Transcription of Benefits - Interpharm
1 Benefits11 Reimbursement rate of healthcare practitioners in hospital medical specialistsTo choose your option, consider your healthcare needs in the three main benefit categories listed 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 Benefit Management (HBM), except in the case of BonSaveStandardPrimaryBonCapLimitUnlimit edUnlimitedUnlimitedR600 000 per family per annumR500 000 per family per annumReimbursement Rate1300% Bonitas Rate150% Bonitas Rate100%Bonitas Rate100% Bonitas Rate100%Bonitas RateProviderAny hospitalAny hospitalAny hospitalAny hospitalPrime Cure Hospital Network Chronic BenefitsChronic Benefits cover medicine for conditions that require medication on an ongoing basis.
2 Subject to pre-authorisation by Chronic Medicine Management. BonComprehensiveBonSaveStandardPrimaryBo nCapUnlimited63 conditions Comprehensive FormularyPrescribed Minimum Benefits only at Designated Service Provider(26 conditions)R6 500 per beneficiary R13 000 per family44 conditionsComprehensive FormularyPrescribed Minimum Benefits only at Designated Service Provider(26 conditions)Prescribed Minimum Benefits only at Designated Service Provider(26 conditions)Any Pharmacy or Dispensing GPPharmacy DirectAny Pharmacy or Dispensing GP up to limit PMBs unlimited at DSPP harmacy DirectPrime Cure Network PharmacyOut of Hospital BenefitsOut of hospital Benefits cover day to day medical expenses incurred out of hospital. New Generation OptionsTraditional OptionsLow Cost CapitationBonComprehensiveBonSaveStandar dPrimaryBonCapSavings account enables members to self-insure and manage their own out of hospital medical expenses.
3 Unspent savings are carried forward with interest. An insured threshold benefit on BonComprehensive provides additional peace of mind for high out of hospital of hospital expenses are insured via a flexible day to day benefit. Dental, optical, radiology and pathology Benefits are provided in addition to the day to day of hospital expenses are managed without financial limits by the Prime Cure five affordable options provide quality health cover for everybody, from the CEO to the factory worker. Select an option to optimise the balance between affordability and richness of Benefits to suit your personal healthcare Medical BenefitCovers medical expenses in hospital and major medical eventsChronic BenefitCovers medicine for conditions that require medication on an ongoing basisSupplementary BenefitAdditional Benefits , medical expenses incurred in or out of hospitalOut of Hospital BenefitCovers out of hospital medical expensesBonitas Benefit Structure and OptionsAnybody may fall ill at any time from dad to John Junior.
4 Which is why we d like to offer you the peace of mind of knowing that with Bonitas, everybody you love is adequately covered - from head to toe. That is our focus. It s lovely. 0860 002 108 Bonitas Medical Fund we are leading the pack in affordable, quality medical cover. Which is why we are voted the No. 1 Medical Aid Brand in South Africa*. 0860 002 108 *Markinor/Sunday Times Top Brand Surveyseen by everybody as the medical fund in South Africa3 Supplementary BenefitsAdditional Benefits , medical expenses incurred in or out of hospitalMaternity Care per event (ante- and postnatal)Unlimited hospitalisation (subject to pre-authorisation) and midwifery servicesAntenatal classes to the value of R750 and private ward for post-delivery12 antenatal consultations, 2 X 2D scans and 4 postnatal consultations with midwife Refractive SurgeryR11 000 per familySubject to pre-authorisationImmune deficiency relatedto HIV infectionUnlimitedSubject to Aid for AIDS (AFA) registration and clinical protocolsMental Health BenefitsR30 000 per family, subject to pre-authorisationSub-limit of R10 000 for consultations in & out of hospitalSpecialised Radiology (out of hospital)
5 R22 000 per familySubject to pre-authorisationEmergency Transportation Unlimited, subject to Netcare 911 Endoscopies in practitioners roomsUnlimited, subject to Internal Prostheses ExternalR38 000 per family R38 000 per familySubject to pre-authorisationHIV test and Flu vaccineFreeInternational coverR5 million per tripAppliancesGeneral appliancesR6 500 per familyWheelchairs & largeorthopaedic appliancesIncluded in the general appliance limitStoma products & CPAP machinesMay exceed general appliance limit by R3 000 Hearing aidsR20 000 per family, biennial benefit Oxygen: Home ventilationUnlimited, subject to pre-authorisation by HBM Out of Hospital BenefitCovers day to day medical expenses GP & specialist consultations, acute medication, paramedical/auxiliary services, optometry, radiology, pathology BenefitPer MonthPer AnnumPrincipal MemberAdult DependantChild DependantR 422R 398R 86R5 064R4 776R1 032 Threshold BenefitThresholdSelf-Funding GapPrincipal MemberAdult DependantChild DependantR6 500R6 000R1 700R1 436R1 224R 668 Acute Medication & Pharmacy Advised TherapyMember Member + 1 Member + 2 Member + 3 +Subject to savings and/or thresholdThe following limits apply:R8 000R9 500R12 000R13 000(90% of the Bonitas rate accrues to threshold.)
