OUT-OF-HOSPITAL BENEFITS
These benefits provide cover for consultations with your GP or specialist , acute medicine , X-rays , blood tests and other out-of-hospital medical expenses . Please note : When you complete a wellness screening or online wellness questionnaire , you unlock the Benefit Booster which can be used to pay for out-of-hospital expenses first . See page 7 for more information .
MAIN MEMBER ADULT DEPENDANT CHILD DEPENDANT SAVINGS R11 412 R9 804 R2 820
GP CONSULTATIONS ( INCLUDING VIRTUAL CARE CONSULTATIONS )
Paid from available savings
SPECIALIST CONSULTATIONS Paid from available savings You must get a referral from your GP
EMERGENCY ROOM BENEFIT ( NEW ) ( FOR EMERGENCIES ONLY )
2 emergency consultations per family at a casualty ward or emergency room facility of a hospital
NON-SURGICAL PROCEDURES Limited to R6 260 per beneficiary Limited to R10 180 per family ACUTE MEDICINE OVER-THE-COUNTER MEDICINE HOMEOPATHIC MEDICINE
ALLIED MEDICAL PROFESSIONALS ( SUCH AS DIETICIAN , SPEECH AND OCCUPATIONAL THERAPIST )
PHYSIOTHERAPY , PODIATRY AND BIOKINETICS
GENERAL MEDICAL APPLIANCES ( SUCH AS WHEELCHAIRS AND CRUTCHES )
Paid from available savings Paid from available savings Paid from available savings
Paid from available savings
Paid from available savings
Paid from available savings
BLOOD TESTS AND X-RAYS R3 860 per beneficiary R8 540 per family
If it is not classified as an emergency , it will be paid from available savings
Subject to frequency limits as per Managed Care protocols
MRIs AND CT SCANS ( SPECIALISED RADIOLOGY )
MENTAL HEALTH CONSULTATIONS ( ALSO SEE CARE PROGRAMMES PAGE 10 )
INSULIN PUMP OR CONTINUOUS GLUCOSE MONITOR ( ALSO SEE CARE PROGRAMMES PAGE 10 )
R35 930 per family , in and out-of-hospital R2 660 co-payment per scan event except for PMB
In and out-of-hospital consultations ( included in the mental health hospitalisation benefit )
R85 000 per family every 5 years Limited to one device per type 1 diabetic for beneficiaries younger than 18
Pre-authorisation required
Limited to R19 310 per family Consumables limited to R85 000 per family
IN-ROOM PROCEDURES
AUDIOLOGY ( HEARING AIDS , CONSULTATIONS AND TESTS ) ( ALSO SEE CARE PROGRAMMES PAGE 11 )
Cover for a defined list of approved procedures performed in the specialist ’ s rooms
R9 200 per device ( maximum two devices per beneficiary ), once every 3 years ( based on the date of your previous claim )
All tests and consultations limited to the Audiology Benefit Management Programme and use of a network provider
Pre-authorisation required
Avoid a 25 % co-payment by using a Designated Service Provider
Claims outside the Audiology Benefit Management Programme paid from available savings
All benefits and limits are per calendar year , unless otherwise stated . Managed Care protocols apply . All benefits are approved by the Council for Medical Schemes . PMB = Prescribed Minimum Benefits
3 BONCLASSIC 2024 OUT-OF-HOSPITAL BENEFITS