BENEFITS BROCHURE · BENEFITS BROCHURE Feel conrident that someone is always on your side. 2014

BENEFITS BROCHURE

Feel confident that someone is always on your side.

2014

Everyone wants to lead their best life. We want tomorrow to be better than yesterday and we want to know that when things get tough, we have all the support we need; whether it’s from family, friends or even a scheme like Bonitas. That’s why at Bonitas, we’re not just in the business of healthcare. Yes, we offer quality, affordable healthcare plans and benefits and yes, when you have a health issue, we’re there for you, but that’s just the beginning. Our business is about supporting your life. We start by making it simple to get the help you need, when you need it.

This means that we have a wide network of top doctors, hospitals and pharmacies, waiting to attend to you. We also have a range of products that are simple to understand so that you know exactly what you are insured for. They’re also simple to use, with up to 90% of your bills being paid directly by us so you don’t have to worry about paying out of your pocket. Most of all, our products are affordable and flexible, adapting to all needs and budgets.

At Bonitas, we believe everyone has the right to live their perfect life, and you can only do that when you know you have the support of people who care.

We want tomorrow to be better than yesterday and we want to know that when things get tough, we have all the support we need.

READY TO LIVE THE LIFE YOU DESERVE?

Benefits 2014 Page 03

INDEX

1.Why Bonitas? 01

2.Product Summary 03

3.BonComprehensive Option 06

4.BonClassic Option 10

5.Standard Option 14

6.

7.BonSave Option 18

Primary Option 22

8.BonEssential Option 26

13.Contact Details 55

9 .BonCap - Network Option 29

10.Chronic Benefits 30

11.Dental Benefits 33

12.At a Glance 45

295 211PRINCIPAL MEMBERS

651 518BENEFICIARIES

In the medical scheme industry, there is safety in numbers. The larger the scheme's membership base, the better its ability to spread the risk of high claims.

With over 295 211 principal members and651 518 beneficiaries covered, Bonitas iswell-equipped to ensure that size reallydoes count.

SIZE OF THE MEDICAL SCHEME

WHY BONITAS?At Bonitas we don’t promise, we do. From the moment we opened our doors over 31 years ago, we have worked hard at bringing affordable healthcare to everyone, and adding value to their lives. We know that part of getting better means you need to be able to focus on the things that matter and not worry about whether you’re covered or if your medical bills will be paid in full.

Bonitas Medical Fund is registered as a Medical Scheme in terms of the Medical Schemes Act. The Scheme complies with all aspects of the Medical Schemes Act. Trustees are elected by members. Trustees act in the best interest of the Scheme and its members. Benefits are approved by the Council for Medical Schemes.

Choosing a medical scheme with a relatively young beneficiary age and low pensioner ratio ensures you get value for money. This is because as people age, their medical costs rise and this tends to increase contributions.

DRASTICALLY LOWER THAN THE VAST MAJORITY OF OPEN SCHEMES IN THE INDUSTRY, BONITAS’ AVERAGE BENEFICIARY AGE IS 31.4 YEARS AND OUR PENSIONER RATIO IS 5.1%.

AVERAGE BENEFICIARY AGE

31.4yrsPENSIONER RATIO

5.1%

WE SUPPORT YOU BY OFFERING REAL BENEFITS THAT MATTER:

Prescribed Minimum Benefit (PMBs)covered at private hospitals

3.Healthy Solvency

8.

Pharmacy Direct provides courier delivery ofchronic medication nationally

5.Traditional options cover dentistry and optometry from risk

10.

Financially sound and reliable, Bonitas has an AA-Global Credit Rating reserve of over R2.7 billion, a solvency margin of 35.5% and administration costs of only 13.7% of gross contribution income. Making your life easier, our advanced support network translates our philosophy of “designed to support your life” into reality for you. Intelligently innovative, lucidly simple and easy to understand, our

13.7% ADMINISTRATION COST OF GROSS CONTRIBUTION INCOMEAA-

GLOBAL CREDIT RATING

35.5%SOLVENCY MARGIN

35.5%SOLVENCY RATIO

RESERVES OF OVER

R2.7 BILLION

FINANCIALLY SOUND AND RELIABLE

forward-thinking product options and exceptional service match what you look for in a scheme. Key indicators such as solvency ratio, average beneficiary age, pensioner ratio and claims ratio are known to provide a dependable indication of a medical scheme's long-term viability, financial stability and value for money.

BONITAS KEY INDICATORS

KEY INDICATORS

Solvency Ratio

Average Beneficiary Age

Pensioner Ratio

Non-Healthcare Expenses per Beneficiary Per Month

Non-Healthcare Expenses as a % of Risk Contribution Income

Non-Healthcare Expenses as a % of Gross Contribution Income

Principal Member

Beneficiaries

BONITAS

35.5%

31.4

5.1%

R144

14%

13.7%

295 211

651 518

OPEN SCHEME AVERAGE

29.1%

33.2

8.2%

R164

15.6%

13.6%

-

-

The table sets out the key indicators for Bonitas compared to the open scheme average based on the latest annual report (updated) from the Council for Medical Schemes

Bonitas’ solvency rate is one of the highest in the country overtaking the prescribed minimum solvency ratio of 25% which not only ensures the scheme has the ability to meetits financial commitments; it is also the most reliable indication of its financial dependability and ability to pay claims.

SOLVENCY RATIO

Expense ratios are an important indicator of whether a scheme offers value for money or not. Inevitably medical schemes have expenses (such as administration fees and broker commission)and the higher these “non-healthcare” costs, the less there is available to pay claims. Schemes with higher than average expense ratios generally don’t offer good value for money.

NON-HEALTHCARE EXPENSE RATIOS

HIV tests and flu vaccines on all options

4.Basket of supplementary benefits paid from risk

9.

An unlimited number of trips on international medical cover

2.Specialist Network

7.

On-site consultants

1.Largest GP Network

6.

This is the financial side of our business. Simply put, it gives you the information you need to reassure yourself that we’re in good shapetoday and into the future.

World Class Managed Care programmesand Clinically Approved (VCT) Programmes.

