the Bonitas Rate
Specialised radiology
Unlimited, subject to pre-authorisation
Subject to pre-authorisation Pathology
Subject to available savings and threshold
Mental health consultations
R13 600 per family, per year (sub-limit to mental health hospitalisation, for in and out-of-hospital consultations.)
R47 250 per family, per year
Physical therapy
Subject to available savings and threshold
Prosthesis external
R47 250 per family, per year
General medical appliances
R7 550 per family, per year
Internal nerve stimulator
R142 000 per family, per year
Stoma care products
Cochlear implants
R250 000 per family, per year
General medical appliances limit may be exceeded by R5 300 per year
Mental health hospitalisation
R40 200 per family, per year
Hearing aids
Take home medication (TTO)
R470 per beneficiary, per admission
R22 100 per family, per two year cycle (10% co-payment)
Physical rehabilitation
R42 500 per family, per year
Foot orthotics
R3 900 per beneficiary, per year (10% co-payment)
Alternatives to hospitalisation
R14 200 per family, per year
Oncology
R530 200 per family, per year
Appliances - wheelchairs, CPAP machines, etc.
Included in general medical appliances limit
Biological drugs
R210 400 per family, per year
HIV/Aids
Organ transplants
Unlimited, subject to pre-authorisation
Unlimited (if registered on Aid for Aids program)
Renal dialysis
Unlimited, subject to pre-authorisation
Paramedical services - speech therapy, occupational therapy, audiology, dietetics
Subject to available savings and threshold
Paramedical services (Allied medical professions) - speech therapy, occupational therapy, audiology, dietetics
Unlimited, at 300% of the Bonitas Rate
Prosthesis internal
BonComprehensive
BonComprehensive
Main member
Page 30
Optometry
Limited to R2 740 and subject to available savings and threshold
Basic dentistry
Paid from available savings and/or threshold benefit
Consultations X-rays: Intra-oral X-rays: Extra-oral
Oral hygiene
Implants and associated laboratory costs
Benefit is subject to managed care protocols
Cost of implant components is limited to R2 205 per implant
1 x per beneficiary, per three year cycle Orthodontics and associated laboratory costs
Laughing gas in dental rooms
Benefit is subject to managed care protocols
IV conscious sedation in rooms
Pre-authorisation is required
Orthodontic treatment is granted once per beneficiary per lifetime
Benefit for fissure sealants is limited to beneficiaries younger than 16 years of age
All pre-authorisation cases will be clinically assessed by using an orthodontic needs analysis. Benefit allocation is subject to the outcome of the needs analysis and funding can be granted up to 100% of BDT
Benefit for fillings are granted once per tooth in 365 days
Benefit for Orthodontic treatment will be granted where function is impaired
Scheme exclusions
29. GastroOesophageal Reflux Disorder
49. Pemphigus
10. Bipolar Mood disorder
30. Generalised anxiety disorder
50. Polyarteritis nordosa
11. Bronchiectasis
31. Glaucoma
51. Post-traumatic stress syndrome
12. Cardiac failure
32. Gout
52. Psoriatic Arthritis
13. Cardiomyopathy
33. Haemophilia
53. Pulmonary interstitial fibrosis
Benefit is subject to managed care protocols
14. Chronic obstructive pulmonary disease
34. HIV/Aids
54. Rheumatoid arthritis
Benefit is limited to extensive dental treatment
15. Chronic renal disease
35. Huntington’s disease
55. Schizophrenia
16. Coronary artery disease
36. Hyperlipidaemia
56. Systemic lupus erythematosus
17. Crohn’s disease
37. Hypertension
57. Systemic sclerosis
18. Cystic Fibrosis
38. Hypoparathyroidism
58. Tourette’s syndrome
19. Depression
39. Hypothyroidism
59. Ulcerative colitis
20. Deep Vein Thrombosis
40. Multiple sclerosis
60. Zollinger-Ellison syndrome
Please refer to www.bonitas.co.za for Scheme rules & exclusions
CHRONIC BENEFITS These offer cover for conditions that require medicine on an ongoing basis. The BonComprehensive option offers generous and extensive cover for all of the 60 chronic conditions listed below. This is limited to R11 850 per beneficiary and R23 600 per family, per year on the Comprehensive Formulary. This is subject to pre-authorisation.
A treatment plan and x-rays may be required for multiple fillings
Benefit will not be granted where Orthodontic treatment is required for cosmetic reasons
Root canal therapy and extractions
Benefit is subject to managed care protocols
Only one family member may commence Orthodontic treatment in a calendar year
Plastic dentures and associated laboratory costs
1 x set of plastic dentures (an upper and a lower) per beneficiary, per four year cycle
1.
Acne
21. Dermatomyosis
41. Myasthenia Gravis
2.
Addison’s disease
22. Dermatitis
42. Narcolepsy
Specialised dentistry
Paid from available savings and/or threshold benefit
Benefit for fixed comprehensive treatment is limited to individuals between ages 9 & 18 years
3.
Allergic rhinitis
23. Diabetes insipidus
43. Neuropathies
Pre-authorisation is required
4.
Ankylosing spondylitis
24. Diabetes Type 1
Benefit is subject to managed care protocols
44. Obsessive compulsive disorder
5.
25. Diabetes Type 2
45. Osteoporosis
Surgery in the dental chair
Benefit is subject to managed care protocols
Attention Deficit Disorder (5-18 year olds)
6.
46. Paget’s disease
Pre-authorisation is required
Alzheimer Disease (early onset)
26. Dysrhythmias
Hospitalisation (general anaesthetic)
7.
Asthma
27. Eczema
47. Panic disorder
8.
Barrett’s oesophagus
28. Epilepsy
48. Parkinson’s disease
Partial metal frame dentures and associated laboratory costs
2 x partial frames (an upper and a lower) per beneficiary, per five year cycle Benefit is subject to managed care protocols
Crown, bridge and associated laboratory costs
Periodontics
Pre-authorisation is required 3 x crowns per family, per year Benefit is subject to managed care protocols Benefits for crowns will be granted once per tooth, per five year cycle
Once this amount is depleted, you will still be covered for the 27 Prescribed Minimum Benefits, highlighted below.
Maxillo-facial surgery and oral pathology
Admission protocols apply
Behcet’s disease
BonComprehensive
BonComprehensive
Pre-authorisation is required Benefit is subject to managed care protocols
1 x treatment every 6 months per beneficiary
Benefit for re-treatment of a tooth is subject to managed care protocols
Page 31
General anaesthetic benefits are available for the removal of impacted teeth. Benefit is subject to managed care protocols
Pre-authorisation is required
Benefit is subject to managed care protocols
Benefit for fluoride is limited to beneficiaries between ages 5 & 16 years Fillings
9.
2 x implants per beneficiary, per five year cycle
1 x consultation per beneficiary every 6 months
Additional benefit may be considered where specialised dental treatment is required
General anaesthetic benefits are available for children under the age of 5 years for extensive dental treatment
A treatment plan and x-rays may be requested
Page 32
SUPPLEMENTARY BENEFITS
Limited to : Blood pressure test
At Bonitas we believe in giving you more. These additional benefits provide cover in or out-of-hospital payable from OAL.
Glucose test
Notes
Cholesterol test Body mass index
Maternity care
Waist to hip ratio assessment Per event
12 x ante-natal consultations 2 x 2D scans 4 x post-natal consultations with a midwife R1 100 for ante-natal classes 1 x amniocentesis
Preventative care
Subject to DSP
Women's health
1 x mammogram female members between ages 50 & 74 years, per two year cycle
BonComprehensive
Men's health
PSA test - between ages 55 & 69 years, who are considered to be at high risk
Children's health
1 x TSA test for infants below 1 month
R2 000 per family, per year Subject to registration and completion of health risk assessment per beneficiary Beneficiary may then choose from the following: GP consultation Biokineticist consultation Dietician consultation Physiotherapy consultation Wearable devices (subject to approval)
BonComprehensive
1 x pap smear - female members between ages 21 & 65 years, per three year cycle
Wellness extender
Smoking cessation program (subject to approval)
Childhood immunisations according to the EPI schedule General health
1 x annual HIV test per beneficiary, per year 1 x annual flu vaccine per beneficiary, per year
Cardiac health
1 x full Lipogram - members 20+ years of age, per five year cycle
Elderly health
1 x lifetime Pneumococcal vaccine members 65+years of age 1 x annual faecal occult blood test members between ages 50 & 75 years 1 x lifetime bone density screening female members 65+ years of age
Wellness screening benefit
Page 33
1 x assessment per beneficiary, per year at a **DSP
Page 34
If you have a family with children or perhaps your children are already all grown up and have moved out of your home, this option offers a comprehensive medical plan with a wide range of medical benefits for you and your loved ones. Overall annual limit (OAL) – Unlimited MONTHLY CONTRIBUTIONS
Biological Drugs Organ transplants Renal dialysis
OUT-OF-HOSPITAL BENEFITS
Main member
Adult dependant
Child dependant
R3 260
R2 799
R805
These benefits cover your day-to-day medical expenses, such as GP and specialist consultations.
Your fourth and subsequent children will be covered free of charge. Savings
IN-HOSPITAL BENEFITS These benefits include major medical events such as hospitalisation, oncology treatment and more. GP consultations Specialist consultations
Paramedical services (Allied medical professions) - speech therapy, physiotherapy, occupational therapy, audiology, dietetics Prosthesis internal and external
BonClassic
Unlimited, at 100% of the Bonitas Rate Unlimited, at the Specialist network rate: 130% of the Bonitas Rate Unlimited, at the Specialist non-network rate:100% of the Bonitas Rate Unlimited, at 100% of the Bonitas Rate Unlimited, at 100% of the Bonitas Rate R24 850 per family, per year (in & out-of-hospital) Subject to pre-authorisation Unlimited, at 100% of the Bonitas Rate
R46 800 per family, per year ICPS is the **DSP for hip and knee replacements, a R5 000 co-payment is payable when not using the DSP R35 350 per family, per year R400 per beneficiary, per admission R42 500 per family, per year R14 200 per family, per year R351 900 per family, per year at the Preferred Provider
Main member
Adult dependant
Child dependant
R5 532
R4 752
R1 368
GP consultations
Subject to available savings
*Specialist consultations
Subject to available savings
Acute medication
Subject to available savings
General radiology
R2 680 per beneficiary, per year
Specialised radiology
R4 130 per family, per year
BonClassic
Pathology General radiology Specialised radiology
Mental health hospitalisation Take home medication (TTO) Physical rehabilitation Alternatives to hospitalisation Oncology
R105 200 per family, per year (10% co-payment and protocols apply) Unlimited, at 100% of the Bonitas Rate Unlimited, at 100% of the Bonitas Rate
R24 850 per family, per year (in & out-ofhospital) Pathology
Subject to pre-authorisation R2 680 per beneficiary, per year R5 890 per family, per year
Mental health consultations
R13 600 per family, per year (sub-limit to mental health hospitalisation limit and for in and out of hospital consultations)
Physical therapy
R1 320 per beneficiary, per year R2 680 per family, per year
General medical appliances
R7 000 per family, per year
Stoma care products
Included in general medical appliances limit
Hearing aids
R14 500 per family, per three year cycle (10% co-payment)
Foot orthotics
R3 900 per beneficiary, per year (10% co-payment)
Appliances - wheelchairs, CPAP machines, etc.
