GP and specialist consultations
(Network doctors covered in full at the Bonitas Rate)
Unlimited at 100% of the Bonitas Rate
Blood tests and x-rays
Unlimited at 100% of the Bonitas Rate
MRIs and CT
scans
R30 370 per family (In and out-of-hospital) (R1 660 co-payment per scan, except PMB)
Internal and external
prostheses
R51 440 per family (Sublimit of R6 120 per breast prosthesis (limited to 2 per year))
Internal nerve
stimulators
R192 600 per family
Cochlear
implants
PMB only
Mental health
hospitalisation
R46 320 per family
Sublimit of hospitalisation for mental health
consultations per family
(In or out-of-hospital)
R18 130 per family
Take-home
medicine
Limited to a 7-day supply up to R540 per hospital stay
Physical
rehabilitation
R57 730 per family
Alternatives to hospital
(Hospice, step-down facilities)
R19 250 per family
Terminal
care
Unlimited for oncology
Cancer treatment
Unlimited for PMBs, R250 000 per family for non-PMBs (30% co-payment applies for use of a non-network provider)
Non-cancer specialised
drugs
(Including biological drugs)
PMB only
Kidney
dialysis
Unlimited at a DSP or 20% co-payment applies at a non-DSP
Organ
transplants
Unlimited
HIV/AIDS
Unlimited, if you register on the HIV/AIDS programme
Co-payments for certain procedures
(Refer to product brochure for details)
Co-payment applies for non-ICPS hip and knee replacements. Co-payment for cataract surgery at non-DSP
Overall day-to-day
limit
*Ranges from R12 000 - R22 000
GP
consultations
Paid from available GP & specialist consultations sublimit. *Ranges from R3 000 - R6 000
Specialist
consultations
Paid from available GP & specialist consultations sublimit. *Ranges from R3 000 - R6 000
X-rays and
ultrasounds
Paid from available X-rays and blood tests sublimit. *Ranges from R3 000 - R6 000
Blood
tests
Paid from available X-rays and blood tests sublimit. *Ranges from R3 000 - R6 000
Acute
medicine
Paid from available acute and over-the-counter medicine sublimit. *Ranges from R3 000 - R6 000
Over-the-counter
medicine
Paid from available acute and over-the-counter medicine sublimit. Limited to R800 per beneficiary, R2 500 per family
Paramedical/Allied medical professionals
(Such as occupational therapists and dieticians)
Paid from available auxiliary services sublimit. *Ranges from R3 000 - R6 000
General medical
appliances
Subject to the available overall day-to-day limit
Hearing
aids
R8 930 per family every 5 years (20% co-payment will apply). Once limit is reached, the balance is subject to the available overall day-to-day limit
Optometry
(Once every 2 years)
R7 035 per family, every 2 years
Basic dentistry
(Subject to dental management protocols)
Covered at the Bonitas Dental Tariff, subject to the Bonitas Dental Management Programme
Specialised dentistry
(Subject to dental management protocols)
Covered at the Bonitas Dental Tariff
Chronic benefits
(Subject to Managed Care Protocols)
45 chronic conditions. R11 180 per beneficiary, R22 440 per family. Unlimited for PMB, subject to use of DSP
Baby advice
line
For children under 3 years
Congenital hypothyroidism
screening
Infants under 1 month old
GP consultations
(Children between ages 2 and 12)
2
Hearing
screening
For newborns up to 8 weeks, in or out-of-hospital
Immunisations
According to the Expanded Programme on Immunisation in South Africa
Paediatric consultations
(Infants between ages 1 and 2)
2
Paediatric consultations
(Infants under the age of 1)
2
Flu vaccine per
beneficiary
1
HIV test per
beneficiary
1
Full lipogram
(Every 5 years, for members aged 20 and over)
1
Mammogram
(Every 2 years, women over 40)
1
Pap Smear
(Every 3 years, women between ages 21-65)
1
Pneumococcal vaccine
(Every 5 years, members aged 65 and over)
1
Prostate screening antigen
test
(Men between ages 45-69)
1
Stool test for colon cancer
(Members between ages 50-75)
1
Bone density screening
(Women aged 65 and men aged 70 and over)
0
Whooping cough booster
vaccine
(Every 10 years, members between 7-64)
1
Human Papillomavirus (HPV)
vaccines
(Girls between ages 9-14)
2
Wellness screening
(Benefit includes: GP and specialist consultations, Acute and over-the-counter medicine, Biokineticist and physiotherapist consultations and treatment, Paramedical services such as dietician, speech and occupational therapy consultations and treatment, Alternative healthcare such as homeopathic consultations and treatment and acupuncture, Non-surgical procedures and tests e.g. wart removal, X-rays, Blood tests)
R2 000 per family. Consultations and treatment paid at 100% of the Bonitas Rate. Subject to completion of an online wellness questionnaire or wellness screening
Wellness screening
(Blood pressure, glucose, cholesterol, body mass index and waist-to-hip ratio)
1 per beneficiary