11.

GOVERNANCE

Benefits 2014

When it comes to health, you don’t want to compromise.

After all, your good health and that of your family is a vital part of your plan to live life on your terms. So why hold back when it comes to medical cover? Our BonComprehensive Option is designed for people like you. It’s the elite medical option and you can expect unlimited consultations above threshold as well as the flexibility of a savings option that gives you the freedom to choose where you spend your funds.

Major medical benefits:Unlimited surgical procedures and consultations at 300% Bonitas rate

BONCOMPREHENSIVE

WHAT WILL IT COST?

MAIN MEMBERRISK CONTRIBUTIONSAVINGS CONTRIBUTIONTOTAL CONTRIBUTION

R3 066R541R3 607

ADULT DEPENDANTRISK CONTRIBUTIONSAVINGS CONTRIBUTIONTOTAL CONTRIBUTION

R2 891R511R3 402

CHILD DEPENDANTRISK CONTRIBUTIONSAVINGS CONTRIBUTIONTOTAL CONTRIBUTION

R624R110R734

BONCOMPREHENSIVE

Elite medical option with surgical procedures and consultations at 300% of the Bonitas rate. Unlimited hospitalisation at any hospital. Cover for 53 Chronic conditions. Unlimited medication

and consultations in threshold. Infant paediatric, childhood illness, preventative care, Centre Diabetes Endocrinology (CDE) and supplementary benefits covered from risk.

63 CHRONIC CONDITIONSCONDITIONS COVERED CENTRE FOR DIABETES AND ENDOCRINOLOGY (CDE) BIOLOGICAL DRUGS

UNLIMITEDMEDICATION, RADIOLOGY, PATHOLOGY AND SPECIALIST CONSULTATIONS IN THRESHOLD

SUPPLEMENTARY BENEFITSINFANT PAEDIATRIC BENEFIT CHILDHOOD ILLNESS BENEFIT COCHLEAR IMPLANTS AND INTERNAL NERVE STIMULATOR PREVENTATIVE CARE

100% BONITAS RATEUNLIMITED HOSPITALISATIONAT ANY HOSPITAL REFRACTIVE SURGERY BIOLOGICAL DRUGS


OVERALL ANNUAL LIMIT (OAL) UNLIMITED

SURGICAL PROCEDURES AND CONSULTATIONS ARE PAID AT 300% OF THE BONITAS RATE

SUB-LIMITS APPLICABLE:

GP AND SPECIALIST CONSULTATIONS Unlimited

PATHOLOGY (100%) Unlimited

RADIOLOGY (SPECIALISED AND GENERAL) (100%) Unlimited

PARAMEDICAL SERVICES (ALLIED MEDICAL PROFESSIONS), E.G. SPEECH THERAPY, OCCUPATIONAL THERAPY, AUDIOLOGY, DIETETICS

Unlimited

ONCOLOGY1 R475 000 per family

BIOLOGICAL DRUGSR200 000 per family per annum (p.f.p.a.) included in the above limit. Pre-authorisation required, 10% co-payment applies, e.g, Herceptin

ORGAN TRANSPLANTS Unlimited

CHRONIC RENAL DIALYSIS (100%) Unlimited

MAXILLO-FACIAL SURGERY (100%) Unlimited, excluding orthognathic surgery

MEDICATION TO TAKE OUT (TTO) R420 per beneficiary, per admission

PHYSICAL REHABILITATION R38 000 per family

ALTERNATIVE TO HOSPITALISATION R12 700 per family

Major medical expenses are covered at 300% of Bonitas' rate. This benefit includes major medical events. All hospital admissions, oncology treatment and renal dialysis require pre-authorisation by Hospital Benefit Management, except in case of emergencies.

MAJOR MEDICAL BENEFITS

1 All members enrolled in clinical trials should inform the scheme.2 Comprehensive formulary up to benefit limit, restrictive formulary once benefit limit exceeded for PMBs. Refer to page 32 for a complete list of chronic conditions.

CHRONIC BENEFITS2

Covers medication for conditions that require medication on an ongoing basis. Subject to pre-authorisation.

53 conditions, R10 600 per beneficiary, R21 150 per family

CHRONIC CONDITIONS2 UP-TO-BENEFIT LIMIT OVER BENEFIT LIMIT

53 CONDITIONS R10 600 per beneficiary. R21 150 per family. Comprehensive formulary applies

PMBs only.Restrictive formulary

Centre for Diabetes and Endocrinology (CDE) Treatment of diabetes

Benefits 2014

OUT OF HOSPITAL BENEFITS

Savings and ThresholdOUT OF HOSPITAL BENEFITS

Covers day-to-day medical expenses, e.g. GP and specialist consultations, acute medication, paramedical services, optometry, radiology, pathology, dentistry, etc.

SAVINGS PER MONTH R541 R511 R110

SAVINGS PER ANNUM R6 492 R6 132 R1 320

THRESHOLD BENEFIT

THRESHOLD R7 400 R6 700 R1 950

SELF-FUNDING GAP R908 R568 R630

Child DependantAdult DependantMain Member

ACUTE MEDICATION AND PHARMACY ADVISED THERAPYSubject to savings and/or threshold (100% of the Bonitas rate accrues to threshold) 25% co-payment in threshold

GP AND SPECIALIST CONSULTATIONS Subject to savings and/or threshold, 25% co-payment in threshold

GENERAL RADIOLOGY Subject to savings and/or threshold

PATHOLOGY Subject to savings and/or threshold

PARAMEDICAL SERVICES (ALLIED MEDICAL PROFESSIONS), E.G. SPEECH THERAPY, OCCUPATIONAL THERAPY, AUDIOLOGY, DIETETICS Subject to savings and/or threshold, 25% co-payment in threshold

OPTOMETRY Limited to R2 450 p.b. 25% co-payment in threshold

BASIC DENTISTRY1Subject to savings and/or threshold. 25% co-payment in threshold. Covered according to DENIS clinical protocols and Bonitas Dental Rate (BDT)1

SPECIALISED DENTISTRY1Subject to savings and/or threshold. 25% co-payment in threshold.Covered according to DENIS clinical protocols and Bonitas Dental Rate (BDT)1. Dental Hospital Admissions are paid from risk.

