ADMIN AND PROCESS GUIDE - CMAC
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ADMIN AND PROCESS GUIDE
INDEX
INDEX
Section A: Why Bonitas?
Choose Bonitas 3
How our plans work 5
Our plans 7
Savings 8
Additional Benefits 9
Contribution table 10
Section B: Contact details
Queries and escalations 13
• General 13
• BonCap 13
• Pharmacy Direct 14
Find a service provider 15
Section C: Membership and admin
Individual underwriting 17
Group underwriting 19
Application process 20
Network service providers 21
GP referral process 22
PMB treatment plan 23
How to claim 24
Hospital pre-authorisation 25
Hospital networks 28
BonCap hospital networks 33
Mental health hospital networks 39
Locate a provider 41
Exclusions 42
Section D: Benefits and Managed Care Programmes
Chronic medicine 49
Register with Pharmacy Direct 51
Over-the-counter, acute and take-home medicine 52
Maternity benefits 54
Childcare benefits 55
Optical benefits 57
Dental benefits 59
Radiology benefits 62
Cancer programme 63
HIV/AIDS programme 65
Diabetes management programme 67
Back and neck programme 69
Hip and knee programme 70
Wellness benefits 71
Mental health programme 72
Preventative care benefits 73
International travel benefit 74
Emergency medical services 75
Please note: Product rules, limits, terms and conditions apply. Where there is a discrepancy between the content provided in this brochure, the website and the Scheme Rules, the Scheme
Rules will prevail. The Scheme Rules are available on request. Benefits are subject to approval from the Council for Medical Schemes.
SECTION A: WHY BONITAS?
CHOOSE BONITAS
WHY
We CHOOSE BONITAS
offer:
Affordable, quality healthcare for you and your Largest GP network and a specialist network
family to give you more value for money
A wide range of plans including savings, Access to quality service providers and
traditional, income based and hospital plans healthcare professionals so you get the best
care
Preventative care and wellness benefits in
Cover for up to 60 chronic conditions and free
addition to savings and day-to-day benefits so
medicine delivery
you get more value
Complete care and support for families including Benefits for dentistry and optometry in
additional benefits for maternity, consultations addition to your savings and day-to-day
with a paediatrician and 24/7 baby advice line benefits
Managed Care programmes to help you Free cover for your fourth and subsequent
manage chronic conditions including cancer, children so you only pay for a maximum of
mental health, HIV/AIDS and diabetes three children (except on BonCap)
We work hard for you
hospital admissions authorised
868 1.06 million
call centre calls answered
per day a year
36 287 95.9%
claims processed per day
of claims
paid within
5 days
SWITCH TO REAL MEDICAL AID I BONITAS.CO.ZA
All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Page 3
V1-10Dec2018.
CHOOSE BONITAS
We care about our members We are
Total beneficiaries
728 943
Average
beneficiary
age
2.2 1.15 stable and
sustainable
33
Average
Principal members Dependants
35
family
338 649 size per member
years
We are there when you need us
Call centre to assist you in all 11 official
industry
languages experience
Walk in centres located countrywide
R4.0
for one-on-one assistance
Website to make things easier for you
billion in
A dedicated key accounts officer
working with your HR manager reserves
so we can
Our finances are healthy* afford to pay
Net healthcare results Solid surplus of
your claims
R345.9 R730.2
million million R R R
* Figures extracted from the 2017 Annual Financial Statements
SWITCH TO REAL MEDICAL AID I BONITAS.CO.ZA
All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Page 4
V1-10Dec2018.
V1-10Dec2018.
HOW OUR PLANS WORK
SAVINGS OPTIONS TRADITIONAL OPTIONS
Above threshold
benefits*
OUT-OF-HOSPITAL ADDITIONAL OUT-OF-HOSPITAL ADDITIONAL
Day-to-day medical expenses BENEFITS Day-to-day medical BENEFITS
Carry over each year expenses
Self-payment
gap*
*BONCOMPREHENSIVE
STANDARD
BONCLASSIC
STANDARD SELECT
*BONCOMPLETE
PRIMARY
BONSAVE
PRIMARY SELECT
BONFIT
MANAGED CARE MANAGED CARE
All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply.
IN-HOSPITAL CHRONIC IN-HOSPITAL CHRONIC
Network & Non-network BENEFITS Network & Non-network BENEFITS
Up to 60 conditions Up to 45 conditions
including PMBs including PMBs
FROM R2 027 FROM R1 904
Page 5
HOW OUR PLANS WORK
V1-10Dec2018.
HOW OUR PLANS WORK
INCOME BASED OPTION HOSPITAL OPTIONS
OUT-OF-HOSPITAL ADDITIONAL
Day-to-day medical BENEFITS
expenses HOSPITAL STANDARD
BONESSENTIAL
IN-HOSPITAL BONESSENTIAL SELECT ADDITIONAL
Network & Non-network BENEFITS
BONCAP
MANAGED CARE
MANAGED CARE
All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply.
CHRONIC CHRONIC
IN-HOSPITAL BENEFITS
Network BENEFITS
27 PMBs 27 PMBs
FROM R1 009 FROM R1 477
Page 6
HOW OUR PLANS WORK
V1-10Dec2018.
OUR PLANS
OURPLANS
BONCOMPREHENSIVE STANDARD BONCAP HOSPITAL STANDARD
This first-class savings plan offers ample This traditional option offers rich This income based entry-level plan offers This hospital plan offers extensive
savings, an above threshold benefit and day-to-day benefits and comprehensive basic day-to-day benefits and hospital hospital benefits with some
extensive hospital cover. hospital cover. cover using a network of doctors, value-added benefits.
providers and hospitals.
BONCLASSIC STANDARD SELECT BONESSENTIAL
This generous savings option offers a This traditional option uses a quality This hospital plan offers comprehensive
wide range of medical benefits, in and provider network to offer rich day-to-day hospital benefits with some value-added
out of hospital. benefits and hospital cover. benefits.
BONCOMPLETE PRIMARY BONESSENTIAL SELECT
This savings option offers generous This traditional option offers simple This hospital plan uses a quality provider
savings, an above threshold benefit and day-to-day benefits and hospital cover. network to offer comprehensive hospital
rich hospital cover. benefits with some value-added benefits.
All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply.
BONSAVE PRIMARY SELECT
This savings option offers sufficient This traditional option uses a quality
savings to use as you choose for medical provider network to offer simple
expenses and extensive hospital cover. day-to-day benefits and hospital cover.
BONFIT
This savings plan offers basic cover for
day-to-day medical needs and essential
hospital cover.