Included in general medical appliances limit
Page 36
HIV/Aids
Benefit for re-treatment of a tooth is subject to managed care protocols
Unlimited, at 100% of the Bonitas Rate (If registered on Aid for Aids program)
A treatment plan and x-rays may be required for multiple fillings
Main member only
R2 550 per year
Main member + 1 dependant
R3 900 per year
Main member + 2 dependants
R4 500 per year
Main member + 3 dependants
R4 800 per year
Main member + 4 dependants or more
R5 150 per year
Optometry
R5 060 per family, per two year cycle
Vision examination (Iso-Leso members)
R490 per beneficiary, per two year cycle
Benefit is subject to managed care protocols
Plastic dentures and associated laboratory costs
1 x set of plastic dentures (an upper and a lower) per beneficiary, per four year cycle
Surgery in the dental chair
Benefit is subject to managed care protocols
Hospitalisation (general anaesthetic)
Specialised dentistry
R4 800 per family, per year. Covered at the Bonitas Dental Tariff (BDT) 2 x partial frames (an upper and a lower) per beneficiary, per five year cycle
Vision examination (Non Iso-Leso members)
R350 per beneficiary, per two year cycle
Single vision lenses (glass/plastic)
R160 per beneficiary, per lens, per two year cycle
Crown; bridge and associated laboratory costs
Subject to DENIS Designated Service Provider Network
Bifocal lenses (glass/plastic)
R350 per beneficiary, per lens, per two year cycle
Multifocal lenses (glass/plastic)
R700 per beneficiary, per lens, per two year cycle
(A bridge comprises 2 or more crown units. Each crown is payable from the available crown and bridge benefit)
Frames
R700 per beneficiary, per two year cycle
Contact lens materials
R1 700 per beneficiary, per two year cycle
Basic dentistry
R4 000 per family, per year. Covered at the Bonitas Dental Tariff (BDT)
Pre-authorisation is required 1 x crown per family, per year Benefit is subject to managed care protocols Benefits for crowns will be granted once per tooth, per five year cycle A treatment plan and x-rays may be requested
Implants and associated laboratory costs
No benefit
Consultations
2 x annual check-ups per beneficiary (once in 6 months)
Orthodontics and associated laboratory costs
X-rays: Intra-oral
Benefit is subject to managed care protocols
X-rays: Extra-oral
1 x per beneficiary, per three year cycle
Oral hygiene
2 x annual scale and polish treatments per beneficiary (once in 6 months)
Pre-authorisation is required Benefit is subject to managed care protocols Orthodontic treatment is granted once per beneficiary, per lifetime Cases will be clinically assessed by using an orthodontic needs analysis. Benefit allocation is subject to the outcome of the needs analysis and funding can be granted up to 100% of BDT Benefit for Orthodontic treatment will be granted where function is impaired Benefit will not be granted where Orthodontic treatment is required for cosmetic reasons
Benefit for fluoride treatment is limited to beneficiaries between ages 5 & 16 years Fillings
Page 37
Root canal therapy and extractions
Partial metal frame dentures and associated laboratory costs
Benefit for fissure sealants is limited to beneficiaries younger than 16 years of age
Benefit for fillings are granted once per tooth in 365 days
Periodontics
Only one family member may commence orthodontic treatment in a calendar year
These offer cover for conditions that require medication on an ongoing basis.
Benefit is subject to managed care protocols Pre-authorisation is required A co-payment of R2 000 per hospital admission applies Admission protocols apply General anaesthetic benefits are available for children under the age of 5 years for extensive dental treatment General anaesthetic benefits are available for the removal of impacted teeth. Benefit is subject to managed care protocols Benefit is subject to managed care protocols Pre-authorisation is required Benefit is subject to managed care protocols Benefit is limited to extensive dental treatment Please refer to the last section herein for exclusions and www.bonitas.co.za for Scheme rules & exclusions
Once this amount is depleted, you will still be covered for the 27 Prescribed
Maxillo-facial surgery
Laughing gas in dental rooms IV conscious sedation in rooms
Scheme exclusions
* Subject to the specialist network. **Designated Service Provider
BonClassic offers generous and extensive cover for the below 59 chronic conditions. Cover is limited to R9 700 per beneficiary and R20 100 per family, per year on the Restrictive Formulary. This is subject to pre-authorisation. A 40% co-payment will be required if you decide to use a non-DSP to obtain your medication. Pharmacy Direct is the **DSP for chronic medication.
1. 2.
Addison’s Disease Alzheimer’s Disease
3. 4.
Angina 23. Diabetes Insipidus Ankylosing Spondylitis 24. Diabetes Type 1
5. 6.
Asthma Attention Deficit Disorder (In 5-18 Year Olds) 7. Barrett’s Oesophagus 8. Benign Prostatic Hypertrophy 9. Bipolar Mood Disorder 10. Bronchiectasis
21. Cushing Syndrome 22. Depression
25. Diabetes Type 2 26. Dysrhythmias
27. Eczema 28. Emphysema
12. Cancer
29. Epilepsy 30. Gastro-Oesophageal Reflux Disorder 31. Generalised Anxiety Disorder 32. Glaucoma
13. 14. 15. 16.
33. 34. 35. 36.
11. Behcet’s Disease
Cardiac Arrhythmias Cardiac Failure Cardiomyopathy Chronic Bronchitis
Gout Haemophilia Hiv/Aids Hormone Replacement Therapy 37. Hyperlipidaemia
17. Chronic Obstructive Pulmonary Disease 18. Chronic Renal Disease 38. Hypertension 19. Coronary Artery 39. Hypoparathyroidism Disease 20. Crohn’s Disease 40. Hypothyroidism
CHRONIC BENEFITS
41. Infective Endocarditi 42. Ischaemic Heart Disease 43. Multiple sclerosis 44. Obsessive compulsive disorder 45. Osteoporosis 46. Paget’s Disease
47. Panic Disorder 48. Paraplegia And Quadriplegia 49. Parkinson’s Disease 50. Polyarteritis Nodosa
BonClassic
BonClassic
Paramedical services - speech therapy, occupational therapy, audiology, dietetics
Benefit for fixed comprehensive treatment is limited to individuals between ages 9 & 18 years Pre-authorisation is required Benefit is subject to managed care protocols
51. Post-Traumatic Stress Syndrome 52. Pulmonary Interstitial Fibrosis 53. Rheumatoid Arthritis 54. Schizophrenia 55. Scleroderma 56. Systemic Lupus Erythematosus 57. Tourette’s Syndrome 58. Ulcerative Colitis 59. Zollinger-Ellison
SUPPLEMENTARY BENEFITS
Page 38
At Bonitas, we believe in giving you more. These additional benefits provide cover in or out of hospital
R1 400 per family, per year Subject to registration and completion of a health risk assessment per beneficiary Beneficiary may then choose from the following:
Maternity care Per event:
Wellness extender
12 x ante-natal consultations
GP consultation
2 x 2D scans
Biokineticist consultation
4 x post-natal consultations with a midwife
Dietician consultation
R1 100 for ante-natal classes
Wearable devices (subject to approval)
1 x amniocentesis
Smoking cessation program (subject to approval)
Preventative care
Subject to **DSP
Women's health
1 x mammogram for female members between ages 50 & 74 years, per two year cycle
Notes
Physiotherapy consultation
1 x pap smear - female members between ages 21 & 65 years, per three year cycle 1 x annual HIV test per beneficiary, per year
BonClassic
BonClassic
General health
1 x annual Flu vaccine per beneficiary, per year Cardiac health
1 x full Lipogram - members 20+ years of age, per five year cycle
Elderly health
1 x lifetime Pneumococcal vaccine members 65+years of age 1 x Faecal Occult blood test - members between ages 50 & 75 years, per beneficiary, per year 1 x lifetime Bone Density screening female members 65+ years of age
Wellness screening benefit
1 x assessment per beneficiary, per year at a **DSP Limited to : Blood pressure test Glucose test Cholesterol test Body mass index Waist to hip ratio assessment
Page 39
Page 40
Take total control of your benefits with BonSave - the flexible option that lets you decide how to use your savings. Designed to offer you cover when you need it most, while allowing you to customise your cover according to your needs, BonSave offers extensive hospital cover. Overall annual limit (OAL) – Unlimited MONTHLY CONTRIBUTIONS
Main member
Adult dependant
Child dependant
R1 908
R1 478
R572
A co-payment will apply to the following procedures in hospital. R2 650 co-payment
R5 250 co-payment
1. Colonoscopy
1. Arthroscopy
1. Back surgery including spinal fusion
2. Conservative back treatment
2. Diagnostic laparoscopy
2. Joint replacements for example Hip and knee replacements (except PMBs)
3. Cystoscopy
3. Laparoscopic Hysterectomy (except cancer and PMBs)
3. Laparoscopic pyeloplasty
4. Facet joint injections
4. Laparoscopic appendectomy
4. Laparoscopic radical prostatectomy
5. Flexible sigmoidoscopy
5. Percutaneous radiofrequency ablations
5. Nissen fundoplication (reflux surgery)
6. Functional nasal surgery
6. Percutaneous rhizotomies
Your fourth and subsequent children will be covered free of charge.
IN-HOSPITAL BENEFITS These benefits include major medical events.
BonSave
GP consultations
Unlimited, at 150% of the Bonitas Rate
Specialist consultations
Unlimited, at 150% of the Bonitas Rate
Pathology
Unlimited, at 100% of the Bonitas Rate
General radiology
Unlimited, at 100% of the Bonitas Rate
Specialised radiology
Unlimited, subject to pre-authorisation
Paramedical services (Allied medical professions) - speech therapy, occupational therapy, audiology, dietetics
Unlimited, at 150% of the Bonitas Rate
Prosthesis internal and external
PMB only
Mental health hospitalisation
R27 650 per family, per year
Take home medication (TTO)
R325 per beneficiary, per admission
Physical rehabilitation
R42 500 per family, per year
Alternatives to hospitalisation
R14 200 per family, per year
Oncology
R295 400 per family, per year
Organ transplants
Unlimited, subject to treatment protocols
Renal dialysis
PMB only
BonSave
R1 050 co-payment
7. Gastroscopy 8. Hyseteroscopy (not endometrial ablation) 9. Myringotomy 10. Tonsillectomy and adenoidectomy (except PMBs) 11. Umbilical hernia repair 12. Varicose vein surgery
Page 42
OUT-OF-HOSPITAL BENEFITS These benefits cover your day-to-day medical expenses, such as GP and specialist consultations, optometry and more.
