2016 Bonitas Product Comparison

Transcription

2016 Bonitas Product Comparison
2016
BONITAS
BonComprehensive
2016
BONITAS
BonClassic
2016
BONITAS
Standard
2016
BONITAS
Standard Select
2016
BONITAS
BonSave
2016
BONITAS
Primary
2016
BONITAS
BonFit
2016
BONITAS
BonEssential
Main Member: R4 696
Adult Dependant: R4 428
Child Dependant: R956
(Your Fourth and Subsequent Children Will Be
Covered Free of Charge)
Main Member: R3 260
Adult Dependant: R2 799
Child Dependant: R805
(Your Fourth and Subsequent Children Will Be
Covered Free of Charge)
Main Member: R2 683
Adult Dependant: R2 321
Child Dependant: R784
(Your Fourth and Subsequent Children Will Be
Covered Free of Charge)
Main Member: R2 321
Adult Dependant: R2 007
Child Dependant: R678
(Your Fourth and Subsequent Children Will Be
Covered Free of Charge)
Main Member: R1 908
Adult Dependant: R1 478
Child Dependant: R572
(Your Fourth and Subsequent Children Will Be
Covered Free of Charge)
Main Member: R1 719
Adult Dependant: R1 345
Child Dependant: R548
(Your Fourth and Subsequent Children Will Be
Covered Free of Charge)
Main Member: R1 598
Adult Dependant: R1 238
Child Dependant: R479
(Your Fourth and Subsequent Children Will Be
Covered Free of Charge)
Main Member: R1 316
Adult Dependant: R1 007
Child Dependant: R386
(Your Fourth and Subsequent Children Will Be
Covered Free of Charge)
Unlimited, Paid at 300% Bonitas Rates
Unlimited, Paid at 100% Bonitas Rates
Unlimited, Paid at 100% Bonitas Rates
Unlimited at Network Hospitals, Paid at 100%
Bonitas Rates
Unlimited, Paid at 150% Bonitas Rate
Unlimited, Paid at 100% Bonitas Rates
Unlimited at Network Hospitals, Paid at 100%
Bonitas Rates
Unlimited, Paid at 100% Bonitas Rates
Principal: R10 632
Adult: R10 020
Child: R2 172
"Annual Savings (14%)
Principal: R5 532
Annual Savings (4%) allocated to use prior to
the Risk Benefits for Acute Medication; GP
and Specialist Consultations; Radiology and
Pathology.
Annual Savings:
Principal: R1 212
Adult: R1 056
Child: R360
Annual Savings (4%) allocated to use prior to
the Risk Benefits for Acute Medication; GP
and Specialist Consultations; Radiology and
Pathology.
Annual Savings:
Principal: R1 056
Adult: R900
Child: R300
Annual Savings (16%)
Principal: R3 672
Adult: R2 844
Child: R1 104
N/A
Annual Savings (15%)
Principal: R2 880
Adult: R2 232
Child: R864
N/A
N/A
N/A
Limited to:
M: R4 020
M + 1: R6 140
M + 2: R6 590
M + 3: R7 110
M + 4: R7 600
Limited to:
M: R4 020
M + 1: R6 140
M + 2: R6 590
M + 3: R7 110
M + 4: R7 600
N/A
Limited to:
M: R1 800
M + 1: R3 250
M + 2: R3 800
M + 3: R4 100
M + 4: R4 450
N/A
N/A
SELF PAYMENT GAP (SPG)
Principal: R3 428
Adult: R2 840
Child: R1 308
N/A
N/A
N/A
N/A
N/A
N/A
N/A
THRESHOLD LEVEL
Principal: R14 060
Adult: R12 860
Child: R3 480
N/A
N/A
N/A
N/A
N/A
N/A
N/A
MONTHLY CONTRIBUTIONS
OVERALL ANNUAL
LIMIT (OAL)
MEDICAL SAVINGS ACCOUNT (MSA)
DAY-TO-DAY BENEFIT
ABOVE THRESHOLD BENEFIT (ATB)
CO-PAYMENTS FOR PROCEDURES
Unlimited
N/A
N/A
N/A
N/A
N/A
N/A
N/A
None
None
None
None
Subject to Deductibles for Certain Procedures
Ranging from R1050 to R2650 and R5250
Subject to Deductibles for Certain Procedures
Ranging from R1050 to R2650 and R5250
Subject to Deductibles for Certain Procedures
Ranging from R1050 to R2650 and R5250
Subject to Deductibles for Certain Procedures
Ranging from R1050 to R2650 and R5250
Limited to R14 200 pfpa
Limited to R14 200 pfpa
Limited to R14 200 pfpa
Limited to R14 200 pfpa
Limited to R14 200 pfpa
Limited to R14 200 pfpa
Limited to R14 200 pfpa
HOSPITALISATION
ALTERNATIVES TO HOSPITALISATION
PHYSICAL REHABILITATION
GP CONSULTATIONS
SPECIALIST CONSULTATIONS
GENERAL RADIOLOGY
Limited to R14 200 pfpa
Limited to R42 500 pfpa
Limited to R42 500 pfpa
Limited to R42 500 pfpa
Limited to R42 500 pfpa
Limited to R42 500 pfpa
Limited to R42 500 pfpa
Limited to R42 500 pfpa
Limited to R42 500 pfpa
Unlimited, Network GP's: Paid at 130% Bonitas Rates.