1 Subject to DENIS clinical protocols and Bonitas dental rate. Refer to page 37 to 44.

bonitas.co.za0860 002 108Bonitas-Medical-Fund @BonitasMedical


MATERNITY CARE* PER EVENT (ANTE- AND POSTNATAL)

Unlimited hospitalisation, subject to pre-authorisation. Ante-natal classes to the value of R1 000 and private ward for post-delivery 12 ante-natal consultations, 2 X 2D scans and 4 post-natal consultations with a midwife

REFRACTIVE SURGERY* R15 900 per family at 100% Bonitas Rate, subject to pre-authorisation

IMMUNE DEFICIENCY RELATED TO HIV INFECTION*Unlimited, subject to Aid for AIDS (AfA) registrationClinical protocols apply

MENTAL HEALTH BENEFITS*R36 000 per family, R12 000 sub-limit for consultation in and out of hospital

SPECIALISED RADIOLOGY* (OUT OF HOSPITAL) R24 000 per family, subject to pre-authorisation

EMERGENCY MEDICAL TRANSPORTATION Subject to ER24 authorisation

ENDOSCOPIES* IN PRACTITIONERS’ ROOMS Unlimited, subject to pre-authorisation

PROSTHESES INTERNAL* R42 300 per family, subject to pre-authorisation

PROSTHESES EXTERNAL* R42 300 per family, subject to pre-authorisation

COCHLEAR IMPLANTS R158 000 per family

INTERNAL NERVE STIMULATORS R127 000 per family

HIV TEST AND FLU VACCINE 1 each per beneficiary, p.b.p.a.

Additional benefits, in or out of hospital:

SUPPLEMENTARY BENEFITS

* Subject to pre-authorisation.* All benefits are per annum, unless otherwise stated. * Prescribed Minimum Benefits are provided on all options in accordance with the Medical Schemes Act and Regulations.

INFANT PAEDIATRIC BENEFIT (OUT OF HOSPITAL PAID FROM RISK)3 consultations p.b.p.a. before the age of 1 year. 2 consultations p.b.p.a. between the ages of 1 and 2 years

CHILDHOOD ILLNESS BENEFIT (CONSULTATIONS PAID FROM RISK) 2 GP consultations p.b.p.a between the ages of 2 and 12 years

PREVENTATIVE CARE

WOMEN’S HEALTH1 mammogram every 3 years for females age 50 to 74 years. 1 pap smear every 3 years for females age 21 to 65 years

CARDIAC HEALTH 1 full lipogram per beneficiary

ELDERLY HEALTH1 Pneumoccocal vaccination above age 65. 1 Faecal Occult blood test p.b.p.a. between the ages of 50 and 75. 1 Bone Densitometry Screening test for females above the age of 65 years

CHILDREN’S HEALTH1 TSH test for infants below 1 month of age. Immunisation for children up to age 12 years, as specified in the Extended Programme on Immunisation (EPI)

APPLIANCES

GENERAL APPLIANCES R6 800 per family

WHEELCHAIRS AND LARGE ORTHOPAEDIC APPLIANCES Included in the General Appliances limit

STOMA PRODUCTS AND CPAP* MACHINES May exceed General Appliances limit by R4 750

HEARING AIDS R21 000 per family, biennial benefit (1 Jan 2014 - 31 Dec 2015)

OXYGEN: HOME VENTILATION* Unlimited, subject to pre-authorisation by Hospital Benefit Management

This 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.

Benefits 2014

Medical expenses tend to come when you can least afford them. Having to make co-payments to your doctor or pharmacist can put you under additional financial strain. Not with BonClassic Option, however. Our BonClassic Option is priced to give you quality cover but not to break the bank. Plus, if you use our network of suppliers, you won’t have to pay a single bill because we do it directly. On top of that, the savings facility gives you control over what medical expenses you spend your funds on.

Major medical benefits:Unlimited 100% Bonitas rate

BONCLASSIC

WHAT WILL IT COST?


R2 261R252R2 513


R1 942R216R2 158


R558R 62R620

BONCLASSIC

Comes with a savings account facility which covers acute medication, Pharmacy Advice Therapy (PAT) and GP and specialist consultations plus radiology, pathology, paramedical services, dentistry and optometry.

Covers 63 chronic conditions, dentistry and cochlear implants. Unlimited hospitalisation at 100% of Bonitas’ rates; supplementary benefits paid from risk.

63 CHRONIC CONDITIONSCOVERED

OUT OF HOSPITALSAVINGS, OPTOMETRY, RADIOLOGY, PATHOLOGY, PARAMEDICAL SERVICES, BASIC AND SPECIALISED DENTISTRY

SUPPLEMENTARY BENEFITSPAID FROM RISKCOCHLEAR IMPLANTS

100% BONITAS RATEUNLIMITED HOSPITALISATION

Benefits 2014


BENEFITS PAYABLE AT 100% OF THE BONITAS RATE


GP AND SPECIALIST CONSULTATIONS (HOSPITAL) 100% of the Bonitas Rate. Subject to pre-authorisation

PATHOLOGY Payable from the OAL

RADIOLOGY (SPECIALISED) R22 200 per family

RADIOLOGY (GENERAL) Payable from the OAL


Payable from the OAL


ORGAN TRANSPLANTS Subject to pre-authorisation

CHRONIC RENAL DIALYSIS Subject to pre-authorisation

MAXILLO-FACIAL SURGERY (100%) Payable from the OAL. Pre-authorisation required


PHYSICAL THERAPY (PHYSIOTHERAPY AND BIOKINETICS) Limited to R1 200 per beneficiary. Limited to R2 400 per family



1 All members enrolled in clinical trials should inform the scheme.2 Restrictive formulary. Refer to page 32 for a complete list of chronic conditions.