Savings
Main member
Adult dependant
Child dependant
R3 672
R2 844
R1 104
Page 43
GP Consultations
Subject to available savings
*Specialist consultations
Subject to available savings
Acute medication
Subject to available savings
General radiology
Subject to available savings
Pathology
Subject to available savings
Paramedical services
Subject to available savings
HIV/Aids
R27 650 per beneficiary, per year (if registered on Aid for Aids program)
Specialised radiology
R20 000 per family, per year (subject to authorisation)
General medical appliances
R6 200 per family, per year
Stoma care products
General medical appliances limit may be exceeded by R5 600 per year
Fillings
General anaesthetic benefits are available for children under the age of 5 years for extensive dental treatment
2 x annual scale and polish treatments per beneficiary (once in 6 months)
General anaesthetic benefits are available for the removal of impacted teeth. Benefit is subject to managed care protocols
At Bonitas, we believe in giving you more. These additional benefits provide cover in or out-of-hospital.
Benefit for fissure sealants is limited to beneficiaries younger than 16 years of age
Laughing gas in dental rooms
Benefit for fluoride is limited to beneficiaries between ages 5 & 16 years
Benefit is subject to managed care protocols
Maternity care
IV conscious sedation in rooms
Pre-authorisation is required
Per event
Benefit for fillings are granted once per tooth in 365 days
Benefit is subject to managed care protocols
Benefit for re-treatment of a tooth is subject to managed care protocols
Benefit is limited to extensive dental treatment
A treatment plan and x-rays may be required for multiple fillings Root canal therapy and extractions
SUPPLEMENTARY BENEFITS
Scheme exclusions
* Subject to the specialist network.
Benefit for root canal includes all teeth except primary teeth and permanent molars
CHRONIC BENEFITS
Plastic dentures and associated laboratory costs
1 x set of plastic dentures (an upper and a lower) per beneficiary, per four year cycle
Specialised Dentistry
Covered at the Bonitas Dental Tariff (BDT)
Partial metal frame dentures and associated laboratory costs
No benefit No benefit
Hearing aids
No benefit
Crown, bridge and associated laboratory costs
Foot orthotics
R3 900 per beneficiary, per year (10% co-payment)
Implants and associated laboratory costs
No benefit
Appliances - wheelchairs, CPAP machines, etc.
Included in general medical appliances limit
Orthodontics and associated laboratory costs
No benefit
Optometry
Subject to available savings
Periodontics
No benefit
Basic Dentistry
Covered at the Bonitas Dental Tariff (BDT)
Consultations
2 x annual check-ups per beneficiary (once in 6 months)
X-rays: Intra-oral
Benefit is subject to managed care protocols
X-rays: Extra-oral
1 x per beneficiary, per three year cycle
Maxillo-facial surgery and oral pathology
1 x amniocentesis
1. Addison’s disease
10. Crohn’s disease
20. Hypertension
2. Asthma
11. Diabetes insipidus
21. Hypothyroidism
3. Bipolar Mood disorder
12. Diabetes Type 1
22. Multiple sclerosis
4. Bronchiectasis
13. Diabetes Type 2
23. Parkinson’s disease
5. Cardiac failure
14. Dysrhythmias
24. Rheumatoid arthritis
6. Cardiomyopathy
15. Epilepsy
25. Schizophrenia
7. Chronic obstructive
16. Glaucoma
26. Systemic lupus
Benefit is subject to managed care protocols
Hospitalisation (general anaesthetic)
Pre-authorisation is required
8. Chronic renal disease
18. HIV/Aids
A co-payment of R2 000 per hospital admission applies
9. Coronary artery disease
19. Hyperlipidaemia
17. Haemophilia
Antenatal classes limited to R1 050 per pregnancy 2 x consultations per beneficiary under 1 year of age
The BonSave option ensures that you are covered for the following 27 Prescribed Minimum Benefits, subject to the use of in-formulary medicine A 40% co-payment will be required if you decide to use a non-DSP to obtain your medication. Pharmacy Direct is the **DSP for chronic medication.
Surgery in the dental chair
Admission protocols apply
4 x post-natal consultations with a midwife
Infant paediatric benefit
These offer cover for conditions that require medicine on an ongoing basis.
pulmonary disease
2 x 2D scans
Please refer to www.bonitas.co.za for Scheme rules & exclusions
Benefit is subject to managed care protocols
6 x ante-natal consultations
1 x consultations per beneficiary between ages 1 and 2 years Childhood illness benefit
Subject to DSP 1 x GP consultations per beneficiary between ages 2 and 12 years
Preventative care Women's health
1 x pap smear - female members between ages 21 & 65 years, per three years cycle
General health
1 x annual HIV test per beneficiary, per year 1 x annual flu vaccine, per beneficiary, per year
Elderly health
1 x lifetime Pneumococcal vaccine members 65+ years of age 1 x annual faecal occult blood test members between ages 50 & 75 years
erythematosus 27. Ulcerative colitis
BonSave
BonSave
With BonSave, Dental is covered from risk and therefore doesn’t have any impact on your savings. (exclusive to BonSave)
Oral hygiene
Additional benefit may be considered where specialised dental treatment is required.
Wellness screening benefit
1 x assessment per beneficiary, per year at DSP Limited to: Blood pressure test
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Glucose test Cholesterol test Body mass index Waist to hip ratio assessment Wellness extender
Notes
R1 000 per family per year Subject to registration and completion of health risk assessment per beneficiary Beneficiary may then choose from the following: GP consultation Biokineticist consultation Dietician consultation Physiotherapy consultation Wearable devices (subject to approval)
BonSave
BonSave
Smoking cessation program (subject to approval)
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If you are young and healthy and just looking for peace of mind knowing that you and your family are covered for major medical events, as well as having access to savings for essential day-to-day medical needs, this option is perfect for you. Overall annual limit (OAL) - Unlimited MONTHLY CONTRIBUTIONS
Main member
Adult dependant
Child dependant
R1 598
R1 238
R479
A co-payment will apply to the following procedures in hospital. R1 050 co-payment
R2 650 co-payment
R5 250 co-payment
1. Colonoscopy
1. Arthroscopy
1. Back surgery including spinal fusion
2. Conservative back treatment
2. Diagnostic laparoscopy
2. Joint replacements for example Hip and knee replacements (except PMBs)
3. Cystoscopy
3. Laparoscopic Hysterectomy (except cancer and PMBs)
3. Laparoscopic pyeloplasty
4. Facet joint injections
4. Laparoscopic appendectomy
4. Laparoscopic radical prostatectomy
5. Flexible sigmoidoscopy
5. Percutaneous radiofrequency ablations
5. Nissen fundoplication (reflux surgery)
6. Functional nasal surgery
6. Percutaneous rhizotomies
Your fourth and subsequent children will be covered free of charge.
IN-HOSPITAL BENEFITS These benefits include major medical events. Major medical expenses are unlimited subject to the use of network hospitals. Non-network hospitals admissions will attract a 30% co-payment. GP consultations
Unlimited, at 100% of the Bonitas Rate
Specialist consultations
Unlimited , at the Specialist network rate: 130% of the Bonitas Rate Unlimited, at the Specialist non-network rate: 100% of the Bonitas Rate
BonFit
7. Gastroscopy 8. Hysteroscopy (not endometrial ablation)
Pathology
Unlimited, at 100% of the Bonitas Rate
General radiology
Unlimited, at 100% of the Bonitas Rate
Specialised radiology
Unlimited, subject to pre-authorisation
9. Myringotomy
Paramedical services (Allied medical professions) - speech therapy, occupational therapy, audiology, dietetics
Unlimited, at 100% of the Bonitas Rate
10. Tonsillectomy and adenoidectomy (except PMBs)
Prosthesis internal and external
PMB only
Mental health hospitalisation
R27 650 per family, per year
11. Umbilical hernia repair
Take home medication (TTO)
R325 per beneficiary, per admission
12. Varicose vein surgery
Physical rehabilitation
R42 500 per family, per year
Alternatives to hospitalisation
R14 200 per family, per year
Oncology
R295 400 per family, per year
Organ transplants
Unlimited, subject to treatment protocols
Renal dialysis
PMB only
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OUT-OF-HOSPITAL BENEFITS
Scheme exclusions
These benefits cover your day-to-day medical expenses, such as GP and specialist consultations, dentistry, optometry and more.
Please refer to www.bonitas.co.za for Scheme rules & exclusions
* Subject to the specialist network.
CHRONIC BENEFITS
Savings
Main member
Adult dependant
Child dependant
R2 880
R2 232
R864
These offer cover for conditions that require medicine on an ongoing basis. The BonFit option ensures that you are covered for the following 27 Prescribed Minimum Benefits subject to the use of in-formulary medicine A 40% co-payment will be required if you decide to use a non-DSP to obtain your medication. Pharmacy Direct is the **DSP for chronic medication.
GP Consultations
Subject to available savings
*Specialist consultations
Subject to available savings
1. Addison’s disease
10. Crohn’s disease
20. Hypertension
Acute medication
Subject to available savings
2. Asthma
11. Diabetes insipidus
21. Hypothyroidism
General radiology
Subject to available savings
3. Bipolar disorder
12. Diabetes Type 1
22. Multiple sclerosis
Pathology
Subject to available savings
4. Bronchiectasis
13. Diabetes Type 2
23. Parkinson’s disease
HIV/Aids
R27 650 per beneficiary, per year (if registered on Aid for Aids program)
5. Cardiac failure
14. Dysrhythmias
24. Rheumatoid arthritis
Paramedical services
Subject to available savings
6. Cardiomyopathy
15. Epilepsy
25. Schizophrenia
Specialised radiology
Subject to available savings
7. Chronic obstructive
16. Glaucoma
26. Systemic lupus
General medical appliances
Subject to available savings
Stoma care products
Subject to available savings
Hearing aids
No benefit
Foot orthotics
Subject to available savings
Appliances - wheelchairs, CPAP machines, etc.
Subject to available savings
Optometry
Subject to available savings
Basic dentistry
Subject to available savings and dental managed care protocols
Maternity care
Consultations
Subject to available savings
Per event
X-rays: Intra-oral
Subject to available savings
2 x 2D scans
X-rays: Extra-oral
Subject to available savings
Oral hygiene
Subject to available savings
4 x post-natal consultations with a midwife
Fillings
Subject to available savings
Root canal therapy and extractions
Subject to available savings
Plastic dentures and associated laboratory costs
Subject to available savings
2 x consultations per beneficiary under 1 year of age
Specialised dentistry
No benefit
1 x consultation per beneficiary between ages 1 and 2
17. Haemophilia 18. HIV / Aids
9. Coronary artery disease
19. Hyperlipidaemia
erythematosus
BonFit
pulmonary disease 8. Chronic renal disease
27. Ulcerative colitis
SUPPLEMENTARY BENEFITS At Bonitas, we believe in giving you more. These additional benefits provide cover in or out-of-hospital and payable from OAL.
