Helpful Hints

Phone a consultant TODAY!

News

Sizwe Medical Fund under provincial curatorship

Quote of the day

Bonitas

WHY BONITAS

Affordable, quality healthcare for all South Africans
Largest GP network and a specialist network to give more value for money
A wide range of plans including savings, traditional, income based and hospital options
Cover for up to 60 chronic conditions and free medicine delivery
Partnerships with quality service providers and healthcare professionals
Preventative care and wellness benefits paid from risk so benefits last longer
Additional benefits for maternity and children, including access to 24/7 paediatric telephonic
advice, 365 days a year
Managed Care programmes to help members manage a range of conditions including cancer, mental health,
HIV/AIDS and diabetes
Separate benefits for dentistry and optometry on several options, paid from risk
Simple, easy to use benefits

IMPORTANT INFORMATION

PREFERRED PROVIDERS AND DESIGNATED 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.
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.

UNDERSTANDING THE BONITAS RATE
The Bonitas Rate is the rate at which we reimburse healthcare providers. Where we pay 100% of the Bonitas Rate and your healthcare provider charges more than this, you will have to pay the outstanding amount. For example, if you visit a healthcare provider that charges 200% of the medical aid rate and you receive a bill of R1 000, we will
only pay R500. If you visit a healthcare provider that charges the Bonitas Rate, we will pay the bill in full
(provided that you have benefits available). On some options we pay more than 100% of the Bonitas Rate.

UNDERSTANDING THE SELF-PAYMENT GAP
On BonComprehensive and BonComplete, once you have finished your savings for the year, you will reach the self-payment gap. The self-payment gap shows an amount for out-of-hospital expenses you must pay before you can access the above threshold benefit.

DEPENDANTS
An adult dependant is any dependant on your medical aid who is 21 years or older. A child dependant is any dependant on your medical aid who is under 21 years. If your child is a student and is registered on your medical aid, child rates will apply up to and including the last day of the month in which he/she turns 24 years old. We will require valid proof of registration from a recognised tertiary institution for child rates to apply to a student.

UNDERWRITING
Late-joiner penalties and waiting periods may apply to your membership. This is a requirement of the Medical Schemes Act 131 of 1998. A late-joiner penalty applies to members 35 years of age or older, who have had a break
in medical aid membership for more than 3 months from 1 April 2001. Late-joiner penalties will result in your premium being increased. This is based on a specific calculation considering the number of years you have not been a member of a medical aid. A general waiting period lasts 3 months. During this period you and your dependants are
not entitled to claim any benefits, except, Prescribed Minimum Benefits (PMB) in some circumstances.
A condition-specific waiting period lasts 12 months. During this period you and your dependants are not entitled to claim benefits related to a specific condition. Please refer to Annexure D of the Scheme Rules for more information. Visit www.bonitas.co.za for the latest version.

PRORATION OF BENEFITS
If you join Bonitas during the year, benefits will automatically be prorated. This means that you will only have access to a percentage of your benefits, based on the month you join us, until the next benefit year begins. For example, if you join in July, you will have access to six months’ worth of benefits, which is 50% of the total benefits.

PROVIDERS ON THE NETWORK WILL BE PAID IN FULL
We encourage all our members to use providers on our network, as this will ensure that
providers are paid in full (provided that you have benefits available).