ALTERNATIVES TO HOSPITALISATION (STEP DOWN OR HOME NURSING)

R12 700 per family

CHRONIC BENEFITS2

Covers medication for conditions that require medication on an ongoing basis. Subject to pre-authorisation.

63 conditions, R8 700 per beneficiary, R18 000 per family

CHRONIC CONDITIONS2 UP-TO-BENEFIT LIMIT OVER BENEFIT LIMIT

63 CONDITIONS R8 700 per beneficiary per annum, R18 000 per family.

40% co-payment applies for the use of non-formulary drugs

If you exceed your benefit limits then only the 26 chronic disease list conditions are covered. The restrictive formulary will apply and medicine is to be obtained from the designated service provider, Pharmacy Direct. 40% co-payment will apply for the use of a non-designated service provider and the non-formulary drugs.

Benefits 2014


Includes savings plus pathology, radiology, physical therapy, dentistry and optical

OUT OF HOSPITAL BENEFITSCovers day-to-day medical expenses such as GP and specialist consultations, acute medication, pathology, radiology, paramedical services (Allied Medical Professions), optometry and dentistry.

GP CONSULTATIONS Subject to savings

SPECIALIST CONSULTATIONS Subject to savings

ACUTE MEDICATION AND PHARMACY ADVISED THERAPY Subject to savings


SAVINGS PER ANNUM R3 024 R2 592 R744


GYNAECOLOGISTS Female beneficiaries, 1 visit per annum without referral

PAEDIATRICIANS No referral required for beneficiaries under age 2 years

ONCOLOGISTS AND OPHTHALMOLOGISTS No referral required

PATHOLOGY R2 400 per beneficiary, limited to R5 300 per family

PHYSICAL THERAPYIncluded in the hospital benefit. R1 200 per beneficiary limitedto R2 400 per family

GENERAL RADIOLOGY R2 400 per beneficiary limited to R3 700 per family

SPECIALISED RADIOLOGYIncluded in the hospital specialised radiology benefit. Subject to pre-authorisation

SPECIALIST CONSULTATIONSThe Bonitas General Practitioner Network is the designated service provider for the provision of all Prescribed Minimum Benefit Conditions (PMBs). A co-payment of 40% will apply for the use of a non-network general practitioner. The Bonitas Specialist Network is the scheme’s designated service provider for the provision of PMBs. No co-payment

will apply at a Specialist Network Provider. Specialist referral management will require all beneficiaries to obtain a referral from a GP to consult with a specialist. Specialist referral by a GP is also required for Prescribed Minimum Benefit conditions. The following exceptions apply:

PARAMEDICAL SERVICE (ALLIED MEDICAL PROFESSIONS), E.G. AUDIOLOGY, HEARING AID ACOUSTICIANS, OCCUPATIONAL THERAPY, ORTHOPTICS, PODIATRY, SPEECH THERAPY, DIETETICS AND SOCIAL WORKERS, NURSING SERVICES

R2 300 R3 500 R4 050 R4 300 R4 600

Main Member 1 Dependant 2 Dependants 3 Dependants 4+ Dependants

Benefits 2014

OPTOMETRY R5 260 per family, per annum. 2 year cycle commenced 1 Jan 2013

OPTOMETRIC EXAMINATION 100% of cost in-network. R295 out-of-network

FRAMES AND PRESCRIPTION LENSES/ADD-ONS R700 per beneficiary

CLEAR SINGLE VISION R185 per lens or

CLEAR AQUITY FLAT-TOP BIFOCAL R430 per lens or

CLEAR AQUITY MULTIFOCAL R750 per lens or

CONTACT LENSES R1 635 per beneficiary

CONSERVATIVE DENTISTRY1Limited to R3 600 per family per annum. Subject to clinical protocols and Bonitas Dental Rate (BDT)

SPECIALISED DENTISTRY1Limited to R4 300 per family per annum.Subject to clinical protocols and Bonitas Dental Rate (BDT)

1 Subject to DENIS clinical protocols and Bonitas dental rate. Refer to pages 37 to 44. * Subject to pre-authorisation. * All benefits are per annum, unless otherwise stated. * Prescribed Minimum Benefits are provided on all options in accordance with the Medical Schemes Act and Regulations.




MATERNITY CARE PER EVENT (ANTE- AND POSTNATAL)Unlimited hospitalisation, subject to pre-authorisation by HBM. R980 for ante-natal classes. 12 ante-natal consultations, 2 X 2D scans and 4 post-natal consultations with a midwife

IMMUNE DEFICIENCY RELATED TO HIV INFECTION* Subject to Aid for AIDS (AfA) registration. Clinical protocols apply

MENTAL HEALTH BENEFITS*R31 700 per family. R12 400 sub-limit for consultations in and out of hospital. Subject to pre-authorisation



PROSTHESES INTERNAL AND EXTERNAL R42 000 per family, subject to pre-authorisation


HIV TEST AND FLU VACCINE 1 each per beneficiary per annum

APPLIANCES



STOMA PRODUCTS AND CPAP* MACHINES Included in the General Appliances limit

HEARING AIDSR13 800 per family per annum over a 3 year cycle (cycle commenced 1 Jan 2013 - 31 Dec 2015)




Benefits 2014

Major medical expenses are covered at 100% of Bonitas rate. This benefit includes major medical events. All hospital admissions, oncology treatment and renal dialysis require pre-authorisation by Hospital Benefit Management, except in case of emergencies.


Major medical benefits: Unlimited 100% Bonitas rate

If you need a medical option that makes your money stretch further and covers all your needs, then this is the option for you.

At Bonitas we understand that getting sick is not exactly something you budget for, which is why we make sure you’ve got it covered. The Bonitas Standard Option is more than a hospital plan, it offers you and your family hospital cover, chronic cover plus generous day-to-day benefits. Best of all, it allows you to make full use of our GP and Specialist Networks, which means you should never have to make co-payments for treatment whether it’s in or out of hospital, subjectto benefit limits.

WHAT WILL IT COST?

MAIN MEMBERR2 186

ADULT DEPENDANTR1 891

CHILD DEPENDANT R639

STANDARD

STANDARD

Comprehensive hospital cover with generousday-to-day benefits.