6 x ante-natal consultations
1 x amniocentesis Infant paediatric benefit
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Childhood illness benefit 1 x GP consultation per beneficiary between ages 2 and 12 years Preventative care Women's health
1 x pap smear - female members between ages 21 & 65 years, per three year cycle
General health
1 x annual HIV test per beneficiary, per year 1 x annual flu vaccine per beneficiary, per year
Elderly health
1 x lifetime Pneumococcal vaccine members 65+ years of age 1 x annual Faecal Occult blood test members between ages 50 & 75 years
Wellness screening benefit
1 x assessment per beneficiary, per year at a **DSP Limited to : Blood pressure test Glucose test
BonFit
Cholesterol test Body mass index Waist to hip ratio assessment Wellness extender
R1 000 per family per year Subject to registration and completion of health risk assessment per beneficiary Beneficiary may then choose from the following: GP consultation Biokineticist consultation Dietician consultation Physiotherapy consultation Wearable devices (subject to approval) Smoking cessation program (subject to approval)
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Notes
BonEssential is the ideal plan for healthier families and individuals who only really need cover for major medical events. BonEssential offers top-quality hospital cover at affordable prices with added Prescribed Minimum Benefits when you really need them. Overall annual limit (OAL) – Unlimited MONTHLY CONTRIBUTIONS
Main member
Adult dependant
Child dependant
R1 316
R1 007
R386
A co-payment will apply to the following procedures in hospital. R2 650 co-payment
R5 250 co-payment
1. Colonoscopy
1. Arthroscopy
1. Back surgery including spinal fusion
2. Conservative back treatment
2. Diagnostic Laparoscopy
2. Joint replacements for example Hip and knee replacements (except PMBs)
3. Cystoscopy
3. Laparoscopic Hysterectomy (except cancer and PMBs)
3. Laparoscopic pyeloplasty
4. Facet joint injections
4. Laparoscopic Appendectomy
4. Laparoscopic Radical Prostatectomy
5. Flexible sigmoidoscopy
5. Percutaneous Radiofrequency Ablations
5. Nissen Fundoplication (Reflux Surgery)
6. Percutaneous rhizotomies
Your fourth and subsequent children will be covered free of charge.
MAJOR MEDICAL BENEFITS These benefits include major medical events.
BonEssential
GP consultations
Unlimited, at 100% of the Bonitas Rate
Specialist consultations
Unlimited at the Specialist network rate: 130% of the Bonitas Rate
6. Functional nasal surgery
Unlimited at the Specialist non-network rate: 100% of the Bonitas Rate
7. Gastroscopy
Pathology
Unlimited, at 100% of the Bonitas Rate
General radiology
Unlimited, at 100% of the Bonitas Rate
8. Hysteroscopy (not endometrial ablation)
Specialised radiology
Unlimited, subject to pre-authorisation
9. Myringotomy
Paramedical services (Allied medical professions) - speech therapy, occupational therapy, audiology, dietetics
Unlimited, at 100% of the Bonitas Rate
10. Tonsillectomy and adenoidectomy (Except Pmbs)
Prosthesis internal and external
PMB only
Mental health hospitalisation
R27 650 per family, per year
Take home medication (TTO)
R325 per beneficiary, per admission
Physical rehabilitation
R42 500 per family, per year
Alternatives to hospitalisation
R14 200 per family, per year
Oncology
R295 400 per family, per year
Organ transplants
Unlimited, subject to pre-authorisation
Renal dialysis
PMB only at **DSP
HIV/Aids
R27 650 per beneficiary, per year (if registered on Aid for Aids program)
BonEssential
R1 050 co-payment
11. Umbilical hernia repair 12. Varicose vein surgery
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CHRONIC BENEFITS These offer cover for conditions that require medicine on an ongoing basis. The BonEssential option ensures that you are covered for the following 27 Prescribed Minimum Benefits subject to the use of in-formulary medicine. A 40% co-payment will be required if you decide to use a non-DSP to obtain your medication. Pharmacy Direct is the **DSP for chronic medication.
Elderly health
1 x annual Faecal Occult blood test members between ages 50 & 75 years
Wellness screening benefit
1 x assessment per beneficiary, per year at a **DSP
Notes
Limited to: Blood pressure test Glucose test
1. Addison’s disease
10. Crohn’s disease
20. Hypertension
Cholesterol test
2. Asthma
11. Diabetes insipidus
21. Hypothyroidism
Body mass index
3. Bipolar mood disorder
12. Diabetes Type 1
22. Multiple sclerosis
Waist to hip ratio assessment
4. Bronchiectasis
13. Diabetes Type 2
23. Parkinson’s disease
5. Cardiac failure
14. Dysrhythmias
24. Rheumatoid arthritis
6. Cardiomyopathy
15. Epilepsy
25. Schizophrenia
7. Chronic obstructive
16. Glaucoma
26. Systemic lupus
17. Haemophilia 18. HIV/Aids
9. Coronary artery disease
19. Hyperlipidaemia
erythematosus 27. Ulcerative colitis
R700 per family per year Subject to registration and completion of health risk assessment per beneficiary Beneficiary may then choose from the following: GP consultation Biokineticist consultation Dietician consultation
SUPPLEMENTARY BENEFITS
Physiotherapy consultation
At Bonitas we believe in giving you more. These additional benefits provide cover in or outof-hospital, and payable from OAL.
Wearable devices (subject to approval)
BonEssential
BonEssential
pulmonary disease 8. Chronic renal disease
Wellness extender
Smoking cessation program (subject to approval)
Maternity care Per event
6 x ante-natal consultations 2 x 2D scans 4 x post-natal consultations with a midwife 1 x amniocentesis
Childhood illness benefit 1 x GP consultations per beneficiary between ages 2 and 12 years Preventative care General health
1 x annual HIV test per beneficiary, per year 1 x annual Flu vaccine per beneficiary, per year
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Benefits & Process Guides All about our processes and partners • • • • •
• •
The YourHealth Portal The YourHealth Portal is an exciting online educational web and mobile health portal that gives you as a beneficiary access to an abundance of resources in order to help you make better health choices and to be well informed. The portal includes e-tutorials and educational articles, tools and quizzes, and so much more, all housed in an easy to use online space. Easily accessible through the secure member zone, you will have access to the following: • E-tutorials - covering topics such as asthma, backache, healthy eating, depression, diabetes, hypertension, smoking cessation, stress, weight loss and work place health. Weekly stepby-step emails with practical advice, motivating case studies and a short questionnaire to help you to assess your understanding
What do I need to register? • • • •
Membership number ID number Email address A username and Password
Benefits & Process Guides
• • • • • • •
The YourHealth Portal Maternity Prescribed Minimum Benefits Managed care Medicine management -- Pharmacy Advised Therapy (PAT) -- Chronic Medicine -- Pharmacy Direct Hospital Management Networks -- GP Network -- Specialist Reffarls -- Specialist Network -- The Standard Select and BonFit Hospital Network Dental benefits Optical benefits Diabetic Program Hip and Knee Replacement Program HIV/Aids Management Emergency medical services Exclusion List
• Wellness programs including fitness and nutrition programs - personalised interactive diet and fitness programs with week-by-week dietary and exercise guidelines, based on a profilesetting questionnaire. Your performance is tracked and displayed • Pregnancy program - regular electronic communication to assist moms and dads during this “journey through life” • A to Z database of diseases and conditions • Condition Centres (provide disease related information and articles on a number of important chronic conditions) • Databases of symptoms, medication, first aid and wellness • Self-assessment tools
How to register on Member Zone to access the YourHealth Portal • Visit the Bonitas website at www.bonitas.co.za • Go to the top right hand corner of the page and click on “Login/Registration” • This will take you to the “Account Login Page” where you can either sign in or create a new account If you are already registered to log into the secure area where you can view personal information: • Fill in your username and password and click on “Sign in” to access your account • Click on “YourHealth Portal” If you are not registered to log into the secure area where you can view personal information: • • • •
Click on “Register” Click on “Members” Fill in your membership number and click “Validate Code” Confirm or choose from the list of members/dependants to indicate your status and name and click “Select”
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Benefits & Process Guides • Enter your chosen Username and validate with your email address • Create a password and confirm your password • Read through the terms and conditions and then click “Create Account” to complete the process • Click on “YourHealth Portal”
Maternity
The Scheme will supply every pregnant member with a mother and baby gift pack when registered on the maternity program. How do I register? Register by either logging on to the Bonitas website or contacting the call centre. -- Go to www.bonitas.co.za in order to login onto the member zone. -- Call 0860 002 108 between 8:30am and 4:00pm Monday to Friday to register for your mother and baby gift pack. This number is not available on public holidays or weekends What information do I need when I apply for the mother and baby gift pack? • • • • • •
Membership number Name and surname Contact details Delivery address Alternative delivery address Date of expected delivery
Please note: In order to ensure that you receive your mother and baby gift pack, the courier company will be in contact with you to arrange a suitable date and time for delivery.
Prescribed Minimum Benefits (PMB) By law, all medical aids are required to fund the diagnosis, treatment and care of any
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emergency medical condition and a list of 270 groups of conditions known as Diagnosis and Treatment Pairs, which includes 27 common chronic conditions known as Prescribed Minimum Benefit conditions.
• Pregnancy and childbirth • Haematological, infectious and miscellaneous systemic conditions • Mental illness
Which PMB conditions are covered by Bonitas?
Chronic conditions
Emergency medical conditions
The following 27 conditions must be covered:
An emergency medical condition means the sudden and, at the time, unexpected onset of a health condition that requires immediate medical treatment and/or an operation. If the treatment is not provided, the emergency could result in damage to bodily functions, serious and lasting damage to organs, limbs or other body parts, or even death.
• • • • • • • • • • • • • • • • • • • • • • • • • • •
Diagnosis and Treatment Pairs (270 medical conditions) The Regulations of the Medical Schemes Act provide a long list of conditions identified as Prescribed Minimum Benefit conditions. The list is in the form of Diagnosis and Treatment Pairs (DTPs). A DTP links a specific diagnosis to a treatment and indicates how these PMB conditions should be treated. Please note: It is not always possible to diagnose a condition before admitting a patient for treatment. However, if doctors suspect that the patient suffers from a condition that is a PMB condition, the medical fund will need to approve treatment in order for it to be paid correctly. Schemes may request that the diagnosis be confirmed with supporting evidence within a reasonable period of time. The 270 conditions that qualify for PMB cover are diagnosis-specific and include a range of ailments that can be divided into 15 broad categories: • • • • • • • • • • • •
Brain and nervous systems Eye Ear, nose, mouth and throat Respiratory system Heart and blood vessels Gastrointestinal Liver, pancreas and spleen Musculoskeletal Skin and breast Endocrine, metabolic and nutritional Urinary and male genital system Female reproductive system
Addison’s disease Asthma Bipolar Mood Disorder Bronchiectasis Cardiac failure Cardiomyopathy Chronic obstructive pulmonary disorder Chronic renal disease Coronary artery disease Crohn’s disease Diabetes insipidus Diabetes mellitus type 1 Diabetes mellitus type 2 Dysrhythmias Epilepsy Glaucoma Hemophilia HIV/Aids Hyperlipidemia Hypertension Hypothyroidism Multiple sclerosis Parkinson’s disease Rheumatoid arthritis Schizophrenia Systemic lupus erythematosus Ulcerative colitis
Did you know? PMB diagnoses may not legally have Scheme Specific Exclusions applied to them. For example, if you contract septicaemia after cosmetic surgery, Bonitas has to provide healthcare cover for the treatment of the septicaemia because it is a PMB condition. The cost
of the cosmetic surgery would however, remain uncovered, as this is on the Exclusion List. Do I need to apply for Prescribed Minimum Benefits? Although the process is mostly automated and these conditions are identified through the ICD-10 (diagnosis) codes reflected on your claims, you can apply for Prescribed Minimum Benefits by calling the call centre or by logging into www.bonitas.co.za How will PMB’s be covered? As per legislation, you will be provided with at least the minimum treatment needed for you PMB condition. Your Fund will pay costs in full for PMB treatment only received from our DSP’s. This will be paid from your available benefit limits first, then your treatment will be covered from risk. For example, radiology services will be paid from your Radiology annual sub-limit. Once your benefit limits are reached, further services clinically appropriate for your PMB condition will continue to be paid from a risk pool. If further treatment is needed for your condition, your treating doctor will need to submit clinical motivation for assessment and approval. How can I avoid rejected PMB claims? Check that your doctor (or any other medical service provider) has placed the correct ICD-10 code on your invoice. ICD-10 codes provide accurate information on your diagnosis and help the Scheme to decide what benefits you are entitled to and how these benefits should be paid. ICD-10 codes must also be provided on medicine prescriptions and referral notes to other healthcare providers (e.g. pathologists and radiologists) who are not able to make a diagnosis, therefore they require the diagnosis information from your referring doctor in order for their claims to be paid correctly by the Scheme. Did you know? Medical Schemes are obliged by law to treat information about members’ conditions as confidential. What do I do if my PMB claim is rejected? In the event of your PMB claim being rejected, you can contact the Bonitas call centre to query the rejection. Once diagnosed, please keep all your supporting documents on file as the consultant may ask for this information when advising on your claim.