Non-Network GP's: Paid at 100% Bonitas Rates
Unlimited, Network GP's: Paid at 130% Bonitas Rates.
Non-Network GP's: Paid at 100% Bonitas Rates
Unlimited, Network GP's: Paid at 130% Bonitas Rates.
Non-Network GP's: Paid at 100% Bonitas Rates
Unlimited, Network GP's: Paid at 130% Bonitas Rates.
Non-Network GP's: Paid at 100% Bonitas Rates
Unlimited, Network GP's: Paid at 130% Bonitas Rates.
Non-Network GP's: Paid at 100% Bonitas Rates
Unlimited, Network GP's: Paid at 130% Bonitas Rates.
Non-Network GP's: Paid at 100% Bonitas Rates
Unlimited, Network GP's: Paid at 130% Bonitas Rates.
Non-Network GP's: Paid at 100% Bonitas Rates
Unlimited, Network GP's: Paid at 130% Bonitas Rates.
Non-Network GP's: Paid at 100% Bonitas Rates
Unlimited, Network Specialists: Paid at 130% Bonitas Unlimited, Network Specialists: Paid at 130% Bonitas Unlimited, Network Specialists: Paid at 130% Bonitas Unlimited, Network Specialists: Paid at 130% Bonitas Unlimited, Network Specialists: Paid at 130% Bonitas Unlimited, Network Specialists: Paid at 130% Bonitas Unlimited, Network Specialists: Paid at 130% Bonitas Unlimited, Network Specialists: Paid at 130% Bonitas
Rates. Non-Network Specialists: Paid at 100%
Rates. Non-Network Specialists: Paid at 100%
Rates. Non-Network Specialists: Paid at 100%
Rates. Non-Network Specialists: Paid at 100%
Rates. Non-Network Specialists: Paid at 100%
Rates. Non-Network Specialists: Paid at 100%
Rates. Non-Network Specialists: Paid at 100%
Rates. Non-Network Specialists: Paid at 100%
Bonitas Rates
Bonitas Rates
Bonitas Rates
Bonitas Rates
Bonitas Rates
Bonitas Rates
Bonitas Rates
Bonitas Rates
Unlimited, Paid at 100% Bonitas Rates
Unlimited, Paid at 100% Bonitas Rates
Unlimited, Paid at 100% Bonitas Rates
Unlimited, Paid at 100% Bonitas Rates
Unlimited, Paid at 100% Bonitas Rates
Unlimited, Paid at 100% Bonitas Rates
Unlimited, Paid at 100% Bonitas Rates
Unlimited, Paid at 100% Bonitas Rates
Unlimited, Subject to Pre-Authorisation
Limited to R24 850 pfpa In and Out of Hospital
Unlimited In Hospital,
Subject to Pre-Authorisation
Unlimited In Hospital,
Subject to Pre-Authorisation
Unlimited In Hospital, Paid at 100% Bonitas
Rates. Subject to Pre-Authorisation
R11 150 pfpa (In & Out of Hospital)
Unlimited, Subject to Pre-Authorisation
Unlimited, Subject to Pre-Authorisation
PATHOLOGY
Unlimited, Paid at 100% Bonitas Rates
Unlimited, Paid at 100% Bonitas Rates
Unlimited, Paid at 100% Bonitas Rates
Unlimited, Paid at 100% Bonitas Rates
Unlimited, Paid at 100% Bonitas Rates
Unlimited, Paid at 100% Bonitas Rates
Unlimited, Paid at 100% Bonitas Rates
Unlimited, Paid at 100% Bonitas Rates
ALLIED PROFESSIONALS
Unlimited, Paid at 100% Bonitas Rates
Unlimited, Paid at 100% Bonitas Rates
Unlimited, Paid at 100% Bonitas Rates
Unlimited, Paid at 100% Bonitas Rates
Unlimited, Paid at 100% Bonitas Rates
Unlimited, Paid at 100% Bonitas Rates
Unlimited, Paid at 100% Bonitas Rates
Unlimited, Paid at 100% Bonitas Rates
SPECIALISED PROCEDURES
Cochlear Implants: Limited to R250 000 pfpa.
