IN-HOSPITAL BENEFITS
Hospitalisation is covered at 100 % of the BonCap Rate at all hospitals on the applicable network . You must get pre-authorisation for your hospital admission . You will have to pay a 30 % co-payment if you use a non-network hospital ( except for emergencies ) or if you do not get pre-authorisation within 48 hours of admission . Managed Care protocols apply .
GP CONSULTATIONS Unlimited , covered at 100 % of the BonCap Rate for BonCap network GPs Non-network GPs are covered at 70 % of the BonCap Rate
SPECIALIST CONSULTATIONS Unlimited , covered at 100 % of the BonCap Rate for BonCap specialists Non-network specialists are covered at 70 % of the BonCap Rate
BLOOD TESTS AND OTHER LABORATORY TESTS R29 690 per family except for PMB
BLOOD TRANSFUSIONS R21 570 per family except for PMB
X-RAYS AND ULTRASOUNDS Unlimited , covered at 100 % of the BonCap Rate
MRIs AND CT SCANS ( SPECIALISED RADIOLOGY )
R13 550 per family
R1 170 co-payment per scan event , except for PMB
Pre-authorisation required
CATARACT SURGERY
ALLIED MEDICAL PROFESSIONALS ( SUCH AS DIETICIAN , SPEECH AND OCCUPATIONAL THERAPIST )
PHYSIOTHERAPY , PODIATRY AND BIOKINETICS
INTERNAL AND EXTERNAL PROSTHESES
You must use a Designated Service Provider or a R7 050 co-payment will apply
PMB only , 30 % co-payment at non-DSP
PMB only , 30 % co-payment at non-DSP
PMB only at the DSP
Pre-authorisation required
Subject to referral by the treating practitioner
Subject to referral by the treating practitioner
Managed Care protocols apply
MENTAL HEALTH HOSPITALISATION ( ALSO SEE CARE PROGRAMMES PAGE 8 )
PMB only
You must use a Designated Service Provider or a 30 % co-payment will apply
No cover for physiotherapy for mental health admissions
NEONATAL CARE Limited to R52 960 per family , except for PMB
TAKE-HOME MEDICINE
Limited to a 7-day supply up to R445 per hospital stay
PHYSICAL REHABILITATION R57 890 per family Pre-authorisation required
All benefits and limits are per calendar year , unless otherwise stated . All claims are paid at the BonCap Rate , unless otherwise stated . Managed Care protocols apply . All benefits are approved by the Council for Medical Schemes . PMB = Prescribed Minimum Benefits DSP = Designated Service Provider
10 BONCAP 2024 IN-HOSPITAL BENEFITS