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Benefits & Process Guides
Benefits & Process Guides
At Bonitas we strive to create the best experience for you and your loved ones during your pregnancy by providing you and your unborn child with the necessary health information and support.
Benefits & Process Guides
Benefits & Process Guides Managed care
Oncology Benefit Management
What is managed care?
This program offers you emotional support through social workers and clinical staff and manages your oncology benefits, on your behalf, by liaising with your treating doctor regarding your treatment plan and, where possible, matching it to your available benefits.
The term “managed care” describes a range of techniques that aim to reduce instances of high cost treatment and hospitalisation that are caused by a medical condition, sometimes due to complications or deterioration, which could have been avoided or improved through quality care and support. By looking at both the type of treatment you are receiving from your doctor and the cost thereof, we aim to improve the quality of care while managing your benefits more effectively. Each Managed Care program has specific criteria and protocols which are followed. The aim of these programs is to ensure that you get good quality medical care while managing your benefits carefully, thereby also minimising the clinical and financial risk to the Scheme. In some cases, we have agreements with doctors, hospitals and healthcare professionals to provide you with a range of services at a reduced cost. With your consent, we work closely with your doctors to help your benefits stretch further and make sure that you are supported more than adequately. Our Managed Care programs put you on the path to wellness by supporting you through your treatment. They cover everything from chronic medicine, to the long-term treatment of a condition like diabetes and emergency hospitalisation. Which Managed Care programs do Bonitas offer? We offer a variety of programs that coordinate care for everything from back ailments to oncology. Chronic Medicine Management This program ensures that you are covered for the treatment of a list of chronic diseases and provides you with quick and easy methods to update your medicine. It also ensure you aren’t paying too much for your medicine by working together with the pharmaceutical industry to regulate medicine prices, to keep track of new products and generics and negotiate dispensing fees. Hospital Benefit Management This program will help you to pre-authorise your hospital stay and support you through the process to make sure that you know what to expect when you’re admitted and discharged. It will ensure that your benefits are managed effectively.
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Bonitas has partnered with The Independent Clinical Oncology Network (ICON) of dedicated specialist oncologists who subscribe to the ICON culture of patient-centric and ethical cancer care. The network represent 80% of the private practising oncologists with a national geographic footprint. The partnership with Bonitas focuses on the enhancement of every aspect of quality of care including patient-centeredness, clinical outcomes and affordability of care. Disease Management through Integrated Care This program supports you through your prescribed treatment to ensure you are getting the best care and doing what you can to get better. A team of health coaches help you to identify the areas you need to improve on, offer you advice on your condition and work together with your treating doctor to give you the best support possible. The Bonitas Back Rehabilitation Program If you are diagnosed with certain back and neck conditions, you will be provided with advice on the most appropriate care, as well as have access to physiotherapists and doctors, where clinically appropriate, that will help you to manage and improve your condition. Contact details: Chronic Medicine Management • Call: 0860 002 108 • Email:
[email protected] Hospital authorisations • Call: 0860 002 108 • Email:
[email protected] Oncology management • Call: 0860 100 572 • Email:
[email protected]
Medicine Management
Apply via telephone
Pharmacy Advised Therapy (PAT)
Call 0860 002 108 and follow the voice prompts. Once you select the appropriate option your call will be routed through to a consultant who will guide you through the process.
What is PAT?
Apply online
You don’t always have to go to a doctor to get medicine. Your pharmacist can recommend and dispense certain medicines without a doctor’s prescription.
• Go to www.bonitas.co.za and log in as a member. • Go to “Clinical Information” and click on “Online Chronic Application”. • Follow the prompts on the system and once all information has been captured click on “View Summary”. You can print this screen for your records. • Click on “Submit” and a reference number will be provided for follow up on the progress of the application.
When is it useful? If you have a mild sore throat, cold, a mild cough or anything similar, ask your pharmacist to dispense appropriate medicine and to clearly write “PAT” on your claim. Why do it? The cost of this claim is deducted from your normal day-to-day benefit or savings accounts. You don’t have to pay for this out of your pocket and you save on the cost of a consultation with your doctor. Chronic medicine Chronic medicine is medication used on an ongoing basis to treat certain chronic health conditions. Did you know? Common chronic conditions include heart disease, diabetes, hypertension, arthritis, asthma and osteoporosis. How do I apply for the chronic medicine benefit? You, your doctor or pharmacist may apply for chronic registration. You will need to have the following information on hand: • • • • •
Your membership number The beneficiary’s date of birth The ICD 10 code The doctor’s practice number The medicine details
Some chronic medication may require additional clinical information.
What happens after I register on the program? • Once registered and your application has been approved, you will receive a Medicine Access Card listing the medicines to be paid from your Chronic Medicine benefit. • If the medicine authorised differs from the medicine requested, a letter of explanation will be attached to your access card and a copy will be sent to the prescribing doctor. • ou will need a repeat script from your doctor for the medicines listed on the card. Please note: The access card is not a prescription and cannot be used to have medicines dispensed. Your doctor determines the number of repeats and will advise you how often he needs to see you to monitor your condition. Whenever you need to have your medicine dispensed, produce a valid doctor’s prescription together with the access card. The duration of authorisation varies from medicine to medicine. Some medicines may be authorised ongoing, whilst others may only be authorised for a limited period. Types of formularies There are two types of formularies: • Restrictive Formulary ---
Restrictive formularies provides access to a restrictive range of medicines to treat your chronic condition. You will not have a co-payment for medicines on this formulary if they are authorised and obtained from the Designated Service Provider.
• Comprehensive Formulary
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Benefits & Process Guides
Benefits & Process Guides
Benefits & Process Guides
Benefits & Process Guides --
Provides access to a wider range of medicines to treat your chronic conditions.
If you choose to use a medicine that is not on the formulary allowed by your option, you may have to pay a co-payment upfront. Your co-payment may be substantial if the cost of your medicine is higher than listed on the Medicine Pricing List. A co-payment may also apply if you are required to use a Designated Service Provider and choose not to. Both formularies include alternative products that will not require a co-payment to be made, so if you do not wish to incur any co-payments, discuss alternative therapies with your treating doctor and ensure that you obtain your medicine through a Designated Service Provider.
When you apply for chronic medicine, you are approved for treatment of your chronic condition and not a specific medicine only. This means that when you need to change or add a new medicine for your condition, you can do this quickly and easily at your pharmacy with your new prescription without having to contact us. Each condition is allocated a basket of medicine for its treatment. The quantity of each medicine in the basket is limited to the most commonly prescribed monthly dose. You do need to contact us on 0860 002 108 if: • You have a medicine that is not in your condition’s basket • If you are diagnosed with a new condition • You require higher quantities than those in the basket You do not need to update us with your new medicine if: • Your medicine is in the basket • You change to another medicine in the basket • You need a quantity or dosage of a medicine that is listed in the basket. Please note: Pre-approved medicine in the basket will still be subject to the Medicine Pricing List and formulary co-payments.
pharmaceutical services available. Pharmacy Direct has the capability to deliver medication to members and dependants residing at different addresses. Patients are advised by SMS, telephone or email of delivery.
An electronic copy of documentation is acceptable. However, by law you are required to send your original prescription for any schedule 5 and 6 medicine to be obtained from Pharmacy Direct.
Hospital Management
Members are required to register with Pharmacy Direct in addition to applying for chronic medication.
How soon can I expect delivery of my medication?
All hospital stays must be pre-authorised (including emergencies). It is best to do this at least two days before you go to hospital.
Contact details: Practice number: Fax: Queries: Aid for AIDS: Email: Website:
0126225 086 611 4000/1/2/3 0860 027 800 0860 103 810
[email protected] www.pharmacydirect.co.za
How do I register with Pharmacy Direct? • Ensure you’ve applied for chronic medicine. • Visit www.pharmacydirect.co.za to download the application form, complete all relevant sections and fax it to 086 611 4000/1/2 or email it through to
[email protected]. • Alternatively, you can call Pharmacy Direct on 086 002 7800 to register an online application. • Please fax a copy of the original repeat prescription for all medication required to 086 611 4000/1 or email to
[email protected]. If you do not have the prescription, please contact your doctor. Please note: An electronic copy of all documentation is acceptable. However, you are required to send your original prescription for schedule 5 and 6 medicine to Pharmacy Direct. How do I order medication? Please fax a copy of the original repeat prescription for all medication required to 086 611 4000/1/2 or
Pharmacy Direct
E-mail to
[email protected]. If you do not have a valid, repeat prescription, please contact your doctor.
Pharmacy Direct is the Designated Service Provider (DSP) for chronic medication. Medicine is delivered to your home, place of work or to the nearest Post Office, depending on your choice. A large number of our patients are based in rural areas where there are no other
Please note: By law, medication can only be dispensed once a pharmacy is in possession of a valid prescription. It remains the responsibility of the patient to obtain his/her prescription from the prescribing doctor and to forward this to Pharmacy Direct and to Chronic Medicine Management for chronic authorisation.