Internal Nerve Stimulators: Limited to R142 000
pfpa
Cochlear Implants Limited to R250 000 pfpa
Cochlear Implants: Limited to R250 000 pfpa.
Internal Nerve Stimulators: Limited to R142 000
pfpa
Cochlear Implants: Limited to R250 000 pfpa.
Internal Nerve Stimulators: Limited to R142 000
pfpa
N/A
N/A
N/A
N/A
PROSTHESES
Internal Prostheses: Limited to R47 250 pfpa.
External Prostheses: Limited to R47 250 pfpa
Internal and External Prostheses:
Limited to R46 800 pfpa
Internal and External Prostheses:
Limited to R37 900 pfpa
Internal and External Prostheses:
Limited to R37 900 pfpa. Hip and Knee
Replacements Only at ICPS
PMB's Only
PMB's Only
PMB's Only
PMB's Only
MATERNITY CONFINEMENT
Unlimited Hospitalisation, Private Ward after
Delivery
Unlimited, Subject to Pre-Authorisation
Unlimited, Subject to Pre-Authorisation
Unlimited, Subject to Pre-Authorisation
Unlimited, Subject to Pre-Authorisation
Unlimited, Subject to Pre-Authorisation
Unlimited, Subject to Pre-Authorisation
Unlimited, Subject to Pre-Authorisation
R40 200 pfpa. Up to R13 600 pfpa Can Be Used
for Out Of Hospital Consultations
Limited to R35 350 pfpa, Sub-limit of R13 600
pfpa for Consultations In and Out of Hospital
Limited to R34 800 pfpa, Sub-Limit of R13 600
pfpa for Consultations In and Out of Hospital
Limited to R34 800 pfpa, Sub-Limit of R13 600
pfpa for Consultations In and Out of Hospital
Limited to R27 650 pfpa, Sub-Limit of R13 600
pfpa for Consultations In and Out of Hospital
Limited to R13 550 pfpa, Sub-Limit of R8 200
pfpa for Consultations In and Out of Hospital
Limited to R27 650 pfpa In Hospital Only
Limited to R27 650 pfpa In Hospital Only
R470 per Beneficiary per Admission
R400 per Beneficiary per Admission
R400 per Beneficiary per Admission
R400 per Beneficiary per Admission
R325 per Beneficiary per Admission
R325 per Beneficiary per Admission
R325 per Beneficiary per Admission
R325 per Beneficiary per Admission
Paid From Available Savings and/or Threshold
Benefit
Paid from Available Savings
Subject to Available Savings and Day to Day Limit
Subject to Available Savings and Day to Day Limit
Subject to Available Savings
Paid from Available Day to Day Benefit
Paid From Available Savings
No Benefit
SPECIALISED RADIOLOGY:
MRI & CT SCANS
MENTAL HEALTH
TAKE HOME MEDICATION
CASUALTY AND EMERGENCY
CONSULTATIONS
EMERGENCY ASSISTANCE
ONCOLOGY
RENAL DIALYSIS
ORGAN TRANSPLANTS
ER24
ER24
ER24
ER24
ER24
ER24
ER24
ER24
Limited to R530 200 pfpa. Biological Drugs:
Limited to R210 400 pfpa
Limited to R351 900 pfpa. Biological Drugs:
Limited to R105 200 pfpa
(10% co-payment applies)
Limited to R295 400 pfpa
Limited to R295 400 pfpa
Limited to R295 400 pfpa
Limited to R142 000 pfpa
