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 on the applicable network . Pre-authorisation is required . A co-payment may apply to specific admissions and / or procedures . Managed Care protocols apply .
Please note : On this option you can avoid a 30 % co-payment by using a hospital on the applicable network .
SPECIALIST CONSULTATIONS / TREATMENT Unlimited , network specialists covered in full at the Bonitas Rate Unlimited , non-network specialists paid at 100 % of the Bonitas Rate
GP CONSULTATIONS / TREATMENT
BLOOD TESTS AND OTHER LABORATORY TESTS
X-RAYS AND ULTRASOUNDS
MRIS AND CT SCANS ( SPECIALISED RADIOLOGY )
CATARACT SURGERY
ALLIED MEDICAL PROFESSIONALS ( SUCH AS DIETICIAN , SPEECH AND OCCUPATIONAL THERAPIST )
PHYSIOTHERAPY , PODIATRY AND BIOKINETICS
INTERNAL PROSTHESES
Unlimited , covered at 100 % of the Bonitas Rate
Unlimited , covered at 100 % of the Bonitas Rate
Unlimited , covered at 100 % of the Bonitas Rate
R30 460 per family , in and out-of-hospital
R2 660 co-payment per scan event except for PMB
Avoid a R7 050 co-payment by using the Designated Service Provider
PMB only
PMB only
R51 590 per family ( no cover for joint replacements or back and neck surgery except for PMB )
Pre-authorisation required
Subject to referral by treating practitioner
Subject to referral by treating practitioner
Managed Care protocols apply
EXTERNAL PROSTHESES PMB only Managed Care protocols apply
HOSPITALISATION FOR DENTISTRY ( GENERAL ANAESTHETIC )
MODERATE / DEEP SEDATION IN THE ROOMS ( IV CONSCIOUS SEDATION )
MENTAL HEALTH HOSPITALISATION ( ALSO SEE CARE PROGRAMMES PAGE 8 )
A co-payment of R3 500 per admission applies for children under the age of 5 and R5 000 for any other admission , including removal of impacted teeth or any other medical condition OR A R2 500 upfront co-payment if the dental treatment is done in a day hospital
General anaesthetic is only available to children under the age of 5 for extensive dental treatment once per lifetime
Avoid a 30 % co-payment by using a hospital on the applicable network
Managed Care protocols apply
Only applicable in lieu of general anaesthetic for the in-hospital dental benefits
R36 860 per family
Avoid a 30 % co-payment by using a hospital on the applicable network
Managed Care and admission protocols apply
Pre-authorisation required
General anaesthetic benefit is available for the removal of impacted teeth
Pre-authorisation required
No cover for physiotherapy for mental health admissions
TAKE-HOME MEDICINE
Limited to a 7-day supply up to R545 per hospital stay
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 HOSPITAL STANDARD 2024 IN-HOSPITAL BENEFITS