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Please note: Before medication can be sent, to new or existing Pharmacy Direct users, Pharmacy Direct would engage in certain interventions to ensure good pharmacy practice. Case
Dispatch Time
Note
Delivery Time
First time delivery of urgent/lifethreatening medication
24-48 hours until dispatch
Dependant on whether chronic authorisation is already in place
24-72 hours, depending on location
First time delivery of other chronic medication
3-5 working days until dispatch
Dependant on whether chronic authorisation is already in place
24-72 hours, depending on location
Dependant on whether chronic authorisation is already in place
24-72 hours, depending on location
Delivery of medication where a new, valid prescription has been received
3-5 working days until dispatch, or as per automated existing dispense dates
Pre-authorisation for hospital admission
No account will be paid unless pre-authorisation is obtained. In cases of emergency, preauthorisation can be obtained 48 hours after the emergency. On the Standard Select and BonFit options, a 30% co-payment will apply to all non-network and non-authorised hospital admissions, except in the case of an emergency. How do I apply for pre-authorisation? You can apply for pre-authorisation in one of these ways: • Online Log in to www.bonitas.co.za and click on the pre-authorisation button. Follow the prompts. • Email Email all the relevant information to
[email protected]. • Telephone Call 0860 002 108 between 8:30am and 4:00pm Monday to Friday to pre-authorise your hospital stay. This number is not available on public holidays or weekends. What information do I need when I apply for pre-authorisation?
Medication is automatically dispensed on a 28-day cycle. Pharmacy Direct uses an advanced scheduling and planning system to deliver medication to patients on a monthly basis. Did you know? By law, prescriptions are only valid for six months. Therefore, patients don’t need to re-order medication each month, but rather, update their prescription every six months. Pharmacy Direct contact details: Fax: Queries: Email: Website:
086 611 4000/1/2/3 0860 027 800
[email protected] www.pharmacydirect.co.za
• • • • • • •
Membership number Beneficiary name and date of birth Date of admission and the proposed date for the operation Name of the doctor and their telephone and practice numbers Name of the hospital with their telephone and practice numbers All the relevant procedure codes All the relevant associated medical diagnosis codes
Are there any other treatments/procedures that I need pre-authorisation for? You will also need pre-authorisation for the following: • Renal clinic admissions for dialysis
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Benefits & Process Guides
Benefits & Process Guides
Disease Authorisation
Benefits & Process Guides
Benefits & Process Guides • • • • • •
Procedures in doctor’s rooms instead of hospitalisation Physical rehabilitation care in rehabilitation facilities Drug and alcohol rehabilitation care in specific facilities Hospice admissions Oxygen therapy at home All specialised radiology
What happens in the case of an emergency treatment/admission to hospital over a weekend, public holiday or at night?
Failure to obtain pre-authorisation for a planned event or authorisation on the first working day after an emergency event will mean that you are liable for the full account according to the rules of the Scheme. Will I receive any communication about my pre-authorisation? You will receive a letter confirming your pre-authorisation by email or post. This letter contains a number of disclaimers printed at the end. Please make sure you take note of these disclaimers as they reflect the Scheme rules. If you are unclear, please discuss the disclaimers with your treating doctor.
Why are some requests for pre-authorisation declined?
Specialist referrals
Some of the pre-authorisation requests may be declined if:
Your GP should be the first person to advise you about your healthcare needs. Not only does your GP understand your illness, but he/she also knows which type of specialist is best for you to see. The GP will assist you in consulting with the right specialist should you need to, saving you both time and money.
• The planned procedure is not covered by your benefit option as specified in the Scheme rules. • The planned procedure is not in line with the acceptable treatment standards for a particular medical condition. • The appropriate clinical information has not been received. • The membership is inactive or similar issues with membership status. Case Management While you are in hospital, case managers ensure that appropriate care is provided at all times and that appropriate discharge planning takes place where clinically indicated and where benefits are available. This takes place according to the Scheme rules, clinical protocols and funding guidelines. When extended length of stay or level of care is requested, the case manager will request supporting information to be able to make an informed clinical decision. If there is any doubt at all, a medical advisor will assist and motivation might be requested from your treating provider, if needed. All changes in initial approvals are communicated to the hospital and treating provider. With long-term cases, your family members may also be involved.
You will also need to keep note of: • The unique pre-authorisation number • The initial approved length of stay • The status of all the codes What happens if I have to stay in hospital for longer than the initial approved length of stay? Ensure that your doctor, the hospital case manager or a family member emails
[email protected] to inform the case management department of the extended length of stay. If there is a clinical reason for the stay, your Fund will approve the extra days. If not, you will be liable for the costs of the non-approved days and treatment.
Networks GP (General Practitioners) Network Bonitas offers the largest GP network in South Africa, providing you with access to over 7 000 GPs countrywide. We’ve negotiated special rates with these GPs to ensure that you won’t have any co-payments and that your benefits last longer. Members on the Standard and Primary options are advised to use the Bonitas GP Network for all their GP visits. Members on the Standard Select option will be required to nominate their GP per beneficiary from our network on the application form or contact the call centre.
Do co-payments still apply on procedures performed in-hospital?
How do I find a doctor on the Bonitas GP Network
Any procedure that is stipulated in the Scheme rules as attracting a co-payment will still attract a co-payment whilst in-hospital. Your diagnosis or treatment plan will not change this.
• Call us on 0861 002 108 or use the ‘Find a doctor’ tool on our website - www.bonitas.co.za or use the SMS locator facility.
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Please remind your GP to call the call centre to obtain an automated specialist referral authorisation number, via the IVR (Interactive Voice Response) system. On BonClassic, Standard, Standard Select, Primary and BonFit, female members may visit the gynaecologist once a year without referral. Members may also visit the ophthalmologist and oncologist without referral. Specialist Network At Bonitas, we constantly strive to give you access to affordable, quality healthcare. That’s why we’ve partnered with various healthcare professionals to create the Bonitas Specialist Network, which gives you access to over 2 000 specialists nationally. If you are a member on the Standard, Standard Select, Primary, BonSave, BonClassic, BonFit and BonEssential Options, the Specialist Network will provide you with access to specialist services at a negotiated tariff for both in and out-of-hospital costs. The benefit of this initiative will result in your claim being paid in full without you being responsible for any shortfall. If you have a Prescribed Minimum Benefit condition and your day-to-day benefit limits have been exhausted, you can continue to consult with a specialist within the Bonitas Specialist Network without incurring any co-payments. Services for these conditions will be subject to the guidelines as contained within the Medical Schemes Act. How do I find a specialist on the Bonitas Specialist Network? Visit www.bonitas.co.za and use the provider locator tool. Alternatively, call us on 0860 002 108 or email us at
[email protected]. The Standard Select and BonFit Hospital Network The Standard Select and BonFit options offers members access to the best quality private hospitals on the extensive hospital network list. Visit www.bonitas.co.za and use the hospital locator tool. Alternatively, call us on 0860 002 108 or email us at
[email protected].
Dental benefits DENIS is a fully accredited managed care organisation that manages your dental benefits. There is a pre-defined benefit per procedure, which is paid at the published Bonitas Dental Rate (see www.denis.co.za for the list of dental rates). Your dentist will also be able to provide information regarding your benefits, as DENIS supplies all dentists with a Chair side & Benefit Guide, which illustrate the dental benefit management methodology and benefits. Benefits for dentistry are paid on a fee for service basis. This means that for every procedure done by a dentist, there is a fee that is charged. These fees may differ from dentist to dentist. Your fund pays a benefit for each procedure, which may differ from the fee charged by your dentist. It is your right to negotiate this difference with your dentist. Dental benefits are paid at the Bonitas Dental Tariff (BDT) and are dependent on the plan you’re on. Hospitalisation and certain specialised dentistry procedures and treatment must be preauthorised. Please note: • Procedures and treatment not pre-authorised will not attract a benefit, with the exception of crown and bridge procedures where a 20% penalty will apply if authorisation is applied for after the treatment has been done. • A co-payment of R2 000 is applicable on all hospital admissions for dentistry on the Standard, Standard Select, BonSave, Primary, Bonfit and BonEssential options. • Failure to pre-authorise orthodontic treatment will result in payment only from the date of authorisation for the remaining months of treatment, provided that the treatment is clinically indicated. • Penalties do not apply to emergency hospital admissions. • Co-payments for Orthodontics are levied on the Standard and Standard Select Option. • A benefit for Crown & Bridgework on the Standard & BonClassic Options is subject to a DENIS Designated Service Provider Network. • All conservative, out-of-hospital services on the BonCap Option are subject to a DENIS Designated Service Provider Network. • Dental benefits are subject to managed care protocols and interventions, which may include the requirement of treatment plans and/or radiographs prior to benefit application.
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Benefits & Process Guides
Benefits & Process Guides
In this case, you must contact the pre-authorisation call centre on the first working day after the incident.
Benefits & Process Guides
Benefits & Process Guides Dental Wellness Program As a Bonitas member, you are automatically a member of the Dental Wellness Program. You will receive various treatment-related information leaflets and oral screenings, advice and dental products will be provided at your company’s wellness days. Visit www.denis.co.za for more information. How do I find a DENIS Network Provider? Visit www.denis.co.za and use the “find a dentist” tool.
• • • • • • • •
Hospital practice number Anaesthetist practice number Treating clinician Hospital admission date Procedure code(s) with ICD10 code(s) and where relevant the applicable tooth numbers Main complaint as to why the procedure is needed If applicable, medical report of special medical conditions X-rays are needed if a 54 practice applies for the removal of impactions
To pre-authorise the following specialised dental benefits, please use the relevant email contact details:
Post the original copies of your dental claims to Private Bag X 1 Century City 7446, Cape Town or email
[email protected]
• Crown and bridge procedures – Email
[email protected] • Orthodontics – Email
[email protected] • Implants – Email
[email protected]
Please ensure the following details are clearly visible:
Alternatively, you can fax the details to 0866 770 336.
• • • • • • •
For more details on the pre-authorisation requirements for the above-mentioned specialised dental benefits, please visit www.denis.co.za
Your membership number The dentist’s details and practice registration number The correct dependant name and code (see your membership card) The treatment date The relevant procedure codes The tooth numbers (if applicable) The relevant ICD-10 codes
The Periodontal Program This benefit is only available to those members on the Standard, Standard Select, BonClassic and BonComprehensive Options. How do I apply to the Periodontal Program?
Which specialised dental benefits need to be pre-authorised? • • • • • •
Crown and bridge procedures Orthodontics Implants Hospitalisation Intravenous Conscious Sedation Periodontics
How do I get pre-authorisation for these specialised dental procedures? To pre-authorise dental procedures in hospital or under IV Conscious Sedation, please call 0860 336 346. Please have the following information on hand:
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Submit your CPITN score (supplied to you by your dental practitioner), together with your Periodontal treatment plan to
[email protected], or alternatively, fax it to 0866 770 336. Once authorisation has been obtained, cover for the treatment is subject to Scheme rules, exclusions and benefit protocols.
What happens if my procedure is not pre-authorised? • Procedures and treatment not pre-authorised will not attract a benefit and thus not be paid by the Scheme, with the exception of crown and bridge procedures where a 20% penalty will apply if authorisation is applied for after the treatment has been done. • Failure to pre-authorise orthodontic treatment will result in payment only from the date
of authorisation for the remaining months of treatment, provided that the treatment is clinically indicated. • Penalties do not apply to emergency hospital admissions. Co-payments for Orthodontics are levied on the Standard and Standard Select options.