Page 7
OUR PLANS
SAVINGS
Savings is defined as the amount payable towards the member’s personal medical savings account which is included in the total monthly
SAVINGS
contribution payable by a member. We offer several additional benefits that are paid from Risk in addition to Savings. This includes
preventative care benefits, maternity as well as childcare benefits. Please refer to page 9 for the additional day-to-day benefits which are
paid from the Risk benefit.
Annual savings
Plans % Main member Adult dependant Child dependant
BonComprehensive* 18.9% R14 568 R13 740 R 2 964
BonClassic 14.1% R 7 584 R 6 516 R 1 872
BonComplete* 15% R 6 432 R 5 148 R 1 752
BonSave 16% R 4 776 R 3 696 R 1 428
BonFit 15% R 3 660 R 2 832 R 1 092
*These plans have an above threshold benefit.
HOW THE BALANCE OF YOUR PERSONAL MEDICAL SAVINGS IS USED
Any amount available in the Personal Medical Savings Account shall be used to provide benefits in respect of day-to-day medical expenses.
Provided there are actual funds available in a member’s Personal Medical Savings Account, such funds may, in addition to providing for
day-to-day benefits, be used to pay for services generally or specifically excluded from Risk benefits or where the actual costs exceed the
benefit payable or available.
ADVANCES OF MEDICAL SAVINGS BENEFITS
At the beginning of each benefit year or on the date of joining the Fund or this benefit option, each member shall be allocated a medical
savings benefit for the year. This benefit shall be deemed to be an advance by the Fund to the member and shall be equal to 12 (twelve)
times the amount, pro-rated in respect of a member who joins the Fund or this benefit option during the course of the year.
A member whose membership of the Fund or of an option with a Personal Medical Savings Account is terminated during the course of a
benefit year and whose claims exceeded the savings benefit advance, pro-rated on a monthly basis at the date of termination, shall be liable
to repay the excess / shortfall to the Fund.
THE ABOVE THRESHOLD BENEFIT
Once a member has used their savings for the year on BonComprehensive and BonComplete, they will need to pay for day-to-day medical
expenses from their pockets until they have paid the full self-payment gap. They will then have access to the above threshold benefit.
Members must submit all claims they have paid towards the self-payment gap to us, so that we can let them know when they have access
to the above threshold benefit.
BONCOMPREHENSIVE
Main member Adult dependant Child dependant
Savings R 14 568 R 13 740 R 2 964
Self-payment gap R 4 000 R 3 310 R 1 520
Above threshold benefit Unlimited Unlimited Unlimited
BONCOMPLETE
Main member Adult dependant Child dependant
Savings R 6 432 R5 148 R1 752
Self-payment gap R 1 740 R1 470 R 375
Above threshold benefit R4 610 R2 720 R1 180
Please note: Claims accumulate to the threshold at 100% of the Bonitas Rate. Please refer to Annexure B of the Fund Rules for a full list of
claims that accumulate to the threshold. The self-payment gap indicated above can increase depending on the claims submitted by the
member. Sub-limits apply to the above threshold benefit.
All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Page 8
V1-10Dec2018.
ADDITIONAL BENEFITS
CONTRIBUTION TABLE
Bonitas gives you out-of-hospital and additional benefits that are paid from Risk. These include benefits for contraceptives, childcare, preventative
care, wellness and international travel cover. The value of these benefits differs according to the plan you are on. Below is an estimate amount of the
value of these extra benefits Bonitas gives you:
APPROXIMATE VALUE OF ADDITIONAL BENEFITS PER PLAN
• BonComprehensive R51 000 • Standard and Standard Select R49 000
• BonClassic R44 000 • Primary and Primary Select R43 000
• BonComplete R47 000 • BonCap R5 000
• BonSave R49 000 • BonEssential and BonEssential Select R34 000
• BonFit R45 000 • Hospital Standard R38 000
Please note: The figures above are approximate values and exclude out-of-hospital benefits for dentistry, optometry and specialised radiology where
applicable.
ADDITIONAL BENEFITS AVAILABLE ON EACH PLAN
24/7 baby Separate
Maternity advice line Childhood benefit for Wellness Preventative International
Contraceptives
benefits for children immunisations paediatric benefits care travel benefit
under 3 consultations
BonComprehensive ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
BonClassic ✓ ✓ ✓ ✓ x ✓ ✓ ✓
BonComplete ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
BonSave ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
BonFit ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
Standard ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
Standard Select ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
Primary ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
Primary Select ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
BonCap ✓ ✓ ✓ x x * ✓ x
✓
Hospital Standard ✓ ✓ ✓ x x ✓ ✓ ✓
BonEssential ✓ ✓ ✓ x x ✓ ✓ ✓
BonEssential Select ✓ ✓ ✓ x x ✓ ✓ ✓
* Does not offer the Wellness Extender Benefit
All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Page 9
V1-10Dec2018.CONTRIBUTION TABLE 2019
CONTRIBUTION TABLE 2019
CONTRIBUTION TABLE
BONCOMPREHENSIVE
You only pay for a maximum of three children. Full-time students up to age 24 years pay child rates.
2019 Main member Adult dependant Child dependant
Total R6 438 R6 072 R1 310
BONCLASSIC
You only pay for a maximum of three children. Full-time students up to age 24 years pay child rates.
2019 Main member Adult dependant Child dependant
Total R4 470 R3 838 R1 104
BONCOMPLETE
You only pay for a maximum of three children. Full-time students up to age 24 years pay child rates.
2019 Main member Adult dependant Child dependant
Total R3 581 R2 868 R973
BONSAVE
You only pay for a maximum of three children. Full-time students up to age 24 years pay child rates.
2019 Main member Adult dependant Child dependant
Total R2 486 R1 925 R744
BONFIT
You only pay for a maximum of three children. Full-time students up to age 24 years pay child rates.
2019 Main member Adult dependant Child dependant
Total R2 027 R1 570 R607
STANDARD
You only pay for a maximum of three children. Full-time students up to age 24 years pay child rates.
2019 Main member Adult dependant Child dependant
Total R3 556 R3 083 R1 043
STANDARD SELECT
You only pay for a maximum of three children. Full-time students up to age 24 years pay child rates.
2019 Main member Adult dependant Child dependant
Total R3 080 R2 665 R902
All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Page 10
V1-10Dec2018.CONTRIBUTION TABLE 2019
PRIMARY
CONTRIBUTION TABLE
PRIMARY
You only pay for a maximum of three children. Full-time students up to age 24 years pay child rates.
You only pay for a maximum of three children. Full-time students up to age 24 years pay child rates.
2019 Main member Adult dependant Child dependant
2019 Main member Adult dependant Child dependant
Total R2 240 R1 752 R713
Total R2 240 R1 752 R713
PRIMARY SELECT
PRIMARY SELECT
You only pay for a maximum of three children. Full-time students up to age 24 years pay child rates.
