BonCap Product Brochure

2015
BonCap
Product Brochure
Bonitas Medical Fund I 0860 002 108 I www.bonitas.co.za
You can’t put a price
on experience…
With a proudly South African heritage spanning over 32 years, Bonitas has an intimate
understanding of how the healthcare industry works. Our aim is to make quality healthcare
accessible to all South Africans and add value to their lives.
Affordable and generous, our benefits are designed to give our members more value for money.
We have a wide range of products that are simple to understand so you know exactly what you’re
covered for. They’re also easy to use, ensuring you get the support you need when you need it.
Our members know that when things get tough, we’re there to support them and take care of
the little details so that they can receive the best of care and focus on getting better.
Please note: The information contained in this brochure is subject to terms and conditions. Scheme Rules apply. Version CMS01/2015
BonCap Benefits 2015 Page 2
Why choose
Bonitas?
We’re South Africa’s second largest open medical scheme
We cover 293 700 main members and 650 600 lives in total.
Main members
Dependants
Our reputation speaks for itself
Financially sound and reliable, we have over 32 years of experience in the healthcare industry.
We support our members
We aim to provide value-for-money healthcare benefits and add value to our members’ lives.
We pay out more claims than any other open medical scheme – 93%
We’re fully committed to making healthcare more affordable for all South Africans and pay out 93% of all claims – the highest by an open medical scheme.
We:
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Have the largest GP network in SA
Are the only medical scheme to pay for dental benefits
from risk
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Offer free flu vaccines and HIV tests on all options
Pay supplementary benefits from risk so savings and
day-to-day benefits last longer
Check us out online
Visit our website at www.bonitas.co.za to learn more about our products.
BonCap Benefits 2015 Page 3
10 reasons to choose
BonCap
1
Your premiums are based on your earnings
BonCap premiums are income-based. This means your premium will depend on the income-band you fall into. We
require proof of earnings and will verify income to ensure there is no fraudulent activity. We look at the highest
individual income in the family and not household income. Income reviews are done at the beginning of each
benefit year.
2
Unlimited hospitalisation* in the BonCap hospital network at 100% of the
Bonitas Rate
BonCap may be an entry-level plan, but we offer you cover when you really need it. Our hospital benefits include:
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R20 700 per family for pathology while in hospital
R9 450 per family for CT scans and MRIs in hospital
R3 500 for physical therapy and paramedical services in hospital
Flexibility for GP consultations
BonCap allows members to visit any GP on the BonCap Network, they do not have to elect a GP for all visits as is
the case with other schemes.
4
Cover when you need to visit a specialist
We understand our members may require specialist care, that’s why BonCap offers 3 specialist consultations per
beneficiary (limited to R2 550) and up to 5 specialist consultations per family (limited to R3 770).
5
Chronic cover for 26 PMB conditions and delivery of your medicine to you
6
Bring your baby into the world with the best possible start
BonCap gives you and your dependants cover for 26 chronic conditions using the Restrictive Formulary. Your
medicine will be delivered to you through Pharmacy Direct. MyCare is responsible for authorisation.
Our maternity benefits are rich and include R37 000 for neonatal care per family per year. You’ll also be covered at
100% of the Bonitas Rate in a network hospital to give birth.
7
Wellness benefits to keep you and your loved ones healthy
BonCap offers each beneficiary one wellness assessment a year at a registered provider. This includes:
• A blood pressure test
• A BMI test
• A glucose test
• A hip to waist ratio measurement
• A cholesterol test
8
Cover for dentistry and optometry
We cover conservative dentistry for you and your family including 1 consultation and 1 preventative treatment
per person per year. We also cover 1 set of plastic dentures per family every two years. In addition, we offer a pair
of glasses per beneficiary and one eye examination per person once every two years.
9
Supplementary benefits to help your other benefits last longer
Our supplementary benefits are paid from risk so they don’t impact on your other benefits. They include:
• Emergency medical transport from ER24
• R4 450 per family for general appliances such as wheelchairs
• A flu vaccine and HIV test per person once a year
10 Dedicated customer service channels
We offer BonCap members access to a call centre which caters exclusively for them. This allows us to resolve
queries and assist you quickly and easily.
* Terms and conditions apply
BonCap Benefits 2015 Page 4
BonCap is our entry-level product that offers access to network providers and hospitals. Designed to help us achieve our
aim of making private healthcare more affordable for all South Africans, BonCap offers basic day-to-day benefits and
hospital cover.