How do I find an Iso-Leso Optical Provider? If you have any questions regarding your nearest Iso-Leso Provider, you can contact Iso-Leso at the following contact details. Contact details:
Contact details: Call: 0860 336 346 Fax: 0866 770 336 Email:
[email protected] Claims:
[email protected] Hospital authorisations:
[email protected] Orthodontic and implant authorisations:
[email protected] Crown and bridge authorisations:
[email protected] Periodontal authorisations:
[email protected]
Optical benefits Your optical benefits depend on the plan you have chosen. Our preferred provider for optical benefits is Iso-Leso. Their respected national network of optometric practices has a reputation for delivering high quality service and products to its patients and members of medical Schemes. They offer medical aid members substantial savings on clear single vision, bifocal and multifocal quality spectacle lenses. Their mission is to ensure the viability and stability of the optometric environment for all role players. The Iso-Leso philosophy is to encourage participation of all registered optometrists in the provision of optometric services. As the Iso-Leso provider base is diverse and includes private practitioners, group practices and optometric franchisees, we have a fair representation of the choices that Bonitas members face in seeking optometric care. In addition, Iso-Leso has embarked on improving the quality of professional services with the Practitioner Enhancement Program. This initiative is designed to accredit optometrists who invest in their professional standards of practice. This ultimately translates into a higher level of the quality of care for the Bonitas member. Your available savings may be used for Optical benefits. You can visit a non-network provider, however, your plan’s optical benefit is limited to the IsoLeso tariff. This means you may have to make a co-payment.
Call: 0860 10 30 50 / 60 Email:
[email protected] Each beneficiary is entitled the following benefit over a 24-month cycle commencing on 1 January 2015: Either: One consultation and, if the required prescription is not less than 0,50DS or 0,50DC or the required reading addition is greater than 0,75DS
Benefits & Process Guides
Benefits & Process Guides
How do I submit claims to DENIS?
Benefits & Process Guides
One pair single vision lenses or; One pair flat top bifocal lenses or; One pair multifocal lenses or; A spectacle frame to the value of the specific benefit option Or: One consultation and contact lenses to the value of specific benefit option Please note: • Services not covered by the matrix are for the members’ portion and should be paid directly to the practice, or can be refunded from available savings. • Please note that claims older than 4 months from the date of service will not be accepted for payment. • The practice is not entitled to collect the unpaid portion for the above products from the patient unless they are: -- Lens enhancements and add-ons (tints, ARC etc.) -- The difference on the frame value over the specific plan maximum benefit -- The difference on the contact lens value over the specific plan maximum benefit • All tariffs are inclusive of VAT. • Mobile Practice claims will only be paid if confirmation of registration as a mobile practice by HPCSA is supplied.
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Benefits & Process Guides • Spectacle lens prescriptions must be included in both paper and electronic claims. Please contact your service provider for assistance in this regard. • Payment for materials will be declined under the following circumstances: -- Where no script is indicated -- Where no ICD 10 codes are indicated -- Where the script is less than 0.50 D sphere or 0.50 D cylinder (with no sphere) in both eyes in the case of spectacles -- Invoices that do not comply with VAT legislation requirements -- Where the claim is older than 4 months from the date of service
Bonitas Medical Fund has partnered with the Centre for Diabetes and Endocrinology to provide excellent care to members with diabetes.
Eye screening (ophthalmologist), and foot screening (podiatrist) services are also important components – these are made available by Bonitas via their normal funding mechanisms. Your diabetes medication is important. The CDE, in conjunction with your treating doctor and a CDE endocrinologist, will ensure that your diabetes prescription is optimized for your diabetes treatment. Importantly, you will have your diabetes medication sent directly to you by the Bonitas preferred provider, Pharmacy Direct. This valuable service makes it convenient for you and ensures you always receive what you need for your diabetes care in a timeous manner. If you wish to remain with the doctor who is currently treating your diabetes, ask him / her to contact the CDE central office in Houghton, Johannesburg. They will then provide information and the doctor will be trained and accredited as a “preferred provider” within the “Centre for Diabetes” network. How do I join the CDE?
The CDE is a holistic, multi-specialist Diabetes Centre in Houghton, Johannesburg. The Centre manages diabetes by using a team approach that includes diabetes specialists, diabetes educators, a dietician, podiatrists, a clinical psychologist, as well as exercise specialists if necessary. In addition, the Centre trains healthcare professionals in the principles and practice of good diabetes care and acts as the central office for a nationwide network of over 240 affiliated “Centres for Diabetes”. These accredited centres are contracted to provide all the benefits of the diabetes management program, which is a complete diabetes management package.
Members on all options who have diabetes can join the Centre for Diabetes and Endocrinology by:
The CDE has won numerous awards over the last 20 years for their excellence and they are acknowledged as world-class providers of diabetes care. Join now to optimise your diabetes health!
There is no joining fee and no charge for your diabetes care services.
The CDE program includes: • consultations with a doctor who has received further training in diabetes management (a minimum of two per year) • diabetes education to supplement your knowledge in diabetes and to enable you to “selfmanage” your diabetes more effectively • annual consultations with a registered dietician • access to the best and most appropriate medicines for diabetes • a diabetes 24 hour emergency hotline • a diabetes specialist (endocrinologist) supporting your treating doctor regarding your treatment as well as care support from a CDE case manager.
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• Calling them on 011 053 4400 to join the program. • Asking your doctor to refer you to the nearest CDE Centre where you can register on the program. How much does it cost?
If your Bonitas GP Network doctor is not a CDE accredited doctor, they are still able to participate. This means that you should be able to stay with your current Bonitas GP network doctor if you wish. The CDE will facilitate this if required. Contact details: Tel: Fax: Email: Website:
(011) 053 4400 (011) 728 6661
[email protected] www.cdediabetes.co.za
Hip and Knee Replacement Program
ICPS (Improved Clinical Pathway Services) is a group of orthopaedic surgeons that specialise in performing hip and knee replacements according to standardised clinical care pathways. These care pathways have been developed in accordance with evidence based outcomes to ensure that the quality of the hip and/or knee replacement is of highest standard and to ensure the best health outcomes. ICPS uses a multidisciplinary team dedicated to assist with rapid and successful recovery and keeping the patient as comfortable as possible during the healing period. How to access and orthopaedic surgeon on the ICPS program Call the Bonitas call centre on 0860 00 2108 where you will be given the details of an ICPS orthopaedic surgeon closest to you. Following your consultation with the ICPS orthopaedic surgeon and if the decision for surgery is made, an application for an authorisation number will be arranged on your behalf by the admin staff of the practice. This will allow you access to the ICPS program and ensure payment in full (subject to your prosthesis benefit) with no co-payment for the procedure. The ICPs surgeon will give you a booklet providing you with information on the ICPS program. The program is applicable to all members on the Bonitas Standard, Standard Select and BonClassic options. ICPS will assist with your hospital pre-authorisation should an operation be required. To alleviate the admin burden of submitting accounts, ICPS will submit one account to Bonitas for payment which will include: • • • •
All hospital costs Surgeons and anaesthetist fees Prosthesis (subject to prosthesis benefit) Physiotherapist (pre-, intra-, and post-operative)
Should you choose not to use an ICPS orthopaedic surgeon and are admitted for hip or knee surgery you will be liable for a R5 000 co-payment on admission to the hospital. If you are on the Standard Select option you are only allowed to use ICPS facilities. The program has been established to assist you in taking an active part in planning your care and recovery for hip or knee surgery as well as ensuring financial peace of mind.
HIV/Aids Management
South Africa’s leader in HIV/Aids management and care, Aid for AIDS is a revolutionary, integrated approach to HIV/Aids management that has been delivering excellence since 1998. Our approach is to act as a care-coordinator between the funder, doctors, pathology labs, pharmacies and patients. Supported by a team of worldwide-respected clinicians in their field. Backed by a custom IT system that has become the gold standard in HIV/Aids disease management and we enable the optimal care of patients with an end-to-end solution. Our program is designed to meet the needs of patients and equip them with the treatment and tools to lead normal, fulfilled lives. We empower funders to guard against the financial risk posed by unmanaged HIV/Aids in their employee or member populations. Shaped over years of clinical research and expertise, our methods are considered as the industry standard by healthcare professionals globally. It is very important to register on the program as soon as you know your status. Benefits & Process Guides
Benefits & Process Guides
Diabetic Program
Benefits & Process Guides
Your plan has a benefit amount specifically for HIV/Aids-related medication. This benefit amount is used to pay for: • Antiretroviral therapy (ART) • Medication to protect you against illnesses such as TB and flu • Regular monitoring tests Aid for AIDS offers a complete HIV/Aids disease management program to both members and beneficiaries: • Medication to treat HIV (including drugs to prevent mother-to-child transmission and infection after sexual assault or needle-stick injury) at the most appropriate time • Treatment to prevent opportunistic infections like certain serious pneumonias and TB • Regular monitoring of disease progression and response to therapy • Regular monitoring tests to detect possible side-effects of treatment • Ongoing patient support via a team of trained and experienced counsellors • Clinical guidelines and telephonic support for doctors • Help in finding a registered counsellor for face-to-face emotional support Even if you do not need ART because it is still too early, it is important to register on the program in order to have access to all the other benefits that will assist in keeping you healthy.
Strict confidentiality Every effort is made to keep members’ HIV status confidential. The staff members at our Aid for AIDS unit have all signed confidentiality agreements and work in a dedicated unit. They
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Benefits & Process Guides use separate telephone, fax, email and private mailbag facilities. Patients need to use these facilities to maintain confidentiality. How do I register with Aid for AIDS? If you are HIV-positive, you must register with Aid for AIDS as soon as possible in order to make use of this benefit.
What happens after I have registered? A highly qualified medical team will check your medical details and, if necessary, discuss cost-effective and appropriate treatment with your treating doctor. Once treatment has been agreed upon, you and your doctor will be sent a detailed treatment plan, which explains the approved medicine, as well as the regular tests that need to be done to ensure that the drugs are working correctly and safely. Contact details: Call: Fax: Email: Website: Mobi-site: Please call me:
0860 100 646 0800 600 773
[email protected] www.aidforaids.co.za www.aidforaids.mobi 083 410 9078
Emergency medical services ER24 is the designated service provider for all emergency medical services for Bonitas members and their registered dependants. This benefit includes: • Emergency medical response by road or air to the scene of the medical emergency
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• • • • • •
Transfer to the closest appropriate medical facility by road or air Inter-hospital transfers (subject to authorisation) in accordance with Scheme rules Medical information and assistance hotline Trauma counseling and referral to appropriate healthcare professionals as required Member/dependant validation Medical information and assistance hotline where trained personnel provide trauma counseling, medical advice in emergencies and HIV counseling
What do I need to do in the case of a medical emergency? • • • • •
Call 084 124 Provide your name and the telephone number you are calling from Provide a brief description of the incident and the severity thereof Provide the address/location (road name, number and nearest crossroad) Do not hang up until ER24 has all the details
Please note: When you join Bonitas, you will receive specially designed ER24 car stickers. Please ensure that these are attached to your vehicle as described in the letter sent with the stickers. If you use another service provider, a 40% co-payment will apply. Ensure that ER24 is informed of this and that the account is submitted to
[email protected] no later than 30 days after the date of service.