You only pay for a maximum of three children. Full-time students up to age 24 years pay child rates.
2019 Main member Adult dependant Child dependant
2019 Main member Adult dependant Child dependant
Total R1 904 R1 489 R606
Total R1 904 R1 489 R606
HOSPITAL STANDARD
HOSPITAL STANDARD
You only pay for a maximum of three children. Full-time students up to age 24 years pay child rates.
You only pay for a maximum of three children. Full-time students up to age 24 years pay child rates.
2019 Main member Adult dependant Child dependant
2019 Main member Adult dependant Child dependant
Total R2 040 R1 720 R776
Total R2 040 R1 720 R776
BONESSENTIAL
BONESSENTIAL
You only pay for a maximum of three children. Full-time students up to age 24 years pay child rates.
You only pay for a maximum of three children. Full-time students up to age 24 years pay child rates.
2019 Main member Adult dependant Child dependant
2019 Main member Adult dependant Child dependant
Total R1 731 R1 324 R507
Total R1 731 R1 324 R507
BONESSENTIAL SELECT
BONESSENTIAL SELECT
You only pay for a maximum of three children. Full-time students up to age 24 years pay child rates.
You only pay for a maximum of three children. Full-time students up to age 24 years pay child rates.
2019 Main member Adult dependant Child dependant
2019 Main member Adult dependant Child dependant
Total R1 477 R1 130 R433
Total R1 477 R1 130 R433
BONCAP
BONCAP
You only pay for a maximum of three children. Full-time students up to age 24 years pay child rates.
You only pay for a maximum of three children. Full-time students up to age 24 years pay child rates.
2019 Main member Adult dependant Child dependant
2019 Main member Adult dependant Child dependant
R0 to R8 030 R1 009 R956 R475
R0 to R8 030 R1 009 R956 R475
R8 031 to R13 050 R1 226 R1 159 R563
R8 031 to R13 050 R1 226 R1 159 R563
R13 051 to R17 830 R2 000 R1 780 R757
R13 051 to R17 830 R2 000 R1 780 R757
R17 831+ R2 456 R2 187 R931
R17 831+ R2 456 R2 187 R931
All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Page 11
V1-10Dec2018.SECTION B: CONTACT DETAILS
QUERIES AND ESCALATIONS
GENERAL
Description Contact details Turnaround time
Chronic medicine authorisations chronicmeds@bonitas.co.za 5 to 7 days
3 days
Commissions commissions@medscheme.co.za
5 days new broker contract
General queries and customer service queries@bonitas.co.za or 0860 002 108 1 day
QUERIES AND ESCALATIONS
Group take-ons bontakeons@bonitas.co.za N/A
Group underwriting requests underwriting@afrocentricds.com N/A
Individual underwriting review requests underwriting@afrocentricds.com 5 days
Hospital authorisations hospital@bonitas.co.za 1 day
Membership updates membermaint@bonitas.co.za 3 days
New membership applications newapplications@bonitas.co.za 1 day
Oncology authorisations oncology@bonitas.co.za 3 days
Pre-underwriting requests newapplications@bonitas.co.za (Subject: Pre-underwriting) 2 days
10 days (including processing
Submission of claims claims@bonitas.co.za
and payment)
Processed claims queries queryclaims@bonitas.co.za 7 days
FOR ANY QUERIES THAT DO NOT MEET THE SERVICE LEVEL, PLEASE ESCALATE:
Description Contact details Turnaround time
Broker escalated queries brokerescalations@bonitas.co.za 1 day
BONCAP
Description Contact details Turnaround time
Chronic medicine authorisations boncapchronic@bonitas.co.za 5 to 7 days
Hospital authorisations boncapauthorisations@bonitas.co.za 1 day
Income verification boncapincome@bonitas.co.za 3 days
Queries and customer service boncap@bonitas.co.za or 0861 239 333 5 days
All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Page 13
V1-10Dec2018.QUERIES AND ESCALATIONS
PHARMACY DIRECT
When applying for chronic cover the doctor may contact Bonitas and approve the chronic medicine online. However, members still need to
contact Pharmacy Direct to provide them with the approval code so Pharmacy Direct can deliver the medicine to the member.
1st Level Broker Support
Email: brokersupport@pharmacydirect.co.za
Tel: 011 758 9069
It is important that brokers first escalate to brokersupport@pharmacydirect.co.za before
contacting the second and third levels.
QUERIES AND ESCALATIONS
2nd Level Senior Fund Account Manager
Hansley Kiewiets
Email: hansley@pharmacydirect.co.za
Tel: 012 643 3037
3rd Level Business Unit Manager
Arregante Storbeck
Email: arregante@pharmacydirect.co.za
Tel: 012 643 3028
All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Page 14
V1-10Dec2018.FIND A SERVICE PROVIDER
We’ve partnered with several reputable service providers to ensure that our members receive excellent service and more value for money.