Limited to R295 400 pfpa
Limited to R295 400 pfpa
Unlimited
Unlimited, Paid at 100% Bonitas Rates
Unlimited, Paid at 100% Bonitas Rates
Unlimited, Paid at 100% Bonitas Rates
PMB's Only
PMB's Only
PMB's Only
PMB's Only
Unlimited
Unlimited, Paid at 100% Bonitas Rates
Unlimited, Paid at 100% Bonitas Rates
Unlimited, Paid at 100% Bonitas Rates
Unlimited
PMB's Only
Unlimited, Subject to Pre-Authorisation
Unlimited, Subject to Managed Care Protocols
Unlimited, Subject to Registration on
Aid for AIDS (AfA) Programme
Unlimited, Subject to Registration on
Aid for AIDS (AfA) Programme
R27 800 pbpa if Registered on Aid for
AIDS (AfA) Programme
R27 800 pbpa if Registered on Aid for
AIDS (AfA) Programme
R27 650 pbpa If Registered on Aid for
AIDS (AfA) Programme
R21 250 pbpa If Registered on
Aid for AIDS (AfA) Programme.
Limited to R27 650 pbpa If Registered on Aid for
AIDS (AfA) Programme
Limited to R27 650 pbpa If Registered on Aid for
AIDS (AfA) Programme
GP CONSULTATIONS
Paid From Available Savings and/or
Threshold Benefit
Paid from Available Savings
Paid from Available Savings
Network GP:
M: R1 700
M +1: R3 150
M + 2: R3 700
M + 3: R4 000
M + 4 +: R4 500
of Which only the Following Values Can be Used
at a Non-Network GP:
M: R560
M + 1: R1 050
M + 2: R1 200
M + 3: R1 350
M + 4 +: R1 550
Paid From Available Savings
No Benefit
SPECIALIST CONSULTATIONS
Paid From Available Savings and/or
Threshold Benefit
Paid from Available Savings
Paid from Available Savings,
Then Covered From Day to Day Benefit
Paid from Available Savings,
Then Covered From Day to Day Benefit
Paid from Available Savings
Paid From Available Day to Day Benefit
Paid From Available Savings
No Benefit
ACUTE MEDICATION
Paid From Available Savings and/or
Threshold Benefit
Paid from Available Savings
Paid from Available Savings,
Then Covered From Day to Day Benefit
Paid from Available Savings,
Then Covered From Day to Day Benefit
Paid from Available Savings
Paid from available Day to Day Benefit.
Over the Counter Medication:
Sub-limit of R420 pbpa or R1 230 pfpa
Paid From Available Savings
No Benefit
GENERAL RADIOLOGY
Paid From Available Savings and/or
Threshold Benefit
Limited to R2 680 pbpa, and R4 130 pfpa
Paid from Available Savings, Then Covered From
Day to Day Benefit
Paid from Available Savings, Then Covered From
Day to Day Benefit
Paid from Available Savings
Paid From Available Day to Day Benefit
Paid From Available Savings
No Benefit
Limited to R26 850 pfpa,
Subject to Pre-Authorisation
Limited to R24 850 pfpa In and Out of Hospital
Limited to R22 400 pfpa Out of Hospital,
Subject to Pre-Authorisation
Limited to R22 400 pfpa Out of Hospital,
Subject to Pre-Authorisation
Limited to R20 000 pfpa.