What it costs
You earn
Main member
Adult dependant
Child dependant
R500 or less
R330
R313
R155
R501 to R6 100
R675
R640
R318
R6 101 to R9 950
R821
R776
R376
R9 951 to R13 950
R1 338
R1 192
R507
R13 951 or more
R1 643
R1 463
R623
In-hospital benefits
Unlimited hospitalisation in the BonCap hospital network at 100% of the Bonitas Rate
Hospitalisation is covered at 100% of the Bonitas Rate at all hospitals on the BonCap Network. You must pre-authorise your stay
(except for emergencies). A R5 350 co-payment must be paid if you use a non-network hospital (except for emergencies) or you
do not get pre-authorisation.
There is no overall limit on your hospital cover. You will have cover for medical admissions; childbirth (other than Caesarian sections
done for non-medical reasons) and surgical admissions except for the procedures listed as not covered.
We cover PMB surgical admissions which include procedures such as appendix removal, gallstone surgery, kidney stone treatment,
heart surgery, trauma surgery, repair of broken bones, cancer surgery, as well as all medical emergencies. The pre-authorisation
department will be able to assist you in determining whether or not a procedure qualifies for cover as a PMB.
Surgeries that are not covered include back and neck surgery, joint replacements and repairs, colonoscopies and gastroscopies,
hernia repair, Bunion surgery, laparoscopic surgery, nasal/sinus surgery and varicose vein surgery. Some procedures that will also not
be covered are spine facet block injections, percutaneous rhizotomies, robotic surgery, dental surgery, transcatheter aortic valve
implantation, implantable cardiac defibrillators and surgery for cosmetic reasons.
You also get the following:
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Unlimited GP and Specialist consultations for network
doctors while in hospital
R20 700 per family for pathology in hospital
R9 450 per family for CT scans and MRIs in hospital
R3 500 for physical therapy (physiotherapy, occupational
therapy and biokinetics) and paramedical services while in
hospital
Cover for organ transplants for Prescribed Minimum Benefit
conditions
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Cover for general radiology in hospital
Cover for HIV immune deficiency (subject to MyCare
registration and protocols)
Cover for physical rehabilitation (subject to using the
contracted provider)
R11 650 per family for alternatives to hospitalisation such
as nursing and out-patient antibiotic therapy
R310 per person for admission for medicine on discharge
BonCap Benefits 2015 Page 5
Out-of-hospital benefits
GP benefits that treat you right
You and your dependants get 12 GP consultations to use on the BonCap network. A maximum of 2 visits per family (maximum of
R850) may be out-of-network with a 20% co-payment.
Non-GP pooled benefit
This benefit is to be used for GP-referred radiology, pathology and acute medicine.
Main member only
Main member + 1
Main member + 2
Main member + 3
Main member + 4 or more
R1 500
R2 500
R3 000
R3 300
R3 600
Specialist benefits for the best of care
Specialist consultations are limited to 3 visits or R2 550 per beneficiary up to 5 visits or R3 770 per family. This limit must cover all
associated claims prescribed by the specialist such as acute medicines, pathology, basic radiology and specialised radiology.
Over-the-counter medicine is covered
BonCap members get R215 per person per year for over-the-counter medicine at network providers. This is limited to a maximum
of R75 per event, three times a year.
Dental benefits to put a smile on your face
We cover you and your family for conservative dentistry (such as cleaning and polishing) as follows:
• 1 consultation per person per year
• 1 preventative treatment per person per year
• 1 set of plastic dentures per family, every two years for beneficiaries over the age of 21 and a 20% co-payment applies
Optical benefits to help you see clearly
Optical benefits work on a 2-year cycle so you can only access your benefits once every two years. You get:
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1 pair of glasses per person (for approved lenses and frames)
1 eye examination per person per year
You must use the contracted provider.
Paramedical services are also covered for Prescribed Minimum Benefits
Paramedical services such as occupational therapy, speech therapy, dietetics and nursing services will be covered for Prescribed
Minimum Benefit conditions only.
Oncology is covered for Prescribed Minimum Benefits
On BonCap, you get cover for oncology in and out of hospital. This must be pre-authorised and a preferred provider must be used.
100% cover for chronic renal dialysis
We cover renal dialysis at 100% of the Bonitas rate for Prescribed Minimum Benefit conditions at a network provider.