Emergency assistance Chronic medicine Optical benefits
Call: 084 124 Call: 0860 027 800 Call: 0861 103 529
Email: queriescqc@er24.co.za Fax: 0866 114 000 www.ppn.co.za
Email: claims@er24.co.za Email: care@pharmacydirect.co.za
www.er24.co.za www.pharmacydirect.co.za
FIND A SERVICE PROVIDER
Dental benefits HIV/AIDS programme Diabetes programme
Call: 0860 336 346 Please call me: 083 410 9078 Call: 0860 002 108
Fax: 0866 770 336 Call: 0860 100 646 Email: diabeticcare@bonitas.co.za
Email: bonitas@denis.co.za Fax: 0800 600 773
www.denis.co.za Email: afa@afadm.co.za
www.aidforaids.co.za
Back and neck programme Hip and knee programme Babyline
Call: 0860 105 104 Call: 011 327 2599 Call: 0860 999 121
Email: admin@icpservices.co.za
Cancer programme
Call: 0860 100 572
Email: oncology@bonitas.co.za
All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Page 15
V1-10Dec2018.SECTION C: MEMBERSHIP AND ADMIN
INDIVIDUAL UNDERWRITING
CATEGORIES FOR INDIVIDUAL UNDERWRITING:
A Members who NEVER belonged to a medical scheme before or whose break in
cover has been MORE than 3 months
B Members who ARE ACTIVE members of a medical scheme and have a break in
membership of LESS than 90 days and a previous membership of LESS than 24 months
C Members who ARE ACTIVE members of a medical scheme for MORE than 24 months
UNDERWRITING DECISIONS PER CATEGORY:
A B C
No cover for more than 90 days No cover for less than 90 days and Cover for more than 24 months
previous cover for less
than 24 months
3 12 LJP 12 LJP 3 LJP
INDIVIDUAL UNDERWRITING
3-month 12-month 12-month 3-month
general condition Late-joiner condition Late-joiner general Late-joiner
waiting specific penalty specific penalty waiting penalty
period waiting period waiting period period
NO PMB ELIGIBILITY FULL PMB COVER FULL PMB COVER
Ordinary dependants Spouse, common-law spouse (partner), same-sex spouse/partner, fiancée, customary partners, biological
children, adopted children, foster children, stepchildren and disabled biological children
Special dependants Brother, sister, parents, nephew, niece, cousins, grandparents, mother-in-law, father-in-law and
grandchildren
• Full underwriting will apply to registration of all special dependants at all times
• For the purpose of determining contributions, any special dependant under the age of 21 years will be
regarded as a child dependant and child rates will apply
• Special dependants, who are dependants on a membership where the main member is compelled
to resign from a closed Fund due to a change of employment, will be accepted underwriting free if
application is made to join Bonitas as a dependant within 3 months after termination at a closed fund (no
waiting periods, but late-joiner penalties if applicable)
Grandchildren Grandchildren will ONLY be accepted underwriting free if:
The parent (MOTHER OR FATHER of the baby) has been an ACTIVE member on the grandparent’s existing
membership BEFORE the start of the pregnancy
The Act stipulates the following:
• A medical fund may not impose a general or a condition-specific waiting period on a child dependant
born during the period of membership
Definition of a child in the main rules:
• “a member’s natural child, or a stepchild or legally adopted child or a foster child or a child who has
been placed in the custody of the member or his/her spouse or partner”
• A newborn baby who is the grandchild of a member does not qualify as a child dependant in terms of
the rules and will thus be defined as a special dependant. UNDERWRITING will therefore be applied to
any special dependant born into Fund membership
• The relationship of the newborn baby should always be clearly stated on the application form to ensure
that the correct underwriting rule is applied
Newborns The newborn must be registered within 30 days from date of birth in order to qualify for NO
(Ordinary dependants UNDERWRITING
only)
Inception date of a newborn has to be the date of birth to qualify for NO UNDERWRITING
All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Page 17
V1-10Dec2018.Newly-weds Newly-weds need to be registered within 30 days from date of marriage, to qualify for NO UNDERWRITING
Inception date of a newly-wed has to be the date of marriage in order to qualify for NO UNDERWRITING
Upon application a temporary marriage certificate needs to be supplied as a supporting document
The official marriage certificate needs to be supplied to Bonitas Medical Fund within 6 months from the
inception date of the member being accepted on their medical plan with Bonitas Medical Fund
If the above criteria is not met, the newly-wed will be seen as a late registration and full underwriting will
apply.
Foster and adopted child If application is made to register a foster or adopted child dependant within 3 months from date on which
dependants fostership or adoption was granted, with an inception date backdated to the date of adoption or fostership
of child, NO UNDERWRITING will apply
If the above criteria are not met, the foster/adopted child will be seen as a late registration and full
underwriting will apply.
Dependants transferring All dependants who are forced to terminate their membership in accordance with the Fund rules of a closed
from closed Funds and Fund in the following cases:
becoming dependants • Overaged dependants who have reached the maximum age as child dependant of that specific closed
on Bonitas Fund
• Spouse that has divorced the main member
• Main member has passed away
Will be accepted with no waiting periods if application is made to join Bonitas as dependants or as a main
member within 3 months after termination at a closed fund, irrespective of the length of cover at the closed
fund (no waiting periods, but late-joiner penalties if applicable)
All dependants, who are dependants on a membership where the main member is compelled to
resign from a closed fund due to a change of employment, will be accepted with no waiting periods if
application is made to join Bonitas as dependants within 3 months after termination at a closed fund (no
waiting periods, but late-joiner penalties if applicable)
Beneficiaries going on When a beneficiary goes on pension and applies to become a new Bonitas member or a new dependant
pension and is forced to resign from their current fund (open and closed schemes) because they are going on
pension, it will be regarded as a change of employment, thus no waiting periods will apply as per the Act, if
the break in cover is not greater than 3 months (no waiting periods, but late-joiner penalties may apply)
Local students Local students will be accepted underwriting free irrespective of choice of Bonitas option as a main
(SA citizens) member but only if valid copy of ID, proof of residence and proof of FULL-TIME studentship is submitted
along with the application form
Foreign students Foreign students will be accepted underwriting free irrespective of choice of Bonitas option as a main
(Non-SA Citizens) member but only if a valid copy of passport, proof of residence and proof of full-time studentship is
submitted along with the application form
INDIVIDUAL UNDERWRITING
Foreign students will be required to pay the full contributions of the first 12 months of their membership up
front in order to qualify for Bonitas membership.
Over-aged dependants A dependant of 21 to 24 years of age (including the last day of the calendar month that the dependant turns
24 years old) who is a student will be seen as a CHILD DEPENDANT
Students are classified into 3 groups namely: full-time students, part-time students and “in-service training”
students – all 3 of these groups qualify as CHILD DEPENDANTS (21 – 24 years old) as long as sufficient
proof of studentship is supplied, namely proof of registration or a letter from the applicable institution
clearly stating the nature of studentship
A dependant of 21 years and older who is not a student will be seen as an ADULT DEPENDANT, except
disabled biological children
Child rates will be charged for disabled children of 21 years and older where sufficient proof has been
provided that the child is indeed disabled and where application for child rates has been approved by a
clinical specialist and Fund Management
Any other dependant can remain on the Fund as a dependant after the age of 24 years, but will be seen as
an ADULT DEPENDANT
Dependants who turn 21 and 24 years old will be terminated if no response is received to the notifications
sent in respect of the age reviews
Where no response is received for any age review the dependants will be terminated
These terminated over-aged dependants will be accepted underwriting free if application is made to
reinstate their membership within 3 months from termination date
If application is made to reinstate these dependants after 3 months from the termination date, they will have
to reapply for membership and full underwriting will apply.
Definition of late-joiner “Late-joiner” means an applicant or the adult dependant of an applicant, who at the time of application for
membership or admission as a dependant, as the case may be, is 35 years of age or older, but excludes any
beneficiary who enjoyed cover with one or more registered medical funds in South Africa as from a date
preceding 1 April 2001, without a break in cover exceeding three consecutive months since 1 April 2001
Credible coverage • Credible coverage is seen as medical aid cover on a South African registered medical aid Fund
• Coverage from age 21 and older only, is seen as credible coverage and must be taken into consideration
when calculating the late-joiner penalty
• Late-joiner penalties are applied from age 36 only in line with the applicable penalty band as stipulated
in the Medical Funds Act No. 131 of 1998
General waiting period A period in which a beneficiary is not entitled to claim any benefits
Condition specific A period during which a beneficiary is not entitled to claim benefits in respect of a condition for which
waiting period medical advice, diagnosis, care or treatment was recommended or received within the twelve-month period
ending on the date on which an application for membership was made
All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Page 18
V1-10Dec2018.GROUP UNDERWRITING
Only employer groups of 10 and more employees will be considered for group underwriting.