6 10% co-payment in threshold)GP and Specialists ConsultationsSubject to savings and/or threshold, unlimited in thresholdGeneral RadiologySubject to savings and/or threshold, unlimited in thresholdPathologySubject to savings and/or threshold, unlimited in threshold1 Paramedical Services/ Auxiliary Services speech therapy, occupational therapy, physiotherapy Subject to savings and/or threshold, limited to R5 500 per familyOptometry Subject to savings and/or threshold, limited to R2 250 per beneficiaryIn addition: Dental BenefitsBasic DentistrySubject to clinical protocols & Bonitas Dental Tariff (BDT)3 Advanced DentistrySubject to clinical protocols & Bonitas Dental Tariff (BDT)3 BonComprehensiveContributionsPrincipal MemberAdult DependantChild DependantRisk R1 687 R1 591R343 SavingsR 422R 398R 86 Total R2 109R1 989R429 WHAT IT WILLCOST1 Subject to pathology management programme - Pathology programme2 Comprehensive formulary, refer to page 12 for a complete chronic disease list3 Comprehensive list of dental Benefits (DENIS)
7 Page 13 Major MedicalUnlimited 300% Bonitas RateChronic Medication63 Chronic Conditions at any service providerOut of HospitalSavings & Threshold Plus Basic & Advanced DentistrySupplementaryAdditional Benefits in or out of hospitalBonComprehensiveMajor Medical BenefitsThis benefit covers medical expenses incurred in hospital, as well as major medical events oncology. All hospital admissions, oncology treatment plans and renal dialysis require pre-authorisation by Hospital Benefit Management (HBM) except in the case of Annual LimitUnlimitedBenefits payable at 300% of the Bonitas RateSub-limits applicable:GP & Specialist ConsultationsUnlimited, 300% Bonitas ratePathologyUnlimited1 Radiology (Specialised & General)UnlimitedParamedical/Auxiliary Services physiotherapy, speech therapy, occupational therapy Unlimited OncologyBiological drugs HerceptinUnlimited, sub-limit ofR450 000 for medicineR150 000 per family, subject to clinical protocols and 10% co-paymentOrgan TransplantsUnlimitedRenal DialysisUnlimitedMaxillo Facial SurgeryUnlimited, excluding orthognatic surgery Medication to take out (TTO)R350 per beneficiary, per admissionPhysical RehabilitationR30 000 per familyChronic Medicine Benefits2 Covers medication for conditions that require medication on an ongoing cover for 63 diseases, subject to pre-authorisation Biological drugs.
8 R120 000 per family, subject to clinical protocols and 10% co-paymentThis Summary is for information purposes only and does not supersede the Rules of the Fund. In the event of any discrepancy between the Summary and the Rules, the Rules will prevail. BonComprehensive is a new generation product with a threshold benefit to provide members with peace of mind. Major medical expenses are covered at 300% of the Bonitas rate. It covers a wide range of chronic diseases at any service provider and unlimited hospitalisation with no hospital MemberAdult DependantChild DependantRisk R685 R531R206 SavingsR228R177R 69 Total R913R708R275 WHAT IT WILLCOSTThis Summary is for information purposes only and does not supersede the Rules of the Fund. In the event of any discrepancy between the Summary and the Rules, the Rules will prevail.
9 Chronic Medicine Benefits2 Covers medication for conditions that require medication on an ongoing basis. Chronic Disease List (CDL) as per the Prescribed Minimum Benefits (PMB), at the Designated Service Provider (DSP), subject to pre-authorisationOut of Hospital BenefitsCovers day to day medical expenses GP & specialist consultations, acute medication, paramedical/auxiliary services, optometry, radiology, pathology BenefitPer MonthPer AnnumPrincipal MemberAdult DependantChild DependantR228R177R 69R2 736R2 124R 828 Acute Medication & Pharmacy Advised TherapySubject to savingsGP & Specialist ConsultationSubject to savingsGeneral Radiology Subject to savings PathologySubject to savings1 OptometrySubject to savingsParamedical/Auxiliary Services speech therapy, occupational therapy, physiotherapySubject to savingsIn addition.
10 Dental BenefitsBasic DentistrySubject to clinical protocols and Bonitas Dental Tariff (BDT)3 Advanced DentistrySubject to clinical protocols and Bonitas Dental Tariff (BDT)3 Supplementary BenefitsAdditional Benefits ; medical expenses incurred in or out of hospitalMaternity Care per event(ante- and postnatal)Unlimited hospitalisation (subject to pre-authorisation) and midwifery services Antenatal classes to the value of R750 and private ward for post-delivery12 antenatal consultations, 2 X 2D scans and 4 postnatal consultations with midwife Immune deficiency relatedto HIV infectionR20 000 per beneficiarySubject to Aid for AIDS (AFA) registration and clinical protocolsMental Health Benefits R20 000 per family, subject to pre-authorisationSub-limit of R10 000 for in & out of hospital consultationsSpecialised Radiology (out of hospital)