OUT-OF-HOSPITAL BENEFITS
Remember to unlock the Benefit Booster which can be used to pay for out-of-hospital expenses first ( See page 8 for more information ). Simply follow the steps below .
• To activate Level 1 , complete an online wellness questionnaire ( on the Bonitas app or website )
• To activate Level 2 and get the rest of the amount , complete a wellness screening ( at a participating pharmacy , biokineticist or Bonitas wellness day )
• To activate the total amount from the get-go , simply complete a wellness screening from the start
STANDARD
STANDARD SELECT
OVERALL DAY-TO-DAY LIMIT DAY-TO-DAY BENEFITS DAY-TO-DAY BENEFITS
The day-to-day benefits provide cover for consultations with your GP and specialist , acute medicine , X-rays , blood tests and other out-of-hospital medical expenses up to the overall day-to-day limit , subject to the relevant sublimit per category . There is a separate benefit for tests and consultations for PMB treatment plans so this will not affect your day-to-day benefits .
MAIN MEMBER ONLY R12 780 R12 780 MAIN MEMBER + 1 DEPENDANT R19 170 R19 170 MAIN MEMBER + 2 DEPENDANTS R21 300 R21 300 MAIN MEMBER + 3 OR MORE DEPENDANTS R23 430 R23 430
STANDARD & STANDARD SELECT
DAY-TO-DAY SUBLIMITS |
GP & SPECIALIST CONSULTATIONS |
ACUTE AND OVER-THE-COUNTER MEDICINE |
X-RAYS & BLOOD TESTS |
AUXILIARY SERVICES |
The sublimits below are the maximum available for each category , subject to the overall day-to-day limit . |
For specialist consultations you must get a referral from your GP . ( Including virtual care consultations ) On Standard Select :
• You must nominate 2 GPs on our network for each beneficiary for the year
• 2 non-nominated network GP visits allowed per family per year
• Consultations with non-network GPs are limited to PMBs only
|
• Avoid a 20 % co-payment by using a Bonitas Pharmacy Network
• Avoid a 20 % co-payment by using medicine that is on the formulary
• Over-the-counter medicine is limited to R850 per beneficiary and R2 660 per family
|
This category applies to blood and other laboratory tests as well as X-rays and ultrasounds . |
This category applies to physiotherapy , podiatry and biokinetics , allied medical professionals ( such as dieticians , speech and occupational therapists ) and alternative healthcare ( 20 % co-payment applies to homoeopathic medicine ). |
MAIN MEMBER ONLY |
R3 200 |
R3 200 |
R3 200 |
R3 200 |
MAIN MEMBER + 1 DEPENDANT |
R4 790 |
R4 790 |
R4 790 |
R4 790 |
MAIN MEMBER + 2 DEPENDANTS |
R5 330 |
R5 330 |
R5 330 |
R5 330 |
MAIN MEMBER + 3 OR MORE DEPENDANTS |
R6 390 |
R6 390 |
R6 390 |
R6 390 |
GENERAL MEDICAL APPLIANCES ( SUCH AS WHEELCHAIRS AND CRUTCHES )
Subject to the available overall day-to-day limit
R8 130 per family for Stoma Care and CPAP machines ( Note : CPAP machines subject to Managed Care protocols )
Subject to frequency limits as per Managed Care protocols
NON-SURGICAL PROCEDURES Subject to the available overall day-to-day limit Subject to the available overall day-to-day limit
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 STANDARD & STANDARD SELECT 2024 OUT-OF-HOSPITAL BENEFITS