Subject to Pre-Authorisation
R11 150 pfpa (In & Out of Hospital)
Paid From Available Savings
No Benefit
Paid From Available Savings and/or
Threshold Benefit
Limited to R2 680 pbpa and R5 890 pfpa
Paid from Available Savings,
Then Covered From Day to Day Benefit
Paid from Available Savings,
Then Covered From Day to Day Benefit
Paid from Available Savings
Paid From Available Day to Day Benefit
Paid From Available Savings
No Benefit
HIV/AIDS
DAY-TO-DAY BENEFITS
SPECIALISED RADIOLOGY: MRI & CT
SCANS
PATHOLOGY
GP Consultations Paid from GP Benefit:
GP Consultations Paid from GP Benefit:
Network GP:
Network GP:
M: R3 580
M: R3 580
M + 1: R5 260
M M + 1: R5 260
M
+ 2: R5 790
+ 2: R5 790
M + 3: R6 100
M + 3: R6 100
M + 4 +: R6 630
M + 4 +: R6 630
of Which only the Following Values Can be Used of Which only the Following Values Can be Used
at a Non-Network GP:
at a Non-Network GP:
M: R1 160
M: R1 160
M + 1: R1 790
M + 1: R1 790
M + 2: R1 950
M + 2: R1 950
M + 3: R2 050
M + 3: R2 050
M + 4 +: R2 210
M + 4 +: R2 210
2016
BONITAS
BonComprehensive
2016
BONITAS
BonClassic
2016
BONITAS
Standard
2016
BONITAS
Standard Select
2016
BONITAS
BonSave
2016
BONITAS
Primary
2016
BONITAS
BonFit
2016
BONITAS
BonEssential
Paid From Available Savings and/or Threshold
Benefit
M: R2 550
M + 1: R3 900
M + 2: R4 500
M + 3: R4 800
M + 4 +: R5 150
Paid from Available Savings, Then Covered From Day
to Day Benefit
Paid from Available Savings, Then Covered From Day
to Day Benefit
Paid from Available Savings
Paid From Available Day to Day Benefit
Paid From Available Savings
No Benefit
General Appliances: R7 550 pfpa, Stoma Products and
CPAP: May exceed annual General Limit by R5 300.
Hearing Aids: Limited to R22 100 per family every
2 years (10% co-payment applies). Foot Orthotics:
Limited to R3 900 pbpa (10% co-payment applies).
General Appliances: Limited to R7 000 pfpa. Hearing
Aids: Limited to R14 500 pf every 3 years(10% CoPayment Applies) . Foot Orthotics: Limited to R3 900
pbpa (10% Co-Payment Applies). CPAP Machines and
Stoma Products: Included in General Appliances Limit
General Appliances: R6 900 pfpa, Stoma Products and
CPAP: May exceed annual General Limit by R5 600.
Hearing Aids: Limited to R13 700 per family every
2 years (10% co-payment applies). Foot Orthotics:
Limited to R3 900 pbpa (10% co-payment applies).
General Appliances: R6 900 pfpa, Stoma Products and
CPAP: May exceed annual General Limit by R5 600.
Hearing Aids: Limited to R13 700 per family every
2 years (10% co-payment applies). Foot Orthotics:
Limited to R3 900 pbpa (10% co-payment applies).
General Appliances: Limited to R6 200 pfpa, Stoma
Products and CPAP: May Exceed Annual General Limit
by R5 600. Foot Orthotics: Limited to R3 900 pbpa
(10% co-payment applies)
General Appliances: Limited to R6 200 pfpa, Stoma
Products and CPAP: May Exceed Annual General Limit by
R5 600. Hearing Aids: Limited to R7 800 per Family Once
every 2 years (10% co-payment applies). Foot Orthotics:
Limited to R3 900 pbpa (10% co-payment applies)
Paid From Available Savings
No Benefit
BASIC DENTISTRY
Paid From Available Savings and/or Threshold
Benefit
Limited to R4 000 pfpa
Subject to DENIS Clinical Protocols and Bonitas rate
Subject to DENIS Clinical Protocols and Bonitas rate
Subject to DENIS Clinical Protocols and Bonitas Rate
Subject to DENIS Clinical Protocols and Bonitas Rate
Paid From Available Savings
No Benefit
SPECIALISED DENTISTRY
Paid From Available Savings and/or Threshold
Benefit
Limited to R4 800 pfpa
Subject to DENIS Clinical Protocols and Bonitas rate
Subject to DENIS Clinical Protocols and Bonitas rate
No Benefit
No Benefit
No Benefit
No Benefit
OPTICAL LIMIT
Limited to R2 740 pbpa, Paid From Available Savings
and/or Threshold Benefit
Limited to R5 060 pf Every 2 Years
Limited to R5 270 pf Every 2 Years
Limited to R5 270 pf Every 2 Years
Paid from Available Savings
Limited to R4 270 pf Every 2 Years
Paid From Available Savings
No Benefit
MATERNITY PROGRAMME BENEFITS
Consultations: 12 xAnte-Natal Consultations.