Covers 42 chronic conditions. Unlimited annual benefits and hospitalisation at 100% Bonitas rate. Supplementary benefits paid from risk.

42 CHRONIC CONDITIONSCENTRE FOR DIABETES ANDENDOCRINOLOGY (CDE)

GENEROUS GP ANDDAY-TO-DAY BENEFITS BASIC AND SPECIALISED DENTISTRY AND OPTOMETRY

SUPPLEMENTARY BENEFITSPAID FROM RISKCOCHLEAR IMPLANTSINTERNAL NERVE STIMULATOR

100% BONITAS RATEUNLIMITED ANNUAL BENEFITS

Benefits 2014





PATHOLOGY Unlimited

RADIOLOGY (SPECIALISED AND GENERAL) Unlimited


Unlimited



CHRONIC RENAL DIALYSIS Unlimited

MAXILLO-FACIAL SURGERY Unlimited, excluding orthognathic surgery




1 All members enrolled in clinical trials should inform the scheme.2 Comprehensive formulary up to benefit limit, restrictive formulary once benefit limit exceeded for PMBs. Refer to page 32 for a complete list of chronic conditions.

CHRONIC BENEFITS2

Covers medication for conditions that require medication on an ongoing basis, subject to pre-authorisation. 42 chronic conditions covered plus applicable chronic DTPs.

CHRONIC CONDITIONS2

UP TO BENEFIT LIMIT OVER BENEFIT LIMIT

42 CONDITIONS PROVIDER

R7 400 p.b. R14 800 p.f.

Comprehensive formulary at any pharmacyor dispensing GP

26 PMB conditions

Restrictive formulary at (DSP) Pharmacy Direct

Treatment of Diabetes Centre for Diabetes and Endocrinology

Chronic medical benefits:42 chronic conditions, R7 400 per beneficiary, R14 800 per family


GP benefit plus day-to-day benefits, basic and specialised dentistry, optometry


Covers day-to-day medical expenses e.g. GP and specialist consultations, acute medication, pathology, radiology, paramedical services (Allied Medical Professions), optometry, dentistry, etc.

GP BENEFITSA benefit has been created specifically for out of hospital general practitioner consultations empowering the GP to become your coordinator of care. By making use of a GP in the network, you are not only guaranteed that the doctor will charge the Bonitas rate, but that the benefit available is more generous.

A sub-limit applies to non-network visits; this limit is included in the GP benefit limit allowing you the flexibility to see any doctor when you are away from home. To find a network doctor near you, call 0860 00 2108 or visit our website: www.bonitas.co.za

Benefits 2014

The Bonitas GP Network is the scheme’s designated service provider for the provision of Prescribed Minimum Benefits. PMBs are covered at 100% of scheme rate at DSP once benefits limits are exhausted. A 40% co-payment will apply for PMBs at a non-DSP once benefit limits are exhausted.

IN-NETWORK GP BENEFITS R3 200 R4 700 R5 200 R5 500 R5 900

NON-NETWORK GP BENEFITS**Benefit included in the network benefit

R1 050 R1 600 R1 750 R1 850 R2 000



PAEDIATRICIANS No referral required for beneficiaries under age 2


IN ADDITION TO THE DAY-TO -DAY BENEFIT THE FOLLOWING ARE ALSO PROVIDED:

CONSERVATIVE DENTISTRY1 Subject to clinical protocols and Bonitas Dental Rate (BDT)1

SPECIALISED DENTISTRY1Subject to clinical protocols and Bonitas Dental Rate (BDT)1 20% co-payment applies to orthodontic treatment

OPTOMETRY 2 year benefit, per beneficiary

OPTOMETRIC EXAMINATION 100% of cost in network, or R295 at a non-network provider

FRAMES AND PRESCRIPTION LENSES /ADD-ONS R800 per beneficiary



CLEAR AQUITY MULTIFOCAL R600 per lens or

CONTACT LENSES R1 550 per beneficiary

SPECIALIST CONSULTATIONSThe Bonitas Specialist Network is the scheme’s designated service provider for the provision of PMBs. No co-payment will apply at a Specialist Network Provider. Specialist referral management will require all beneficiaries to obtain a referral from a GP to consult with a specialist. Specialist referral by a GP is also required for Prescribed Minimum Benefit conditions.

The following exceptions apply:

DAY-TO-DAY BENEFITThe day-to-day benefit is the pool of benefits from which your GP can prescribe the appropriate care to improve your health. This benefit covers acute medication, out of hospital radiology, pathology, paramedical services (dietetics, occupational therapy,

speech therapy, social workers, audiology, physiotherapy and others) and includes specialist consultations which will only be payable on referral by your GP. Benefits are subject to your day-to-day benefit limit.

DAY-TO-DAY BENEFITS Sub-limit of R620 per beneficiary and R1 900 per family for Pharmacy Advised Therapy (PAT).

R3 600 R5 500 R5 900 R6 400 R6 950


1 Subject to DENIS clinical protocols and Bonitas dental rate. Refer to page 37 to 44.

Benefits 2014


Additional Benefits, in or out of hospital:


MATERNITY CARE* PER EVENT (ANTE- AND POSTNATAL)Unlimited hospitalisation, subject to pre-authorisation. R950 for ante-natal classes, 12 ante-natal consultations, 2 X 2D scans and 4 post-natal consultations with a midwife

IMMUNE DEFICIENCY RELATED TO HIV INFECTION*R24 900 per beneficiary, subject to Aid for AIDS (AFA) registration. Clinical protocols apply

MENTAL HEALTH BENEFITS*R31 200 per family, subject to pre-authorisation. Includes a sub-limitof R12 200 for consultations in and out of hospital

SPECIALISED RADIOLOGY* (OUT OF HOSPITAL) R20 100 per family subject to pre-authorisation



PROSTHESES INTERNAL AND EXTERNAL* R33 900 per family, subject to pre-authorisation


INTERNAL NERVE STIMULATORS R127 000 per family

HIV TEST AND FLU VACCINE 1 each per beneficiary, per annum

INFANT PAEDIATRIC BENEFIT (OUT OF HOSPITAL PAID FROM RISK)2 consultations before the age of 1 year. 1 consultation between the ages of 1 and 2 years per beneficiary

CHILDHOOD ILLNESS BENEFIT (CONSULTATIONS PAID FROM RISK) 2 GP consultation p.b.p.a between the ages of 2 and 12 years

APPLIANCES









Benefits 2014

Do you think that some medical allocations are too prescriptive? Do you prefer to decide where you’re going to spend your funds?