GROUP UNDERWRITING WILL BE APPLIED IN ONE OF THREE WAYS:
• Annual underwriting-free group
• Underwriting-free take-on period (1-3 months, depending on group size)
• Individual underwriting applied to each individual beneficiary within the group
Determining the status of a particular group will be the responsibility of the Underwriting Department of AfroCentric Distribution Services.
In order for the Underwriting Department to consider the underwriting of a group, the group’s demographic information must be submitted
in Excel format with a business questionnaire and sent to underwriting@afrocentricds.com.
Bonitas reserves the right to review or revoke the underwriting decision should the status of the group change within the first three (3)
months of joining the Fund, or if the information on the application forms differs from the information provided on the initial underwriting
request.
FREE UNDERWRITING / NO UNDERWRITING AS PER CATEGORY A & B
• No condition specific waiting periods
• No general waiting periods
• No late-joiner penalties
Except:
• Employees joining more than 3 months after their permanent employment date (start date) at the company
• Ordinary dependants who do not join from exactly the same inception date as the main member during an underwriting free take-on
period, except for newborns and newly-weds who will be accepted underwriting free if they follow the correct procedures as set out
above for newly-weds and newborns
• All special dependants will be fully underwritten at all times
INDIVIDUAL UNDERWRITING RULES APPLY IN THE BELOW CASES:
AfroCentric Distribution Services Underwriting Department with the result being one of the following
Decisions made by:
3 categories:
GROUP UNDERWRITING
A B C
Category Annual underwriting-free group Underwriting-free take-on period Individual underwriting
of 1-3 months
Rules
New applications No underwriting for new and No underwriting for new and Individual underwriting as per
existing employees and their existing employees and their categories set out above for
ordinary dependants who join from ordinary dependants who join from main member and their ordinary
the same inception date as the the same inception date as the dependants during the one-month
main member main member take-on period
Dependants Full underwriting for: Full underwriting for: Full underwriting for:
• Special dependants • Special dependants • Special dependants
• Late registration of ordinary • Late registration of ordinary • Late registration of ordinary
dependants dependants dependants
Period of underwriting Underwriting-free groups will be 1-3 months, unless an extension 1 month
status reviewed on an annual basis is granted by the Underwriting If take-on period expires:
Department Underwriting remains on the
If take-on period expires: current Individual Underwriting rule
Underwriting automatically defaults
to Individual Underwriting (Group
C), unless notification is provided
by the Underwriting Department
to change underwriting status to
that of an annual underwriting-free
group
New employees No underwriting for new No underwriting for new No underwriting for new
employees and their ordinary employees and their ordinary employees and their ordinary
dependants who join on the same dependants who join on the same dependants who join on the same
inception date, within 3 months inception date, within 3 months inception date, within 3 months
from permanent employment date from permanent employment date from permanent employment date
at group at group at group
Special dependants will be fully Special dependants will be fully Special dependants will be fully
underwritten at all times underwritten at all times underwritten at all times
All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Page 19
V1-10Dec2018.APPLICATION PROCESS
MANDATORY SUPPORTING DOCUMENTS: NEW APPLICATIONS
We require the following with all new applications:
• Fully completed application and signed declaration with a copy of the main member’s ID or passport and ID numbers of all
beneficiaries listed on the application form; and
• Membership certificates as proof of previous medical scheme cover
In addition, we require:
• Proof of income as set out in the application form for individual members for BonCap
• A copy of the most recent payslip for Persal members
Where the contribution payer’s details differ from the main member, we require the following:
• A copy of a cancelled cheque or bank statement showing the account holder’s details; and
• A letter from the contribution payer instructing Bonitas to debit his/her account
Where a company is paying the monthly contributions, we require the following:
• A copy of a cancelled cheque or bank statement showing the company’s details; and
• A letter from the company (on company letterhead) authorising Bonitas to deduct monthly contributions from the company’s bank
account
WHICH FORM TO USE:
Group take-on application Individual member application
Members joining a new paypoint during an underwriting-free All direct paying members
take-on period
Members joining an existing paypoint during an underwriting-free Members joining a new paypoint during an individual underwriting
window period during the year or at year end take-on period
Members joining an existing annual underwriting-free paypoint Members joining an existing individual underwriting paypoint
APPLICATION PROCESS
All new employees joining an existing paypoint after the initial If special dependants are added during a take-on or window period
take-on period or a window period and within 3 months from their of a group, an Individual member application form needs to be
employment date completed
Name of form To be used for:
Individual member application Direct paying members joining Bonitas
Group take-on application Members joining Bonitas from a paypoint or employer group
Health questionnaire Confirms current health status for members reinstating application
Change in banking details Updates to banking details
Option change Changes in option
Change of dependants Addition or termination of a dependant
Change in details Updates to personal details, address, contact details and/or
marital status
Principal member change Changing a dependant to a main member
Termination of membership Cancellation of membership
Broker application Brokers contracting to sell Bonitas policies
Company application Companies joining Bonitas as an employer group
Please note: All application forms or changes received after the 15th of the month will be actioned effective the 1st of the following month.
All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Page 20
V1-10Dec2018.NETWORK SERVICE PROVIDERS
We negotiate rates with preferred providers and Designated Service Providers to ensure that they do not charge you more than the agreed
rate. This will ensure that your benefits last as long as possible and give you more value for money.
The Fund reserves the right to charge a member interest (to a maximum of the prevailing mora interest rate) on medical savings benefit
advances not settled within 30 (thirty) days of resignation from the Fund or an option with a savings component.
Please note: Where you are required to use a Designated Service Provider and you do not do so, a significant co-payment will apply.
You can call us on 0860 002 108 or log in to www.bonitas.co.za to view the list of preferred providers and Designated Service Providers.