Exclusion list Certain holistic procedures • Aromatherapy • Art therapy • Ayurvedics • Herbalists • Iridology • Reflexology • Sleep therapy • Therapeutic Massage Therapy Appliances, devices and procedures not scientifically proven • Back rests and chair seats • Bandages and dressings (except medicated dressings)
• Cardiac assist devices – e.g. Berlin Heart • Diagnostic kits, agents and appliances unless otherwise stated (except for diabetic accessories) • Humidifiers, ionisers and air purifiers • Orthopaedic shoes and boots • Pain relieving machines, stethoscopes and blood pressure monitors • Oxygen hire or purchase, unless authorized • Portable oxygen cylinders and Portable oxygen concentrators Specific reproductive technology and procedures • Medical and surgical treatment for infertility • 3D and 4D maternity scans • Anabolic steroids and immuno stimulants unless Prescribed Minimum Benefits • Contraceptives (including oral, parenteral, foams and IUCDs) • Erectile dysfunction and loss of libido treatment (medical or surgical) • Gender reassignment medical or surgical treatment Cosmetic procedures and items • Breast augmentation • Breast reconstruction - unless mastectomy following cancer and pre-authorised • Cosmetic items such as moisturisers, sunscreen and shampoos, except for the treatment of lice, scabies and other microbial infections and coal tar products for the treatment of psoriasis • Epilation • Electric toothbrushes • Cosmetic effect contact lenses • Contact lens accessories and solutions • Keloid surgery and revision of scars except for functional impairment • Optical devices which are not regarded by the relevant managed healthcare program, as clinically essential or clinically desirable, except on BonSave and BonComprehensive Options • Rhinoplasties for cosmetic purposes • Sunglasses Dentistry • Appointments not kept • Behavior management • Caries susceptibility and microbiological tests • Cost of Mineral Trioxide • Cost of prescribed toothpastes, mouthwashes (e.g. Corsodyl) and ointments • Crown and bridge procedures for cosmetic reasons and associated laboratory costs
• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •
Crowns or crown retainers on wisdom teeth (3rd molars) Dental bleaching Dental testimony including Dento-legal fees Diagnostic dentures and associated laboratory costs Direct and indirect pulp capping procedures Dolder bars and associated abutments on implants including the associated laboratory costs Electrognathographic recordings, pantographic recordings and other such electronic analyses Emergency crowns that are not placed for the immediate protection in tooth injury and associated laboratory costs Enamel micro abrasion Fillings to restore teeth damaged due to toothbrush abrasion, attrition, erosion and fluorosis Fissure sealants on patients 16 years and older Full mouth rehabilitations and associated laboratory costs Gold foil restorations High impact acrylic Implants on wisdom teeth (3rd molars) Intramuscular or subcutaneous injection Invisible retainer material Multiple hospital admissions Nutritional and tobacco counseling Oral hygiene evaluation and/or instructions Orthodontic re-treatment and any related Laboratory costs Orthognathic (jaw correction) and other orthodontic related surgery and any related Hospital cost including associated Laboratory costs Ozone therapy Perio chip placement Pontics on 2nd molars Porcelain veneers and inlays and associated laboratory costs Procedures that are defined as unusual circumstances and procedures that are defined as unlisted procedures Professionally applied fluoride for beneficiaries 16 years and older Provisional crowns and associated laboratory costs Provisional dentures and associated laboratory costs Pulp tests Resin bonding for restorations that are charged as a separate procedure to the restoration Root canal therapy on primary (milk) teeth and on wisdom teeth (3rd molars) Snoring appliances and associated laboratory costs Special reports
Benefits & Process Guides
Benefits & Process Guides
• Call 0860 100 646 and ask for an application form. All calls are strictly confidential. • You may also pre-register yourself on the program where you will receive guidance on how to continue on the program to receive the benefit. • You and your doctor must complete the application form and return it to Aid for AIDS by using the confidential, toll-free fax-line number on the form or via email.
Benefits & Process Guides
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Benefits & Process Guides
Dietary and nutritional supplements • Food and nutritional supplements including baby food and special milk preparations unless prescribed for life-threatening malabsorption disorders and if registered on the relevant managed healthcare program • Slimming preparations for obesity • Smoking cessation and anti-smoking preparations, except for benefits paid from wellness extender • Tonics, multi-vitamins, supplements and mineral combinations (except for registered products that include haemotonics and those for use by infants and pregnant mothers) Medical and clinical protocols • All benefits for clinical trials unless pre-authorised by the relevant managed healthcare program • Appointments which a beneficiary fails to keep • Autopsies • Balloon Sinuplasty on Primary, BonEssential, BonClassic and BonSave Options • Bilateral gynaecomastia • Bone densitometry performed by a GP or specialist not included in the Scheme credential list • Carmustine Wafers for the treatment of malignant Gliomas • Chiropractor benefits in hospital • Cryo-storage of fetal stem cells and sperm • CT colonography for screening • Genioplasties as an isolated procedure • Holidays for recuperative purposes • Hyperbaric oxygen therapy (except for anaerobic life-threatening infections, Diagnosis Treatment Pairs 277S and specific conditions pre-authorised by the relevant managed healthcare program) • MDCT Coronary Angiography for screening • Medicines used specifically to treat alcohol and drug addiction, unless it is a PMB • MRI scans ordered by a GP, unless there is no reasonable access to a relevant specialist • Organ and bone marrow donations to a person who is not a member or dependant on Bonitas • Otoplasties
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• Pectus excavatum / carinatum • Positron Emission Tomography, except on BonComprehensive and PET plus PET-CT for screening on all options • Robotic assisted surgery • Screening that has not been pre-authorised or is not in accordance with the Scheme’s protocols • Specialised radiology procedures where pre-authorisation is not made or declined • Surgical treatment for obesity (excluding certain bariatric surgical procedures performed for life threatening morbid obesity by a multidisciplinary team in accordance with an agreed protocol in a credentialed centre of excellence when pre- authorised, but not including post-operative plastic and reconstructive surgery) • Uvulo-palatal pharyngoplasty (UPPP and LAUP) • X-rays performed by chiropractors
Termination of Bonitas membership
Benefits & Process Guides
Benefits & Process Guides
• Surgical periodontics which includes gingivectomies, periodontal flap surgery tissue grafting and the hemisection of a tooth • The cost of dental materials for procedures performed under general anaesthesia • The cost of gold, precious metal, semi-precious metal and platinum foil • The metal base to full dentures and associated laboratory costs • The polishing of restorations • Where the only reason for admission to hospital is dental fear and anxiety • Where the only reason for the admission request is for a sterile facility
Notes
Your membership will be terminated if you no longer pay your contributions. You may also leave Bonitas after giving one calendar month’s written notice. If you leave Bonitas and join a Scheme with a savings account, the full amount available in your savings account will be transferred to that of your new Scheme. This will take place after a waiting period of five months. If you do not join another medical Scheme, or if the medical Scheme you are joining does not have a savings account, the full balance in your savings account will be paid to you. Please note: Your refund is taxable and must be declared in your annual income tax return. If you leave Bonitas during the year, the savings amount due to you will be pro-rated according to the number of months you were a member of Bonitas. If claims at that stage exceed the pro-rated value, you will have to pay the shortfall.
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Benefits & Process Guides
Benefits & Process Guides
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Notes Notes
How-To Guide Use these helpful tips on how to get the most out of your Bonitas medical aid membership.
2. Check your account and receipt
Do you have a question for us?
Make sure that your membership number is clearly indicated on both the account and the receipt.
Contact the call centre on 0860 002 108 or email
[email protected]. Please include your membership number in all correspondence with us. How To: Change your personal details You must let us know if any of your details change within 30 days of the change. This includes changes to: • Your marital status • Dependants on your medical aid • Your contact details
• • • • • • •
Your name and initials Your medical aid number The treatment date The name of the patient as shown on your membership card The amount charged The tariff The ICD-10 code
Please check that prescriptions for medicine show all your details. Also check that the correct amount of medicine dispensed is shown on the claim. If the pharmacy omits any of these details, we will not be able to process your claim. 3. Send us a copy of the account and receipt
Change your banking details
Please post all claims to:
If your banking details change, please let us know immediately. If your medical aid is a deduction on your salary you will also need to inform your employer’s payroll department immediately. You will need to send us your latest bank statement and a copy of your ID to validate the change.
Bonitas Claims Department PO Box 74 Vereeniging, 1930
Submit claims in 4 easy steps
How-To Guide
Simply contact the call centre on 0860 002 108 or email the changes through to
[email protected]
Please ensure that your account shows the following:
Or email:
[email protected]
Submit your claims
4. Check that your claim has been paid
You must send us your claims within four months of receiving treatment or they will not be paid. Submit claims quickly and easily by following these simple steps.
We pay claims weekly. A statement will be sent to you, by post or email at the end of the month showing your claims. You can also log in to the website to view the status of your claims.
1. Ensure your bank details are correct Claims refunds are only paid into a bank account via electronic transfers. Please contact the call centre on 0860 002 108 if you need to update your banking details.
Report fraud Fraudulent use of membership cards (I.e. letting other people use your membership card) is illegal. It results in increased costs that affect all members. Phone our toll-free fraud hotline on 0860 002 108 to report cases of fraud or abuse of Bonitas.
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How-To Guide
Notes
Use the Bonitas website
How-To Guide
How-To Guide
If you have internet access, you will be able to log into a secure area to view your statements, claims history, monthly contribution, personal information and much more. You will also be able to view your benefits and update certain personal details. Visit www.bonitas.co.za and follow the steps to register.
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Visit one of our walk-in centres Resolve queries; get a new membership card and so much more at our walk-in centres.
Pretoria
Northam
Port Elizabeth
Kathu
Ground Floor, Benstra Building,473B Church Street, Arcadia, Pretoria
180 Botha Street, Northam
Block 6, Greenacres Office Park, 2nd Avenue, Newton Park, Port Elizabeth
6 Rietbok Street, Kathu, Northern Cape
Vereeniging
Bloemfontein
Roodepoort
Polokwane
36 Merriman Avenue, Ground Floor, Vereeniging
Shop C7, 1st Floor, Middestad Centre, c/o Charles and West Burger Street,Bloemfontein
37 Conrad Road, Florida North, Roodepoort
Ground Floor, Bonitas House, 22 Hans van Rensburg Street, Polokwane
Secunda
Rustenburg
Lephalale
Cape Town
Grand Palace, Unit 82, 2302 Heinis Street, Secunda
141 Fatima Bhayat Street,Rustenburg
Onverwacht Business, Mienie Building, Block C, Walter Sisulu Avenue, Lephalale
The Icon Building, Ground Floor, Corner Lower Long Street andHans Strydom Avenue,Cape Town
Durban 3rd Floor, 67 Old Fort Road, Durban
CONTACT
Call our customer service team on 0860 002 108 Available between 08:30am and 4:00pm, Monday to Friday the Bonitas Call Centre is here to help you with everything you need. You can:
• • • •
Visit us online Visit our website at to learn more about our products. You can also join us on Facebook and get health tips, benefit information and much more. www.bonitas.co.za I www.facebook.co.za/BonitasMedicalFund
Get hospital and specialised radiology authorisation Authorise chronic medicine Get a tax certificate Resolve queries Page 80