Scans: 2 x 2D Scans per Pregnancy.
Ante-Natal Classes: Limited to R1 100 per Pregnancy.
Post-Natal Consultations: 4 x Consultations With a
Midwife. Tests: 1 x Amniocentesis per Pregnancy
Consultations: 12 x Ante-Natal Consultations.
Scans: 2 x 2D Scans per Pregnancy.
Ante-Natal Classes: Limited to R1 100 per Pregnancy.
Post-Natal Consultations: 4 x Consultations With a
Midwife. Tests: 1 x Amniocentesis per Pregnancy
Consultations: 12 x Ante-Natal Consultations.
Scans: 2 x 2D Scans per Pregnancy.
Ante-Natal Classes: Limited to 1 050 per Pregnancy.
Post-Natal Consultations: 4 x Consultations With a
Midwife. Tests: 1 x Amniocentesis per Pregnancy
Consultations: 12 x Ante-Natal Consultations.
Scans: 2 x 2D Scans per Pregnancy.
Ante-Natal Classes: Limited to 1 050 per Pregnancy.
Post-Natal Consultations: 4 x Consultations With a
Midwife. Tests: 1 x Amniocentesis per Pregnancy
Consultations: 6 x Ante-Natal Consultations.
Scans: 2 x 2D Scans per Pregnancy.
Ante-Natal Classes: Limited to 1 050 per Pregnancy.
Post-Natal Consultations: 4 x Consultations With a
Midwife. Tests: 1 x Amniocentesis per Pregnancy
Consultations: 6 x Ante-Natal Consultations.
Scans: 2 x 2D Scans per Pregnancy.
Post-Natal Consultations: 4 x Consultations With a
Midwife. Tests: 1 x Amniocentesis per Pregnancy
Consultations: 6 x Ante-Natal Consultations.
Scans: 2 x 2D Scans per Pregnancy.
Post-Natal Consultations: 4 x Consultations With a
Midwife. Tests: 1 x Amniocentesis per Pregnancy
Consultations: 6 x Ante-Natal Consultations.
Scans: 2 x 2D Scans per Pregnancy.
Post-Natal Consultations: 4 x Consultations With a
Midwife. Tests: 1 x Amniocentesis per Pregnancy
ALLIED PROFESSIONALS
GENERAL MEDICAL APPLIANCES
PREVENTATIVE CARE
PREVENTATIVE CARE BENEFIT
General Health: 1 HIV Test pbpa. Women's Health: 1
Mammogram every 2 years Between Ages 50 - 74
years, 1 Pap Smear every 3 years Between ages
21 - 65 years. Men's Health: PSA Test Approved
for Men Aged 55 to 69 Considered to be at High
Risk. Cardiac Health: 1 Full Lipogram every 5 years
pb . Elderly Health: 1 Pneumococcal Vaccination
above age 65 years & 1 Faecal Occult Blood Test
pbpa Between ages 50 - 75, 1 Bone Densitometry
Screening Test for Females > 65 years. Children's
Health: 1 TSH Test for Infants Below 1 month
General Health: 1 HIV Test pbpa.
Women's Health: 1 Mammogram every 2 years
Between Ages 50 - 74 years, 1 Pap Smear every 3
years Between ages 21 - 65 years.
Cardiac Health: 1 Full Lipogram every 5 years pb.
Elderly Health: 1 Pneumococcal Vaccination above
age 65 years & 1 Faecal Occult Blood Test pbpa
Between ages 50 - 75, 1 Bone Densitometry
Screening Test for Females > 65 years.
General Health: 1 HIV Test pbpa.
Women's Health: 1 Mammogram every 2 years
Between Ages 50 - 74 years, 1 Pap Smear every 3
years Between ages 21 - 65 years.
Cardiac Health: 1 Full Lipogram every 5 years pb .
Elderly Health: 1 Pneumococcal Vaccination above
age 65 years & 1 Faecal Occult Blood Test pbpa
Between ages 50 - 75
General Health: 1 HIV Test pbpa.
Women's Health: 1 Mammogram every 2 years
Between Ages 50 - 74 years, 1 Pap Smear every 3
years Between ages 21 - 65 years.