BonCap Benefits 2015 Page 6
Maternity benefits that bring your baby into the world with the best start
You get R37 000 for neonatal care per family per year. Your hospital stay will be covered at 100% of the Bonitas Rate provided that you
pre-authorise it and use a network hospital. You’ll also get the Bonitas baby pack which features a beautiful baby bag and goodies for
both mom and baby. Caesarian sections for non-medical reasons are not covered.
Wellness benefits to keep you in tip-top condition
BonCap offers each member and their dependants one wellness assessment a year. This must be done by a registered provider and
includes.
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A blood pressure test
A glucose test
A cholesterol test
A BMI test
A waist to hip ratio measurement
Chronic cover for Prescribed Minimum Benefits at a DSP
BonCap gives you and your dependants full cover for 26 chronic conditions and delivers your medicine to you through Pharmacy Direct.
1.
2.
3.
4.
5.
6.
7.
Addison’s disease
Asthma
Bipolar disorder
Bronchiectasis
Cardiac failure
Cardiomyopathy
Chronic obstructive pulmonary
disease
Chronic renal disease
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
Coronary artery disease
Crohn’s disease
Diabetes insipidus
Diabetes Type 1
Diabetes Type 2
Dysrhythmias
Epilepsy
Glaucoma
Haemophilia
18.
19.
20.
21.
22.
23.
24.
25.
26.
Hyperlipidaemia
Hypertension
Hypothyroidism
Multiple sclerosis
Parkinson’s disease
Rheumatoid arthritis
Schizophrenia
Systemic lupus erythematosus
Ulcerative colitis
You will have to pay a 40% co-payment for medicine not listed on the formulary or if you do not use Pharmacy Direct. MyCare will be
responsible for chronic and HIV medication authorisation subject to pre-authorisation.
Supplementary benefits
Our supplementary benefits are paid from risk so they won’t impact your day-to-day or hospital benefits. They can be used for
treatment in and out of hospital and are designed to give you more value for money.
Ensure peace of mind with mental health benefits
Mental health is covered for Prescribed Minimum Benefit conditions in and out of hospital at the contracted network providers.
Benefits for appliances such as wheelchairs
We offer the following benefits:
• R4 450 per family for general appliances such as wheelchairs and stoma products (excluding hearing aids, foot orthotics and
CPAP machines)
• Unlimited cover for oxygen and home ventilation if pre-authorised
You also get:
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Cover for internal prostheses for Prescribed Minimum Benefit conditions
Emergency medical transport from ER24
If you’re looking for basic cover and don’t mind using a specific
network, then BonCap is the option for you.
BonCap Benefits 2015 Page 7
Contact us
BonCap members have dedicated customer service channels
We offer BonCap members access to a customer service centre which caters exclusively for them. This allows us to resolve
queries and assist you quickly and easily.
Call 0861 239 333 between 08:30 and 17:00, Monday to Friday.
Email us at boncap@bonitas.co.za
Visit one of our walk-in centres
Resolve queries; get a new membership card and so much more at our walk-in centres.
Pretoria
Polokwane
Rustenburg
Roodepoort
Vereeniging
Johannesburg
Cape Town
Lephalale
Secunda
Northam
Durban
Kathu
Bloemfontein
Port Elizabeth
Ground Floor, Benstra Building,
473B Church Street,
Arcadia,
Pretoria
36 Merriman Avenue,
Ground Floor,
Vereeniging
Grand Palace, Unit 82,
2302 Heinis Street,
Secunda
6 Rietbok Street,
Kathu,
Northern Cape
Ground Floor, Bonitas House,
22 Hans van Rensburg Street,
Polokwane
Mathomo Mall, 115 Main
Street,
Marshalltown,
Johannesburg
180 Botha Street,
Northam
Shop C7, 1st Floor, Middestad
Centre,
c/o Charles and West Burger
Street,
Bloemfontein
141 Fatima Bhayat Street,
Rustenburg
The Icon Building, Ground Floor,
Corner Lower Long Street and
Hans Strydom Avenue,
Cape Town
37 Conrad Road,
Florida North,
Roodepoort
Onverwacht Business,
Mienie Building, Block C,
Walter Sisulu Avenue,
Lephalale
3rd Floor,
67 Old Fort Road,
Durban
Block 6, Greenacres Office Park,
2nd Avenue, Newton Park,
Port Elizabeth
Check us out online
Visit our website at to learn more about our products. You can also join us on Facebook and get health tips, benefit information
and much more. www.bonitas.co.za I www.facebook.co.za/BonitasMedicalFund
Bonitas Medical Fund I 0860 002 108 I www.bonitas.co.za