Bonessential & Bonessential select 2024 | Page 4

BONESSENTIAL BONESSENTIAL SELECT
TAKE-HOME MEDICINE
Limited to a 7-day supply up to R445 per hospital stay
Limited to a 7-day supply up to R445 per hospital stay
PHYSICAL REHABILITATION
R57 890 per family
R57 890 per family
ALTERNATIVES TO HOSPITAL ( HOSPICE , STEP-DOWN FACILITIES )
R19 310 per family Managed Care protocols apply R19 310 per family Managed Care protocols apply
PALLIATIVE CARE ( CANCER ONLY )
Unlimited , subject to using the Designated Service Provider
Including hospice / private nursing , home oxygen , pain management , psychologist and social worker support
Unlimited , subject to using the Designated Service Provider
Including hospice / private nursing , home oxygen , pain management , psychologist and social worker support
CANCER TREATMENT ( ALSO SEE CARE PROGRAMMES PAGE 10 )
Unlimited for PMBs at a Designated Service Provider
Avoid a 30 % co-payment by using a Designated Service Provider
Pre-authorisation required
Sublimit of R57 680 per beneficiary for Brachytherapy
Unlimited for PMBs at a Designated Service Provider
Avoid a 30 % co-payment by using a Designated Service Provider
Pre-authorisation required
Sublimit of R57 680 per beneficiary for Brachytherapy
CANCER MEDICINE
Subject to Medicine Price List and preferred product list
Avoid a 20 % co-payment by using a Designated Service Provider
Subject to Medicine Price List and preferred product list
Avoid a 20 % co-payment by using a Designated Service Provider
ORGAN TRANSPLANTS PMB only PMB only
KIDNEY DIALYSIS
Unlimited
Avoid a 20 % co-payment by using a Designated Service Provider
Unlimited
Avoid a 20 % co-payment by using a Designated Service Provider
HIV / AIDS ( ALSO SEE CARE PROGRAMMES PAGE 11 )
Unlimited , if you register on the HIV / AIDS programme
Chronic medicine must be obtained from the Designated Service Provider
Unlimited , if you register on the HIV / AIDS programme
Chronic medicine must be obtained from the Designated Service Provider
DAY SURGERY PROCEDURES ( APPLIES TO SELECTED PROCEDURES )
Avoid a R2 590 co-payment by using a network day hospital
Avoid a R5 170 co-payment by using a network day hospital
R1 840 co-payment R4 690 co-payment R8 680 co-payment
PROCEDURE CO-PAYMENTS ( PER EVENT , SUBJECT TO PRE-AUTHORISATION )
1 .
Colonoscopy
2 .
Conservative Back Treatment
3 .
Cystoscopy
4 .
Facet Joint Injections
5 .
Flexible Sigmoidoscopy
6 .
Functional Nasal Surgery
7 .
Gastroscopy
8 .
Hysteroscopy ( not Endometrial Ablation )
9 .
Myringotomy
10 . Tonsillectomy and Adenoidectomy
11 . Umbilical Hernia Repair
12 . Varicose Vein Surgery
1 .
Arthroscopy
2 .
Diagnostic Laparoscopy
3 .
Laparoscopic Hysterectomy
4 .
Percutaneous Radiofrequency Ablations
( Percutaneous Rhizotomies )
1 .
Laparoscopic Pyeloplasty
2 .
Laparoscopic Radical Prostatectomy
3 .
Nissen Fundoplication ( Reflux Surgery )
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
4 BONESSENTIAL & BONESSENTIAL SELECT 2024 IN-HOSPITAL BENEFITS