If so, you’re going to want the BonSave Option. This option lets you pay for certain medical needs from a savings account that accumulates every month. It is all about flexibility. Its savings portion lets you decide how you use your funds, giving you control and most importantly, the ability to use your money where you need it most.


BONSAVE

WHAT WILL IT COST?


R1 293R265R1 558


R1 002R205R1 207


R388R80R468

BONSAVE

A host of day-to-day benefits, paid from savings account. Unlimited hospitalisation at 150% Bonitas rate. Chronic medicine for 26 Prescribed Minimum

Benefits obtained from Pharmacy Direct, basic dentistry, infant paediatric, childhood illness and supplementary benefits paid from risk.

CHRONIC MEDICINE FOR 26 PMBsDELIVERED BY PHARMACY DIRECT

OUT OF HOSPITAL BENEFITSCOVERED BY SAVINGS PLUS BASIC DENTISTRY

SUPPLEMENTARY BENEFITSPAID FROM RISK


Benefits 2014





PATHOLOGY Unlimited



Unlimited



CHRONIC RENAL DIALYSIS PMBs, only covered as per state protocol





Major medical expenses are covered at 150% of Bonitas’ rate. This benefit includes major medical events. All hospital admissions, oncology treatment and renal dialysis require pre-authorisation by Hospital Benefit Management, except in case of emergencies.


1 All members enrolled in clinical trials should inform the scheme.

CO-PAYMENT WILL APPLY TO THE BELOW PROCEDURES IN HOSPITAL

R1 000DEDUCTIBLE

R2 500DEDUCTIBLE

R5 000DEDUCTIBLE

1. Colonoscopy 2. Conservative Back Treatment3. Cystoscopy4. Facet Joint Injections5. Flexible sigmoidoscopy6. Functional Nasal Surgery7. Gastroscopy8. Umbilical Hernia Repair9. Hysteroscopy (but not endometrial

ablation)10. Myringotomy11. Tonsillectomy and Adenoidectomy

(except PMBs)12. Varicose Vein Surgery

1. Arthroscopy2. Diagnostic Laparoscopy3. Hysterectomy (except cancer and PMBs)4. Percutaneous Radiofrequency Ablations 5. Percutaneous rhizotomies6. Laparoscopic Appendectomy7. Laparoscopic Nephrectomy

1. Nissen Fundoplication (Reflux Surgery)2. Back Surgery including spinal fusion3. Joint replacements, e.g. Hip and Knee

replacements (except PMBs)4. Laparoscopic Pyeloplasty5. Laparoscopic Radical Prostatectomy

Benefits 2014

CHRONIC BENEFITS1

Covers medication for conditions that require medication on an ongoing basis. Chronic Disease List (CDL) plus applicable chronic DTPs as per the Prescribed Minimum Benefits (PMB), at the Designated Service Provider (DSP), subject to pre-authorisation. 40 % co-payment will apply at a non-DSP.

PMBs only at DSP

CHRONIC CONDITIONS1 DESIGNATED SERVICE PROVIDER

26 PMBs RESTRICTIVEFORMULARY

Pharmacy Direct


Savings plus basic dentistryOUT OF HOSPITAL BENEFITS

Covers day-to-day medical expenses, e.g. GP and specialist consultations, acute medication, paramedical (Allied Medical Professions), optometry, radiology, pathology, etc. The Bonitas Specialist Network is the scheme-designated service provider for the provision of PMBs. No co-payment will apply at a Specialist Network Provider, while in benefit.

1 Restrictive formulary. Refer to page 32 for a complete list of chronic conditions. 2 Subject to DENIS clinical protocols and Bonitas’ dental rate. Refer to pages 37 to 44. * Subject to pre-authorisation.* All benefits are per annum, unless otherwise stated. * Prescribed Minimum Benefits are provided on all options in accordance with the Medical Schemes Act and Regulations.


SAVINGS PER ANNUM R3 180 R2 460 R960


GP CONSULTATIONS

Subject to savings. Once allocated savings for the year have been exhausted, 3 consultations per beneficiary, up to a maximum of 6 consultations per family will be paid from risk. Unused consultations will not be carried over to the following year

SPECIALIST CONSULTATIONS Subject to savings

ACUTE MEDICATION AND PHARMACY ADVISED THERAPY Subject to savings

GENERAL RADIOLOGY Subject to savings

PATHOLOGY Subject to savings

OPTOMETRY Subject to savings


Subject to savings

BASIC DENTISTRY2Covered according to DENIS clinical protocols and Bonitas Dental Rate (BDT)

SPECIALISED DENTISTRY2 No benefit

Benefits 2014




MATERNITY CARE* PER EVENT (ANTE- AND POSTNATAL)Unlimited hospitalisation, subject to pre-authorisation. R950 for ante-natal classes, 6 ante-natal consultations, 2 X 2D scans, 4 postnatal consultations with a midwife

IMMUNE DEFICIENCY RELATED TO HIV INFECTION*R24 800 per beneficiary, subject to Aid for AIDS (AfA) registration Clinical protocols apply

MENTAL HEALTH BENEFITS*R24 800 per family, subject to pre-authorisation and includes a sub-limit of R12 150 for consultations in and out of hospital

SPECIALISED RADIOLOGY* (OUT OF HOSPITAL) R17 000 per family, subject to pre-authorisation



PROSTHESES INTERNAL AND EXTERNAL* PMBs only


INFANT PAEDIATRIC BENEFIT (OUT OF HOSPITAL PAID FROM RISK)2 consultations before the age of 12 months1 consultation before the ages of 1 and 2 years

CHILDHOOD ILLNESS BENEFIT CONSULTATION PAID FROM RISK 1 GP consultation p.b.p.a. between the ages of 2 and 12 years

APPLIANCES








Benefits 2014



Not everyone needs the same level of day-to-day cover. For some, making sure that they and their family have the right quality cover when they need it most is the most important thing. If that’s you, and if affordability is important, then this is your option. The Primary Option combines affordability with great cover and benefits. It covers all your medical expenses at 100% of our rate and then offers a whole lot more on top of that.


