IN-HOSPITAL BENEFITS
This benefit offers cover for major medical events that result in a beneficiary being admitted to hospital . Members have access to cover at a private hospital . Pre-authorisation is required . A co-payment may apply to specific admissions and / or procedures . Managed Care protocols apply .
Please note : On the BonEssential Select option you can avoid a 30 % co-payment by using a hospital on the applicable network .
SPECIALIST CONSULTATIONS / TREATMENT
BONESSENTIAL
BONESSENTIAL SELECT
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 .
Unlimited , network specialists covered in full at the Bonitas Rate
Unlimited , non-network specialists paid at 100 % of the Bonitas Rate
Unlimited , network specialists covered in full at the Bonitas Rate
Unlimited , non-network specialists paid at 100 % of the Bonitas Rate
GP CONSULTATIONS / TREATMENT Unlimited , covered at 100 % of the Bonitas Rate Unlimited , covered at 100 % of the Bonitas Rate
BLOOD TESTS AND OTHER LABORATORY TESTS
Unlimited , covered at 100 % of the Bonitas Rate
Unlimited , covered at 100 % of the Bonitas Rate
X-RAYS AND ULTRASOUNDS Unlimited , covered at 100 % of the Bonitas Rate Unlimited , covered at 100 % of the Bonitas Rate
MRIS AND CT SCANS ( SPECIALISED RADIOLOGY )
R15 170 per family , in and out-of-hospital
R2 660 co-payment per scan event except for PMB
Pre-authorisation required
R15 170 per family , in and out-of-hospital
R2 660 co-payment per scan event except for PMB
Pre-authorisation required
CATARACT SURGERY Avoid a R7 050 co-payment by using the Designated Service Provider Avoid a R7 050 co-payment by using the Designated Service Provider
ALLIED MEDICAL PROFESSIONALS ( SUCH AS DIETICIAN , SPEECH AND OCCUPATIONAL THERAPIST ) |
PMB only |
Subject to referral by treating practitioner |
PMB only |
Subject to referral by treating practitioner |
PHYSIOTHERAPY AND BIOKINETICS |
PMB only |
Subject to referral by treating practitioner |
PMB only |
Subject to referral by treating practitioner |
INTERNAL AND EXTERNAL PROSTHESES PMB only Managed Care protocols apply PMB only Managed Care protocols apply
Pre-authorisation required Managed Care protocols apply Pre-authorisation required Managed Care protocols apply
HOSPITALISATION FOR DENTISTRY ( GENERAL ANAESTHETIC ) |
A co-payment of R5 000 per admission applies for the removal of impacted teeth only OR A R2 500 upfront co-payment if the dental treatment is done in a day hospital |
General anaesthetic benefit is available for the removal of impacted teeth |
A co-payment of R5 000 per admission applies for the removal of impacted teeth only OR A R2 500 upfront co-payment if the dental treatment is done in a day hospital |
General anaesthetic benefit is available for the removal of impacted teeth
Avoid a 30 % co-payment by using a hospital on the applicable network
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MENTAL HEALTH HOSPITALISATION ( ALSO SEE CARE PROGRAMMES PAGE 10 ) |
R36 860 per family |
No cover for physiotherapy for mental health admissions |
R36 860 per family
No cover for physiotherapy for mental health admissions
Avoid a 30 % co-payment by using a hospital on the applicable network
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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 BONESSENTIAL & BONESSENTIAL SELECT 2024 IN-HOSPITAL BENEFITS