SPECIALIST NETWORK INCLUDES, BUT IS NOT LIMITED TO, THE FOLLOWING
SPECIALISTS:
• Cardiology
• Cardiothoracic Surgery
• Dermatology
• Gastroenterology
• Neurology
• Neurosurgery
• Obstetrics and Gynaecology
• Ophthalmology
• Orthopaedics
• Otorhinolaryngology (ENT)
• Paediatrics
• Plastic and Reconstructive Surgery
• Psychiatry
• Pulmonology
• Rheumatology
NETWORK SERVICE PROVIDERS
• Specialist Medicine
• Surgery
• Urology
SPECIALIST NETWORK TARIFFS APPLY TO IN AND OUT-OF-HOSPITAL BENEFITS
ON:
• BonClassic
• BonComplete
• BonSave
• BonFit
• Standard
• Standard Select
• Primary
• Primary Select
• Hospital Standard
• BonEssential
• BonEssential Select
HOW TO ADD A GP TO THE NETWORK
Please encourage your doctor to join the network. You can call 0861 112 666 or email nc@medscheme.co.za and provide the details of
your doctor. The healthcare professional contracting team will follow up with the doctor.
All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Page 21
V1-10Dec2018.GP REFERRAL PROCESS
There is a growing trend of fragmented care, where a number of our beneficiaries are receiving duplicate treatment from multiple doctors
and providers. This leads to poor patient experience and unsatisfactory outcomes. The GP referral process ensures that our members
receive appropriate and effective care. It also helps to ensure that their benefits last longer by avoiding duplication of tests and consultations
with specialists for concerns that can be handled by a GP.
In an effort to enhance the coordination of care, members are required to obtain a referral number from their GP before consulting with
certain specialists. From January 2017, claims for specialist consultations without a valid referral number from a GP have been and will
continue to be rejected (for member’s own pocket) whenever the specialist consultation is payable from Risk.
The following exceptions were approved by Bonitas Medical Fund for all options except BonCap, where the member doesn’t have to obtain
a referral letter:
• One gynaecologist consultation or visit per year for female beneficiaries
• Maternity consultations
• Paediatrician consultations for children under the age of two
• Oncology consultations
• Ophthalmology consultations
HOW TO REGISTER FOR A SPECIALIST REFERRAL AUTHORISATION
Your GP can contact the Bonitas Healthcare Professional call centre on 0861 112 666 and register an authorisation for you or they can use
the online facility.
If your GP refuses to obtain a specialist referral authorisation on your behalf, you must obtain a referral letter from the GP stating which
specialist you are required to visit. You can then call the call centre on 0860 002 108 and the agent will assist you in obtaining a referral
number. The specialist referral authorisations are valid for 6 months per practice type.
On BonCap if you do not obtain a referral a from a Network GP for a specialist consultation, it will not be covered.
Please note: Specialist referral authorisation does not guarantee payment of the consultation. Your claim will be processed subject to
available benefits.
GP REFERRAL PROCESS
All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Page 22
V1-10Dec2018.PMB TREATMENT PLANS
There is a separate benefit for tests and consultations for PMB treatment plans (excluding GP consultations). Therefore, this will not affect
your day-to-day benefits.
Please see an example of a PMB treatment plan below:
Diagnosis Description Start Date End Date
HYPERLIPIDAEMIA 01-Jan-2019 31-Dec-2019
In terms of the approved treatment guideline for your condition, Bonitas Medical Fund will fund the following benefits as per the Fund Rules.
(Please note that certain of these benefits may only be obtained from a Designated Service Provider and co-payments may apply).
Service Description Extended Tariff Codes Disciplines Allowed No. Per
Description Year
Dietician Consultation 84201, 84202, 84203, 84204, 84205 Dieticians 1
ECG Without effort 1232 General Practitioner, 1
Specialist Family
Medicine
ECG 127483, 477387, 643064, 432814, 541369, General Practitioner, 10
413345, 433152, 493663, 588415, 494792, Specialist Family
433004, 444610, 406977, 402971, 431188, Medicine
432717, 405234
GP Consultations 0190, 0191, 0192 General Practitioner, 2
Specialist Family
Medicine
Pathology Alanine 4131 Pathologists 2
aminotransferase (ALT)
Pathology Aspartate 4130 Pathologists 2
aminotransferase
Pathology Chol/HDL/LDL/Trig 4025 Pathologists 1
PMB TREATMENT PLAN
Pathology Cholesterol total 4027 Pathologists 1
Pathology Creatine kinase (CK) 4132 Pathologists 2
Pathology Glucose – Quantitative 4057 Pathologists 1
Pathology HDL cholesterol 4028 Pathologists 1
Pathology LDL cholesterol – 4026 Pathologists 1
Chemical
Pathology Triglyceride 4147 Pathologists 1
PAYMENT OF SERVICES FOR PMB CONDITIONS
Bonitas will pay for the diagnosis, treatment and care of a number of chronic conditions as per the Prescribed Minimum Benefits (PMB)
legislation. To manage the care of these conditions, we have put a Care Plan in place which assigns a basket of care specific to your PMB
condition. Chronic medicine is not included in the Care Plan.
WHAT IS A CARE PLAN?
Your Care Plan is a list of the type and number of services that are likely to be needed by a patient with your diagnosis and that your Scheme
will cover. It includes out-of-hospital treatment such as doctor consultations, radiology and pathology tests that are listed on your Care Plan.
HOW WILL THE CARE PLAN BE COVERED?
As per legislation, you will be provided, at the very least, with the minimum treatment needed for your PMB condition. We will cover the cost
of this treatment. Please note that a DSP (Designated Service Provider) may need to be used to avoid co-payments. If you have available
benefits, this will be used until depleted and then treatment will be paid from the Overall Annual Limit, if clinical criteria are met.
WHAT IF I NEED MORE TREATMENT THAN IS LISTED IN MY CARE PLAN?
If you need treatment and care in excess of your Care Plan, a clinical motivation must be provided and approved before more services will
be covered.
DO I NEED TO DO ANYTHING?
No, this letter is proof that a Care Plan has automatically been put in place. Please make sure that every claim you or your doctor send to us
has an ICD-10 code reflected on it so that it can be identified on the system and paid from the correct benefit.
WHERE DO I SEND MY REQUEST?
You can email pmb@bonitas.co.za.
All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Page 23
V1-10Dec2018.HOW TO CLAIM
Get your claims paid quickly and easily by following these simple steps.
1. Ensure your banking details are correct
We pay claims refunds by electronic transfer (EFT) into your bank account. Please call us on 0860 002 108 if you need to update your
banking details.
2. Check your account and receipt
To allow us to process your claim quickly and efficiently, please make sure that your account and receipt show the following:
• Your name and initials
• Your medical aid number
• Treatment date
• Name of the patient as shown on your membership card
• Amount charged
• Tariff
• ICD-10 code (diagnosis code)
• Healthcare provider’s practice number
Please check that prescriptions for medicine show all the details above as well as the correct amount of medicine dispensed. If the
pharmacy excludes any of these details, we will not be able to process your claim.