WHAT WILL IT COST?

MAIN MEMBERR1 412

ADULT DEPENDANTR1 105


PRIMARY


PRIMARY

All major medical expenses at 100% of Bonitas rate. Unlimited hospitalisation. Substantial GP and day-to-day benefits, while supplementary benefits are

all paid from risk. Chronic medicine for 26 Prescribed Minimum Benefits are obtained from Pharmacy Direct.

GENEROUS GP CONSULTATIONS AND DAY-TO-DAY BENEFITSBASIC DENTISTRY, OPTOMETRY.



Benefits 2014

OVERALL ANNUAL LIMIT UNLIMITED




PATHOLOGY Unlimited



Unlimited


ORGAN TRANSPLANTS PMBs, only covered as per state protocols

CHRONIC RENAL DIALYSIS PMBs, only covered as per state protocols

MAXILLO -FACIAL SURGERY Unlimited, excluding orthognathic surgery




1 All members enrolled in clinical trials should inform the scheme.2 Restrictive formulary. Refer to page 32 for a complete list of chronic conditions.


R1 000DEDUCTIBLE

R2 500DEDUCTIBLE

R5 000DEDUCTIBLE







CHRONIC BENEFITS2

Covers medication for conditions that require medication on an ongoing basis.

Chronic Disease List (CDL) plus applicable chronic DTPs as per the Prescribed Minimum Benefits (PMB), at the Designated Service Provider (DSP), subject to pre-authorisation. 40% co-payment will apply at a non-DSP.


26 PMBsRESTRICTIVE FORMULARY

Pharmacy Direct

PMBs only at DSP

Benefits 2014


GP Network plus day-to-day benefits, basic dentistry and optometry

OUT OF HOSPITAL BENEFITSCovers day-to -day medical expenses, e.g. GP and specialist consultations, acute medication, pathology, radiology, paramedical services (Allied Medical Professions), optometry, dentistry etc.


PAEDIATRICIANS No referral required for beneficiaries under age 2


SPECIALIST CONSULTATIONSThe Bonitas Specialist Network is the scheme designated service provider for the provision of PMBs. No co-payment will apply at a Specialist Network Provider.

Specialist referral management will require all beneficiaries to obtaina referral from a GP to consult with a specialist. Specialist referral by a GP is also required for Prescribed Minimum Benefit Conditions.

The following exceptions apply:

The day-to-day benefit is the pool of benefits from which your GP can prescribe the appropriate care to improve your health. This benefit covers acute medication, out of hospital radiology, pathology,

paramedical services (dietetics, occupational therapy, speech therapy, social workers, audiology, physiotherapy and others) and includes specialist consultations which will only be payable on referral by your GP.

DAY-TO-DAY BENEFITS Sub-limit of R380 per beneficiary and R1 100 per family for Pharmacy Advised Therapy (PAT).

R1 600 R2 900 R3 400 R3 700 R4 000


GP BENEFITSA benefit has been created specifically for out of hospital general practitioner consultations empowering the GP to become your coordinator of care. By making use of a GP in the network, you are not only guaranteed that the doctor will charge the Bonitas rate, but the benefit available is more generous.

A sub-limit applies to non-network visits; this limit is included in the GP benefit limit allowing you the flexibility to see any doctor when you are away from home. To find a network doctor near you, call 0860 00 2108 or visit our website: www.bonitas.co.za

The Bonitas GP Network is the scheme’s designated service provider for the provision of Prescribed Minimum Benefits. A co-payment of 40% will thus apply for out-of-network visits once limits are exhausted.

IN-NETWORK GP BENEFITS R1 500 R2 850 R3 300 R3 600 R4 000

NON -NETWORK GP BENEFITS* *Benefit included in the network benefit

R 500 R 950 R1 100 R1 200 R1 350


DAY-TO -DAY BENEFIT

Benefits 2014

IN ADDITION TO THE DAY TO DAY BENEFIT THE FOLLOWING IS ALSO PROVIDED:

CONSERVATIVE DENTISTRY1 Subject to clinical protocols and Bonitas Dental Rate (BDT)1

SPECIALISED DENTISTRY1 No benefit

OPTOMETRY 2 year benefit, per beneficiary

OPTOMETRIC EXAMINATION 100% of cost in network, or R295 at a non-network provider

FRAMES AND PRESCRIPTION LENSES /ADD-ONSR300 per beneficiary at a network provider. No benefit at a non-network provider



CLEAR AQUITY MULTIFOCAL (UP TO BIFOCAL LIMIT) R600 per lens or

CONTACT LENSES R750 per beneficiary

1 Subject to DENIS clinical protocols and Bonitas dental rate. Refer to page 37 to 44. * Subject to pre-authorisation.* All benefits are per annum, unless otherwise stated.