Cardiac Health: 1 Full Lipogram every 5 years pb.
Elderly Health: 1 Pneumococcal Vaccination above
age 65 years & 1 Faecal Occult Blood Test pbpa
Between ages 50 - 75, 1 Bone Densitometry
Screening Test for Females > 65 years.
General Health: 1 x HIV Test pbpa.
Women's Health: 1 Pap Smear every 3 years Between
ages 21 and 65 years.
Elderly Health: 1 Pneumococcal Vaccination above
age 65 years & 1 Faecal Occult Blood Test pbpa
Between ages 50 - 75
General Health: 1 x HIV Test pbpa.
Women's Health: 1 Pap Smear every 3 years Between
ages 21 and 65 years.
Elderly Health: 1 Pneumococcal Vaccination above
age 65 years & 1 Faecal Occult Blood Test pbpa
Between ages 50 - 75
General Health: 1 x HIV Test pbpa.
Women's Health:1 Pap Smear every 3 years Between
ages 21 and 65 years.
Elderly Health: 1 Pneumococcal Vaccination above
age 65 years & 1 Faecal Occult Blood Test pbpa
Between ages 50 - 75
General Health: 1 HIV Test pbpa.
Elderly Health: 1 Faecal Occult Blood Test pbpa
Between ages 50 - 75
Annual Wellness Check Provided. Must be Done by
a Registered Provider and Includes, Blood Pressure
Test, Glucose Test, Cholesterol Test, a BMI Test and a
Waist to Hip Ratio Measurement
Annual Wellness Check Provided. Must be Done by
a Registered Provider and Includes, Blood Pressure
Test, Glucose Test, Cholesterol Test, a BMI Test and a
Waist to Hip Ratio Measurement
Annual Wellness Check Provided. Must be Done by
a Registered Provider and Includes, Blood Pressure
Test, Glucose Test, Cholesterol Test, a BMI Test and a
Waist to Hip Ratio Measurement
Annual Wellness Check Provided. Must be Done by
a Registered Provider and Includes, Blood Pressure
Test, Glucose Test, Cholesterol Test, a BMI Test and a
Waist to Hip Ratio Measurement
Annual Wellness Check Provided. Must be Done by
a Registered Provider and Includes, Blood Pressure
Test, Glucose Test, Cholesterol Test, a BMI Test and a
Waist to Hip Ratio Measurement
Annual Wellness Check Provided. Must be Done by
a Registered Provider and Includes, Blood Pressure
Test, Glucose Test, Cholesterol Test, a BMI Test and a
Waist to Hip Ratio Measurement
Annual Wellness Check Provided. Must be Done by
a Registered Provider and Includes, Blood Pressure
Test, Glucose Test, Cholesterol Test, a BMI Test and a
Waist to Hip Ratio Measurement
Annual Wellness Check Provided. Must be Done by
a Registered Provider and Includes, Blood Pressure
Test, Glucose Test, Cholesterol Test, a BMI Test and a
Waist to Hip Ratio Measurement
IMMUNISATION PROCEDURES
1 Flu Vaccine pbpa
1 Flu Vaccine pbpa
1 Flu Vaccine pbpa
1 Flu Vaccine pbpa
1 Flu Vaccine pbpa
1 Flu Vaccine pbpa
1 Flu Vaccine pbpa
1 Flu Vaccine pbpa
INFANT PAEDIATRIC BENEFIT
3 Paediatric Consultations per Child in 1st year and
2 Paediatric Consultations per Child for Children
Ages 1-2 years.
N/A
2 Consultations before the Age of 1, 2 Consultations
between the ages of 1 and 2 years per beneficiary
2 Consultations before the Age of 1, 2 Consultations
between the ages of 1 and 2 years per beneficiary
2 Consultations before the age of 1 pbpa, 1
Consultation between the ages of 1 and 2 years
pbpa
1 Consultation before the age of 1 pbpa, 1
Consultation between the ages of 1 and 2 years
pbpa
2 consultations before the age of 1 pbpa, 1
Consultation between the ages of 1 and 2 years
pbpa
N/A
CHILDHOOD ILLNESS BENEFIT
2 GP Consultations pbpa For Children Ages 2-12
years.