3. Check that your claim has been paid
We pay claims weekly. Every month, you will receive a statement showing your claims and available benefits. You can also log in to the
Member Zone to view the status of your claims.
HOW TO CLAIM
All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Page 24
V1-10Dec2018.HOSPITAL PRE-AUTHORISATION
Your in-hospital benefits will depend on the plan you’re on. You must get pre-authorisation for all hospital admissions. This is subject to Fund
Rules and available benefits.
HOSPITAL BENEFITS
Hospital benefits offer cover for major medical events that result in a beneficiary being admitted to hospital. The level of cover you have in
hospital depends on the plan you’ve chosen. We encourage all our members to use healthcare providers on our network, as this will ensure
that the providers are paid in full.
WHAT ARE HOSPITAL CO-PAYMENTS AND WHEN WILL I HAVE TO PAY THESE?
Co-payments are amounts that have to be paid to the hospital directly before
admission.
PLEASE NOTE:
Co-payments will apply in hospital in the following instances:
• If you are required to use a specific network of hospitals and you choose A 30% co-payment will apply to non-network
not to admissions on Standard Select, Primary Select, BonFit
• If you are required to use a Designated Service Provider or preferred and BonEssential Select. A R6 700 co-payment will
provider and you choose not to apply to non-network admissions on BonCap. This will
• There is a list of procedures for which your plan requires you to pay a not apply to emergency admissions.
co-payment on BonSave, BonFit, Primary, Primary Select, Hospital Standard,
BonEssential and BonEssential Select. These are shown in the table below:
R1 450 co-payment R3 680 co-payment R7 250 co-payment
1. Colonoscopy 1. Arthroscopy 1. Back Surgery including Spinal Fusion
2. Conservative Back Treatment 2. Diagnostic Laparoscopy 2. Joint Replacements
3. Cystoscopy 3. Laparoscopic Hysterectomy 3. Laparoscopic Pyeloplasty
HOSPITAL PRE-AUTHORISATION
4. Facet Joint Injections 4. Laparoscopic Appendectomy 4. Laparoscopic Radical Prostatectomy
5. Percutaneous Radiofrequency Ablations
5. Flexible Sigmoidoscopy 5. Nissen Fundoplication (Reflux Surgery)
(Percutaneous Rhizotomies)
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
Please note:
• A R6 000 co-payment will apply if spinal surgery is performed without an assessment and/or intervention by DBC on BonComprehensive,
BonClassic, BonComplete, Standard and Standard Select
• If you do not use the preferred provider for hip and knee replacements, you will have to pay a R6 000 co-payment on BonComprehensive,
BonClassic, BonComplete and Standard
• If you do not use the Designated Service Provider for hip and knee replacements on Standard Select, the procedure will not be covered
HOW DO I FIND A HOSPITAL ON THE NETWORK?
Simply call us on 0860 002 108 and we will assist you, or log in to www.bonitas.co.za and use the ‘Find a Network Provider’ tool. We
negotiate extensively with hospitals to ensure the best possible value for our members.
All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are
All claimstoare
subject paid at the
approval fromBonitas Rate, unless
the Council otherwise
for Medical stated.Version
Schemes. All benefits
01 and limits are per calendar year, unless otherwise stated. Managed Care protocols apply.
- 07SEP2017. Page 25
V1-10Dec2018.PRE-AUTHORISATION
All hospital stays (including emergencies) must be pre-authorised to ensure that your hospital stay is covered. It is best to do this at least two
days before you go to hospital. If you do not get pre-authorisation, you will be liable for the full hospital account.
How do I get pre-authorisation?
Step 1:
Have the following information ready:
• Membership number
• Beneficiary name and date of birth
• Date of admission and proposed date of the operation
• Name of the doctor, his/her telephone number and practice number
• Name of the hospital, the telephone number and practice number
• All the relevant procedure and associated medical diagnosis codes (your doctor can assist you with this)
Step 2:
Call us on 0860 002 108
or
Email the information in Step 1 to us at hospital@bonitas.co.za
Step 3:
Once your procedure has been authorised, you will receive a letter confirming pre-authorisation by email or post. This letter contains
important information about your hospital stay. Please make sure that you read and understand the contents of the letter, as it explains how
your procedure will be covered. If you are unsure of anything, please discuss the letter with your doctor.
Please note the following pre-authorisation information provided in the letter:
• The unique pre-authorisation number
• The initial approved length of stay
HOSPITAL PRE-AUTHORISATION
• The status of all the codes (whether approved or rejected in accordance with the Fund Rules)
WHAT ABOUT EMERGENCIES?
Emergencies must be pre-authorised within 48 hours of admission to hospital or on the first working day after a weekend or public holiday.
No account will be paid unless pre-authorisation is obtained.
WHAT OTHER TREATMENTS OR PROCEDURES REQUIRE PRE-AUTHORISATION?
You will also need pre-authorisation for the following:
• Renal clinic admissions for dialysis
• Procedures in the doctors rooms instead of hospitalisation
• Physical rehabilitation care in rehabilitation facilities
• Drug and alcohol rehabilitation in specific facilities
• Hospice admissions
• Oxygen therapy at home
• All specialised radiology (such as MRIs and CT scans)
WHY ARE SOME REQUESTS FOR PRE-AUTHORISATION DECLINED?
Pre-authorisation requests may be declined if:
• The planned procedure is not covered by your benefit option as specified in the Fund Rules
• The planned procedure is not in line with the acceptable treatment standards for a particular condition
• The appropriate clinical information has not been received
• Your Bonitas membership is inactive
All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are
All claimstoare
subject paid at the
approval fromBonitas Rate, unless
the Council otherwise
for Medical stated.Version
Schemes. All benefits
01 and limits are per calendar year, unless otherwise stated. Managed Care protocols apply.
- 07SEP2017. Page 26
V1-10Dec2018.THE ROLE OF HOSPITAL CASE MANAGERS
While you are in hospital, case managers ensure that the appropriate care is provided at all times and that the appropriate discharge
planning takes place where clinically indicated and where benefits are available. This takes place according to the Fund Rules, clinical
protocols and funding guidelines.
When extended length of stay or level of care is requested, the case manager will request supporting information to be able to make an
informed clinical decision. If there is any doubt at all, a medical adviser will assist and motivation might be requested from your treating
provider, if needed. All changes in initial approvals are communicated to the hospital and treating provider. With long-term cases, your
family members may also be involved.
HOSPITAL PRE-AUTHORISATION
FOR HOSPITAL PRE-AUTHORISATION
Call: 0860 002 108
Email: hospital@bonitas.co.za
All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are
All claimstoare
subject paid at the
approval fromBonitas Rate, unless
the Council otherwise
for Medical stated.Version
Schemes. All benefits
01 and limits are per calendar year, unless otherwise stated. Managed Care protocols apply.
