"2010 Sales Brochure Version 6"
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