Boncap 2024 | Page 4

PHYSIOTHERAPY , PODIATRY AND BIOKINETICS PMB only
GENERAL MEDICAL APPLIANCES ( SUCH AS WHEELCHAIRS AND CRUTCHES )
R6 740 per family Subject to Managed Care protocols
OPTOMETRY
Glasses or contact lenses are available through the contracted service provider once every 2 years ( based on the date of your previous claim )
Managed Care protocols apply
EYE TESTS 1 composite consultation per beneficiary , at a network provider OR R380 per beneficiary for an eye examination , at a non-network provider
SINGLE VISION LENSES ( CLEAR ) OR 100 % towards the cost of lenses at network rates R215 per lens , per beneficiary , out of network
BIFOCAL LENSES ( CLEAR ) OR 100 % towards the cost of lenses at network rates R460 per lens , per beneficiary , out of network
MULTIFOCAL LENSES
100 % towards the cost of base lenses at a network provider , or limited to a maximum of R860 per designer lens , per beneficiary , in and out of network
FRAMES R260 per beneficiary at a network provider OR R195 per beneficiary at a non-network provider
CONTACT LENSES R1 255 per beneficiary
BASIC DENTISTRY
You must use a provider on the DENIS network
Managed Care protocols apply
Covered at the Bonitas Dental Tariff
CONSULTATIONS 1 consultation per beneficiary
EMERGENCY CONSULTATION 1 emergency consultation for sepsis per beneficiary
X-RAYS : INTRA-ORAL 4 X-rays per beneficiary
X-RAYS : EXTRA-ORAL
PMB only
SCALING AND POLISHING 1 scaling and polishing OR 1 polish per beneficiary
FLUORIDE TREATMENTS 1 treatment for beneficiaries from age 5 and younger than 16 years
FISSURE SEALANTS
INHALATION SEDATION IN DENTAL ROOMS ( LAUGHING GAS )
1 per tooth , once every 3 years for beneficiaries under 16 years
Inhalation sedation limited to extensive conservative dental treatment only
Managed Care protocols apply
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
4 BONCAP 2024 OUT-OF-HOSPITAL BENEFITS