- 07SEP2017. Page 27
V1-10Dec2018.HOSPITAL NETWORKS
HOSPITAL
SUBURB/TOWN/ STANDARD PRIMARY BONESSENTIAL
NAME BONFIT
CITY SELECT SELECT SELECT
EASTERN CAPE
Life Beacon Bay Hospital Beacon Bay ✓ ✓ ✓ ✓
Life East London Private Hospital East London ✓ ✓ ✓ ✓
Life St Dominic's Hospital Southernwood ✓ ✓ ✓ ✓
Life St James Hospital Southernwood ✓ ✓ ✓ ✓
Netcare Cuyler Hospital Uitenhage ✓ ✓ ✓ ✓
Netcare Greenacres Hospital
Greenacres ✓ ✓ ✓ ✓
(Pty) Ltd
Netcare Port Alfred Private
Port Alfred ✓ ✓ ✓ ✓
Hospital
Netcare Settlers Private Hospital Grahamstown ✓ ✓ ✓ ✓
FREE STATE
Mediclinic Bloemfontein Westdene ✓ ✓ ✓ ✓
Mediclinic Hoogland Bethlehem ✓ ✓ ✓ ✓
Mediclinic Welkom (Pty) Ltd Welkom ✓ ✓ ✓ ✓
Netcare Kroon Hospital Kroonstad ✓ ✓ ✓ ✓
HOSPITAL NETWORKS
Netcare Pelonomi Private Hospital Heidedal ✓ ✓ ✓ ✓
Netcare Vaalpark Hospital Vaalpark ✓ ✓ ✓ ✓
Universitas Private Hospital Universitas ✓ ✓ ✓ ✓
GAUTENG
Clinix Botshelong - Empilweni
Vosloorus Ext 9 ✓ ✓ ✓ ✓
Private Hospital
Clinix Naledi-Nkanyezi Private
Sebokeng ✓ ✓ ✓ ✓
Hospital
Clinix Tshepo - Themba Private
Dobsonville ✓ ✓ ✓ ✓
Hospital
Dr S K Matseke Memorial Hospital Diepkloof Zone 6 ✓ ✓ ✓ ✓
Intercare Medfem Hospital (Pty)
Bryanston ✓ ✓ ✓ ✓
Ltd
Lakeview Hospital Benoni ✓ ✓ ✓ ✓
Mediclinic Emfuleni Vanderbijlpark ✓ ✓ ✓ ✓
Mediclinic Gynaecological
Sunnyside ✓ ✓ ✓ ✓
Hospital
Mediclinic Heart Hospital Arcadia ✓ ✓ ✓ ✓
Mediclinic Kloof Erasmuskloof Ext 3 ✓ ✓ ✓ ✓
Mediclinic Legae Mabopane ✓ ✓ ✓ ✓
Mediclinic Medforum Arcadia ✓ ✓ ✓ ✓
Mediclinic Midstream Midstream Estate ✓ ✓ ✓ ✓
All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are
All claimstoare
subject paid at the
approval fromBonitas Rate, unless
the Council otherwise
for Medical stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply.
Schemes. Page 28
V1-10Dec2018.HOSPITAL
SUBURB/TOWN/ STANDARD PRIMARY BONESSENTIAL
NAME BONFIT
CITY SELECT SELECT SELECT
GAUTENG
Mediclinic Morningside Morningside ✓ ✓ ✓ ✓
Mediclinic Muelmed Arcadia ✓ ✓ ✓ ✓
Mediclinic Sandton Bryanston ✓ ✓ ✓ ✓
Mediclinic Vereeniging Vereeniging ✓ ✓ ✓ ✓
Netcare Akasia Hospital Karenpark ✓ ✓ ✓ ✓
Netcare Bell Street Hospital Noordheuwel ✓ ✓ ✓ ✓
Netcare Bougainville Private
Daspoort ✓ ✓ ✓ ✓
Hospital
Netcare Clinton Hospital New Redruth ✓ ✓ ✓ ✓
Netcare Femina Hospital Arcadia ✓ ✓ ✓ ✓
Netcare Garden City Hospital Mayfair West ✓ ✓ ✓ ✓
Netcare Jakaranda Hospital Muckleneuk ✓ ✓ ✓ ✓
Netcare Krugersdorp Hospital Krugersdorp ✓ ✓ ✓ ✓
Netcare Linksfield Hospital Linksfield West ✓ ✓ ✓ ✓
Netcare Linkwood Hospital Linksfield West ✓ ✓ ✓ ✓
Netcare Linmed Hospital Rynfield ✓ ✓ ✓ ✓
Netcare Milpark Hospital Parktown West ✓ ✓ ✓ ✓
HOSPITAL NETWORKS
Netcare Montana Private Hospital Montanapark ✓ ✓ ✓ ✓
Netcare Moot General Hospital Rietfontein ✓ ✓ ✓ ✓
Netcare Mulbarton Hospital Mulbarton ✓ ✓ ✓ ✓
Netcare N17 Private Hospital (Pty)
Pollak Park ✓ ✓ ✓ ✓
Ltd
Netcare Olivedale Hospital Olivedale ✓ ✓ ✓ ✓
Netcare Optiklin Eye Hospital Lakefield ✓ ✓ ✓ ✓
Netcare Park Lane Hospital Parktown ✓ ✓ ✓ ✓
Netcare Pinehaven Hospital Pine Haven ✓ ✓ ✓ ✓
Netcare Pretoria East Hospital Moreletapark ✓ ✓ ✓ ✓
Netcare Rand Hospital Berea ✓ ✓ ✓ ✓
Netcare Rosebank Hospital Rosebank ✓ ✓ ✓ ✓
Netcare Sunninghill Hospital Sunninghill ✓ ✓ ✓ ✓
Netcare Sunward Park Hospital Sunward Park ✓ ✓ ✓ ✓
Netcare Union Hospital Alberton ✓ ✓ ✓ ✓
Netcare Unitas Hospital Lyttelton Manor ✓ ✓ ✓ ✓
Netcare Waterfall City Hospital Midrand ✓ ✓ ✓ ✓
Stix Morewa Memorial Hospital Selby ✓ ✓ ✓ ✓
Wits University Donald Gordon
Parktown ✓ ✓ ✓ ✓
Medical Centre
All claims are paid at the Bonitas Rate, unless otherwise stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply. Benefits are
All claimstoare
subject paid at the
approval fromBonitas Rate, unless
the Council otherwise
for Medical stated. All benefits and limits are per calendar year, unless otherwise stated. Managed Care protocols apply.
Schemes. Page 29
V1-10Dec2018.You can also read
