2010 Sales Brochure Version 6 by byrnetown78

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									BonEssential
                                                                                          Major Medical                               Chronic Medication                             Out of Hospital                               Supplementary
                                                                                          Unlimited                                   PMBs only at DSP                               Basic & Advanced                              Additional Benefits
                                                                                          200% Bonitas Rate                                                                          Dentistry                                     in or out of hospital
Are you young and vibrant? Are you looking for a hospital
plan with a difference – one that has dentistry benefits and
is also affordable? Then BonEssential is for you. Simple. So
before you continue with your punching bag, isn’t it a treat
to know in these tough times, there’s a solution that is unique
and won’t put you out of limb?
                                                                                        Chronic Medicine Benefits2                                                                           Supplementary Benefits
Major Medical Benefits                                                                  Covers medication for conditions that require medication                                             Additional benefits, medical expenses
Major medical expenses are covered at 300% of Bonitas                                   on an ongoing basis.                                                                                 incurred in or out of hospital
tariff. This benefit includes major medical events. All hospital                        Chronic Disease List (CDL) as per the Prescribed Minimum
                                                                                        Benefits (PMB), at the Designated Service Provider (DSP),                                            Maternity Care per event              Unlimited hospitalisation (subject
admissions, oncology treatment plans and renal dialysis
                                                                                                                                                                                             (ante- and postnatal)                 to pre-authorisation) and
require pre-authorisation by Hospital Management except                                 subject to pre-authorisation
                                                                                                                                                                                                                                   midwifery services
in case of emergencies.                                                                                                                                                                                                            Antenatal classes to the value
                                                                                                                                                                                                                                   of R750 and private ward for
                                                                                        Out of hospital Benefits                                                                                                                   post-delivery
Overall Annual Limit                            Unlimited
                                                                                                                                                                                                                                   12 antenatal consultations,
                                                                                        No benefits for out of hospital expenses, except for the diagnosis,
Benefits payable at 200% of the Bonitas Rate                                                                                                                                                                                       2 X 2D scans and 4 postnatal
                                                                                        treatment and care of Prescribed Minimum Benefits where                                                                                    consultations with midwife
Sub-limits applicable:                                                                  appropriate.                                                                                         Immune deficiency related             R22 000 per beneficiary
GP & Specialist Consultations                   Unlimited, 200% Bonitas rate                                                                                                                 to HIV infection                      Subject to Aid for AIDS (AfA)
Pathology                                       Unlimited1                              In addition: Dental Benefits                                                                                                               registration and clinical protocols
Radiology (Specialised & General)               Unlimited                                                                                                                                    Mental Health Benefits                R20 000 per family, subject to
                                                                                        Basic Dentistry                Subject to clinical protocols & Bonitas Dental
Paramedical Services (Allied Medical            Unlimited                                                                                                                                                                          pre-authorisation
                                                                                                                       Tariff (BDT)3
Professions)e.g. speech therapy,                                                                                                                                                                                                   Sub-limit of R10 000 for in & out
                                                                                        Advanced Dentistry             Subject to clinical protocols & Bonitas Dental
occupational therapy, audiology,                                                                                                                                                                                                   of hospital consultations
                                                                                                                       Tariff (BDT)3
physiotherapy                                                                                                                                                                                Specialised Radiology                 R16 000 per family, subject to
Oncology                                        Unlimited, sub-limit of R250 000                                                                                                             (out of hospital)                     pre-authorisation
                                                for medicine                                                                                                                                 Emergency Medical                     Unlimited, subject to
Organ Transplants                               Unlimited                                                                                                                                    Transportation                        Netcare 911
Chronic Renal Dialysis                          Unlimited                                                                                                                                    Endoscopies in practitioners’         Unlimited, subject to pre-
Maxillo Facial Surgery                          Unlimited, excluding orthognatic                                                                                                             rooms                                 authorisation
                                                surgery                                                                                                                                      Prostheses Internal                   R27 000 per family, subject to
Medication to take out (TTO)                    R250 per beneficiary, per                                                                                                                    and External                          pre-authorisation
                                                admission                                                                                                                                    HIV test and Flu vaccine              Free, 1 per beneficiary per annum
Physical Rehabilitation                         R30 000 per family                                                                                                                           International cover                   R5 million per trip
                                                                                                                                                                                             Appliances
R1 000                        R2 500                        R5 000                                                                                                                           General appliances                    R4 600 per family
deductible                    deductible                    deductible                                                                                                                       Wheelchairs & large                   Included in the general
                                                                                                                                                                                             orthopaedic appliances                appliance limit
Colonoscopy                  Arthroscopy                 Nissen Fundoplication
                                                                                                                                                                                             Stoma products & CPAP                 May exceed general appliance
Conservative Back            Diagnostic Laparoscopy      (Reflux Surgery)
                                                                                                                                                                                             machines                              limit by R4 000
Treatment                    Hysterectomy                Back Surgery including
                                                                                                                                                                                             Hearing aids                          R6 500 per family, biennial
Cystoscopy                   (except cancer and          spinal fusion
                                                                                                                                                                                                                                   benefit (Jan 2010 - Dec 2011)
Facet Joint Injections       PMBs)                       Joint replacements                This Summary is for information purposes only and does not supersede                              Oxygen: Home ventilation              Unlimited, subject to
Flexible sigmoidoscopy       Percutaneous                e.g. Hip & Knee
                                                                                           the Rules of the Fund. In the event of any discrepancy between the                                                                      pre-authorisation by Hospital
Functional Nasal Surgery     Radiofrequency              replacements
                                                                                           Summary and the Rules, the Rules will prevail.                                                                                          Management
Gastroscopy                  Ablations                   (except PMBs)
Umbilical Hernia Repair      (percutaneous
Hysteroscopy (but not        rhizotomies)
endometrial ablation)
Myringotomy
Tonsillectomy and
Adenoidectomy
(except PMBs)
Varicose Vein Surgery

                                                                                         WHAT                          BonEssential
                                                                                        IT WILL                        Contributions                     Principal Member                         Adult Dependant                         Child Dependant
                                                                                         COST
                                                                                                                       Total                                    R979                                    R749                                    R287

                                                                                   1
                                                                                       Prescribed Minimum Benefits are provided on all options in accordance with the Medical Schemes Act and Regulations, and subject to the use of the relevant Designated Service Provider
        1
            Subject to pathology management programme                              2
                                                                                       Restrictive formulary, refer to page 19 for a complete chronic disease list
                                                                                   3
                                                                                       Comprehensive list of dental benefits (DENIS) page 20
  4                                                                                    All benefits are per annum, unless otherwise stated                                                                                                                           5

								
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