N/A
2 GP consultations pbpa between the ages of 2 and
12
2 GP consultations pbpa between the ages of 2 and
12
1 GP Consultation pbpa Between the ages of 2 and
12 years
1 GP Consultation pbpa Between the ages of 2 and
12 years
1 GP Consultation pbpa Between the ages of 2 and
12 years
1 GP Consultation pbpa Between the ages of 2 and
12 years
Limited to R2 000 pfpa.
Benefits to Choose From:
- GP Consultation
- Biokineticist Consultation
- Dietician Consultation
- Physio Consultation
- Wearable Devices (As Approved)
- Smoking Cessation Program (As Approved)
Limited to R1 400 pfpa.
Benefits to Choose From:
- GP Consultation
- Biokineticist Consultation
- Dietician Consultation
- Physio Consultation
- Wearable Devices (As Approved)
- Smoking Cessation Program (As Approved)
Limited to R1 400 pfpa.
Benefits to Choose From:
- GP Consultation
- Biokineticist Consultation
- Dietician Consultation
- Physio Consultation
- Wearable Devices (As Approved)
- Smoking Cessation Program (As Approved)
Limited to R1 400 pfpa.
Benefits to Choose From:
- GP Consultation
- Biokineticist Consultation
- Dietician Consultation
- Physio Consultation
- Wearable Devices (As Approved)
- Smoking Cessation Program (As Approved)
Limited to R1 000 pfpa.
Benefits to Choose From:
- GP Consultation
- Biokineticist Consultation
- Dietician Consultation
- Physio Consultation
- Wearable Devices (As Approved)
- Smoking Cessation Program (As Approved)
Limited to R1 000 pfpa.
Benefits to Choose From:
- GP Consultation
- Biokineticist Consultation
- Dietician Consultation
- Physio Consultation
- Wearable Devices (As Approved)
- Smoking Cessation Program (As Approved)
Limited to R1 000 pfpa.
Benefits to Choose From:
- GP Consultation
- Biokineticist Consultation
- Dietician Consultation
- Physio Consultation
- Wearable Devices (As Approved)
- Smoking Cessation Program (As Approved)
Limited to R700 pfpa.
Benefits to Choose From:
- GP Consultation
- Biokineticist Consultation
- Dietician Consultation
- Physio Consultation
- Wearable Devices (As Approved)
- Smoking Cessation Program (As Approved)
HEALTH AND WELLNESS ASSESSMENT
WELLNESS EXTENDER
CHRONIC DISEASE MANAGEMENT
CHRONIC MEDICATION LIMIT
NUMBER OF CHRONIC CONDITIONS
DSP FOR CHRONIC MEDICATION
BIOLOGICAL DRUGS
Non-PMB's: Limited to R11 850 pbpa and R23 600 pfpa.
PMB's: Unlimited at DSP
R9 700 pbpa, to a Maximum of R20 100 pfpa,
Thereafter PMB’s Unlimited. Formulary applies
Limited to R8 250 pbpa and R16 500 pfpa.
Thereafter PMB's Unlimited at DSP
Limited to R8 250 pbpa and R16 500 pfpa.
Thereafter PMB's Unlimited at DSP
Unlimited subject to Formulary and DSP
Unlimited subject to Formulary and DSP
Unlimited subject to Formulary and DSP
Unlimited subject to Formulary and DSP
60 Conditions
59 Conditions
44 Conditions
44 Conditions
27 PMB Conditions
27 PMB Conditions
27 PMB Conditions
27 PMB Conditions
Pharmacy Direct
Pharmacy Direct
(40% co-payment at non DSP)
Pharmacy Direct
(40% co-payment at non DSP)
Pharmacy Direct
(40% co-payment at non DSP)
Pharmacy Direct
(40% co-payment at non DSP)
Pharmacy Direct
(40% co-payment at non DSP)
Pharmacy Direct
(40% co-payment at non DSP)
Pharmacy Direct
(40% co-payment at non DSP)
R210 400 pfpa for Oncology Related Treatment and
R168 300 pfpa for Non-Oncology Related Treatment
R105 200 pfpa for Oncology Related Treatment
(10% Co-Payment Applies)
N/A
N/A
N/A
N/A
N/A
N/A
BONITAS PRODUCT COMPARISON 2016
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.
Product Comparison 2016
Bonitas Medical Fund I 0860 002 108 I www.bonitas.co.za