OUT-OF-HOSPITAL BENEFITS
These benefits cover your day-to-day medical expenses at 100 % of the BonCap Rate .
NETWORK GP CONSULTATIONS ( INCLUDING VIRTUAL CARE CONSULTATIONS )
Unlimited GP consultations , using a maximum of 2 nominated BonCap network GPs
Approval is required from the 8th GP consultation per beneficiary
NON-NETWORK GP CONSULTATIONS
1 out-of-network consultation per beneficiary Maximum of 2 consultations per family , limited to R400 per visit
30 % co-payment applies , unless PMB
EMERGENCY ROOM BENEFIT ( NEW ) ( FOR EMERGENCIES ONLY )
2 emergency consultations per family at a casualty ward or emergency room facility of a hospital
Benefit limited to emergencies only
Main member only R2 190
Main member + 1 dependant R3 650
GP-REFERRED ACUTE MEDICINE , X-RAYS AND BLOOD TESTS
Main member + 2 dependants R4 370
Main member + 3 dependants R4 770
Main member + 4 or more dependants R5 290
Subject to the applicable formularies , pharmacy and pathology networks For acute medicine and blood tests : 20 % co-payment applies at non-DSP
NETWORK SPECIALIST CONSULTATIONS ( THIS BENEFIT INCLUDES ACUTE MEDICINE , BLOOD TESTS , X-RAYS , MRIs AND CT SCANS )
Maximum of 3 visits limited to R3 710 per beneficiary
Subject to the BonCap Specialist network and referral from a BonCap network GP
Maximum of 5 visits limited to R5 510 per family
Pre-authorisation required ( including MRIs and CT scans )
NON-NETWORK SPECIALIST CONSULTATIONS PMB only
MATERNITY CARE ( ALSO SEE CARE PROGRAMMES PAGE 8 )
Antenatal consultations are subject to the GP consultation and specialist consultation benefits ( including 2 2D scans )
4 consultations with a midwife after delivery ( 1 of these can be used for a consultation with a lactation specialist )
OVER-THE-COUNTER MEDICINE
ALLIED MEDICAL PROFESSIONALS ( SUCH AS DIETICIAN , SPEECH AND OCCUPATIONAL THERAPIST )
Limited to R110 per event
Subject to the BonCap medicine formulary and Bonitas pharmacy network
PMB only
Maximum of R315 per beneficiary , per year
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
3 BONCAP 2024 OUT-OF-HOSPITAL BENEFITS