Bonitas Medical Fund

(source Bonitas Medical Fund website)

Bonitas Benefit Structure and Options

Nothing can be more important than the health and wellbeing of you and your family. Even if you're fit and healthy, an accident can happen at any time, so being covered for quality healthcare isn't a luxury, it's an imperative. Moreover, in this day and age of rising prices, the one thing that sets Bonitas apart is affordability. Therefore the following Bonitas plans are all designed to fit with your specific needs whilst still providing quality healthcare at affordable prices.

We have categorised our benefits into four main categories illustrated below. When choosing your option, we would like you to consider your healthcare needs in respect of the three main benefit categories listed below. Once you have made your selection we encourage you to look at the option you have selected in more detail, considering also the supplementary benefits provided.

Major Medical

Covers medical expenses in hospital and major medical events

Chronic Medication

Covers medicine for conditions that require medication on an ongoing basis

Supplementary

Additional benefits, medical expenses incurred in or out of hospital

Out of Hospital

Covers out of hospital medical expenses

Major Medical Benefits

Major medical benefits cover medical expenses in hospital and major medical events. Hospital accounts are covered in full as per the negotiated rates between Bonitas and the major hospital groups. Hospital admission is subject to pre-authorisation by Hospital Management, except in the case of emergencies.

Products 2012	BonComprehensive	BonEssential	BonSave
Limit	Unlimited	Unlimited	Unlimited
Reimbursement Rate*	300% Bonitas Rate	100% Bonitas Rate	150% Bonitas Rate
Provider	Any hospital	Any hospital	Any hospital

Products 2012	Standard	Primary
Limit	Unlimited	R1 000 000 per family per annum
Reimbursement Rate*	100% Bonitas Rate	100% Bonitas Rate
Provider	Any hospital	Any hospital

Chronic Benefits

Chronic benefits cover medicine for conditions that require medication on an ongoing basis. Subject to pre-authorisation by Chronic Medicine Management.

BonComprehensive	BonEssential	BonSave	Standard
R10 000 per beneficiary R20 000 per family (53 conditions) Comprehensive Formulary	Prescribed Minimum Benefits only at Designated Service Provider (26 conditions) Restrictive Formulary	Prescribed Minimum Benefits only at Designated Service Provider (26 conditions) Restrictive Formulary	R6 900 per beneficiary R13 800 per family (42 conditions)Comprehensive Formulary in benefit. Restrictive Formulary when benefits are exceeded for PMB’s
Any Pharmacy or Dispensing GP	Pharmacy Direct	Pharmacy Direct	Any Pharmacy or Dispensing GP limit PMB’s unlimited at DSP thereafter

Primary

Prescribed Minimum Benefits only at Designated Service Provider (26 conditions)

Pharmacy Direct

Out of Hospital Benefits

Out of hospital benefits cover day to day medical expenses incurred out of hospital.

New Generation Options

Traditional Options

BonComprehensive BonEssential BonSave A savings account enables members to self-insure and manage their own out of hospital medical expenses. Unspent savings are carried forward with interest. An insured threshold benefit provides additional peace of mind for high out of hospital expenses. A hospital plan and cover for PMB conditions. A savings account enables members to self-insure and manage their own out of hospital medical expenses. Unspent savings are carried forward with interest.

Standard Primary Out of hospital care is coordinated through your general practitioner (GP). Visiting a GP contracted on the Bonitas GP Network ensures that you will not be charged anything in excess of the Bonitas Tariff. Acute medication, radiology and pathology etc. prescribed by your doctor is available from your Day to Day Benefit. Specialist consultations are also payable from this benefit if referred by your GP.

* Reimbursement rate of healthcare practitioners in hospital e.g. medical specialists

Below is a description of each plan

BonComprehensive – New Generation
(Comprehensive plan)

As the name implies – this is comprehensive cover for people who are looking for more out of life. With BonComprehensive you can expect unlimited consultations above threshold. All Major Medical Expenses at 300% of the Bonitas Rate. Plus extremely generous benefits covering biological drugs and ophthalmology including refractive surgery. If you hate to compromise you’ll love BonComprehensive.

BonEssential – New Generation (Hospital Plan)

You may be young, fit and healthy, but that doesn’t mean you’re going to ignore the important things in life. Like a good all-round hospital plan. BonEssential is the plan for you. Not only is it affordable and easy to understand, it also gives you more bang for your buck! Such as cover for PMB conditions.

BonSave – New Generation (Hospital Plan with Savings)

The BonSave option is full of choices, such as flexibility of managing your day-to-day with a savings account. Your basic dentistry and supplementary benefits don’t affect your savings as it is paid from risk. BonSave is about saving money so that quality healthcare is as affordable as it can be.

Standard – Traditional (Traditional Option)

There’s nothing Standard about our Standard option. It provides comprehensive hospital cover as well as generous day-to-day benefits. The Standard option means you can make full use of our GP network where you need not be out of pocket because you won’t be asked to make co-payments. Our standard option also has unlimited overall annual benefits and additional chronic medicine benefit. Not forgetting basic and advanced dentistry, Optometry, and Supplementary benefits paid from risk.

Primary – Traditional (Traditional Option)

If affordable healthcare is your primary concern, then our Bonitas Primary option is for you. Provided you don’t need extensive chronic medication, you are covered for all major medical expenses at 100% of our rate, with an annual limit of R1 million and day-to-day benefits. Primary is a healthy option for healthy individuals.

BonCap – Capitation

This option is ideal for those looking for a more fundamental type of cover. If you are happy to see a preferred provider through our network of practitioners, there are many cost saving benefits that will come your way. The network will provide cover at 100% of our Primecure rates and this includes medical expenses incurred while in hospital, as well as any major medical event. For value-based cover, BonCap caps it all.

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