MATERNITY CARE* PER EVENT (ANTE- AND POSTNATAL)Unlimited hospitalisation, subject to pre-authorisation, 6 antenatal consultations, 2 X 2D scans and 4 post-natal consultations with a midwife

IMMUNE DEFICIENCY RELATED TO HIV INFECTION*R19 000 per beneficiary, subject to Aid for AIDS (AfA) registration. Clinical protocols apply

MENTAL HEALTH BENEFITS*R12 200 per family, subject to pre-authorisation, includes a sub-limit of R7 400 for consultations in and out of hospital

SPECIALISED RADIOLOGY* (JOINT LIMIT IN AND OUT OF HOSPITAL) R9 500 per family, subject to pre-authorisation


ENDOSCOPIES* IN PRACTITIONERS’ ROOMS Unlimited subject to pre-authorisation



INFANT PAEDIATRIC BENEFIT (OUT OF HOSPITAL PAID FROM RISK)1 consultation before the age of 1 year.1 consultation between the ages of 1 and 2 years

CHILDHOOD ILLNESS BENEFIT CONSULTATION PAID FROM RISK 1 GP consultation p.b.p.a. between the ages of 2 and 12 years

APPLIANCES





OXYGEN: HOME VENTILATION* Unlimited subject to pre-authorisation by Hospital Benefit Management





Benefits 2014

BONESSENTIAL

Solid, affordable and uncomplicated hospital plan. Unlimited hospitalisation at 100% of Bonita’s rate. Chronic medicine for 26 Prescribed

Minimum Benefits obtained from Pharmacy Direct. Infant paediatric, childhood illness and supplementary benefits covered from risk.


OUT-OF-HOSPITALBENEFITS FOR PMB CONDITIONS


100% BONITAS RATEUNLIMITED HOSPITALISATION

Most people believe that quality healthcare cover has to be expensive and complicated. By now, you’ll know that’s not how we think at Bonitas. Take our BonEssential Option, for example.

This is the option you need if you want affordable hospital, incident and chronic cover. It is a solid, all-round and uncomplicated hospital plan. Like good health, the BonEssential Option is an essential part of your life that you cannot afford to be without.

Major medical benefits: Unlimited 100% Bonitas rate

WHAT WILL IT COST?

MAIN MEMBERR1 085

ADULT DEPENDANTR830


BONESSENTIAL

Benefits 2014





PATHOLOGY Unlimited



Unlimited



CHRONIC RENAL DIALYSIS PMBs, only covered as per state protocols





Major medical expenses are covered at 100% of Bonitas’ rate. This benefit includes major medical events. All hospital admissions, oncology treatment and renal dialysis require pre-authorisation by Hospital Benefit Management, except in case of emergencies.



R1 000DEDUCTIBLE

R2 500DEDUCTIBLE

R5 000DEDUCTIBLE







1 All members enrolled in clinical trials should inform the scheme.

Benefits 2014

CHRONIC BENEFITS1

Covers medication for conditions that require medication on an ongoing basis.

Chronic Disease List (CDL) plus applicable chronic DTPs as per the Prescribed Minimum Benefits (PMB), at the Designated Service Provider (DSP), subject to pre-authorisation. 40% co-payment will apply at a non-DSP.

PMBs only at DSP


26 PMBs RESTRICTIVE FORMULARY

Pharmacy Direct


OUT OF HOSPITAL BENEFITSNo benefits for out of hospital expenses, except for the diagnosis, treatment and care of Prescribed Minimum Benefits where appropriate.




MATERNITY CARE* PER EVENTUnlimited hospitalisation. Subject to pre-authorisation. 6 ante-natal consultations, 2 x 2D scans and 4 post-natal consultations with a midwife

IMMUNE DEFICIENCY RELATED TO HIV INFECTION*R24 800 per beneficiary. Subject to Aid for AIDS (AfA) registration.Clinical protocols apply

MENTAL HEALTH BENEFITS* R24 800 per family in hospital only. Subject to pre-authorisation




CHILDHOOD ILLNESS BENEFIT (CONSULTATION PAID FROM RISK) 1 GP consultation p.b.p.a between the ages of 2 and 12 years

This 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.

1 Restrictive formulary. Refer to page 32 for a complete list of chronic conditions.* Subject to pre-authorisation.* All benefits are per annum, unless otherwise stated.


Benefits 2014

Major medical expenses are covered at 100% of the Bonitas rate. This benefit includes major medical events. All hospital admissions, oncology treatment and renal dialysis require pre-authorisation, except in the case of emergencies.

Pre-authorisation is required for all non-emergency admissions. Emergencies require authorisation within 48 hours of being admitted to hospital or the first working day if over a weekend.


Too often, people avoid going to the doctor because they’re a little cash-strapped or it’s a week away from pay day and every cent is spent. Well, at Bonitas, your health is the most important thing to us.

That’s why our Bonitas BonCap Option gives you access to a professional network of medical experts when you need them, not just when you can afford them. You see, we pay them directly at predetermined rates, which means you’ll never see a bill. What’s more, we help you take control of your health by easily letting you know what you’re covered for and getting the treatment you deserve at no extra cost.

Major medical benefits: Unlimited 100% of the Bonitas rate

BONCAP – NETWORK

*BONCAP CONTRIBUTIONS (CALCULATED ON PENSIONABLE INCOME)

INCOME BAND

MAIN MEMBER

ADULT DEPENDANT

CHILD DEPENDANT

0 to R5 700 R615.00 R583.00 R290.00

R5 701 to R9 300 R748.00 R707.00 R342.00

R9 301 to R12 700 R1 219.00 R1 086.00 R462.00

R12 701+ R1 496.00 R1 332.00 R567.00

Contributions are calculated according to the pensionable income and number of principal members and number of child dependants.

BONCAP-NETWORK

All major medical expenses at 100% of Bonitas rate, with no overall annual limit. Substantial GP and day-to-day benefits with additional supplementary benefits.

Chronic Medicine for 26 Prescribed Minimum Benefits are obtained from Pharmacy Direct.


OUT-OF-HOSPITAL BENEFITSAT NETWORK PROVIDERS

SUPPLEMENTARYADDITIONAL BENEFITS, IN OR OUT OF HOSPITAL.


Benefits 2014





PATHOLOGY Limited to R19 500, except for PMBs

GENERAL RADIOLOGY Unlimited

SURGICAL PROCEDURES Limited to R13 500 per family per annum

BLOOD TRANSFUSION Limited to R14 200 per family per annum

PHYSIOTHERAPY AND OCCUPATIONAL THERAPY R3 300 per family per annum

ONCOLOGY 1, CHEMO AND RADIOLOGY PMBs only

ORGAN TRANSPLANTS PMBs only

CHRONIC RENAL DIALYSIS PMBs only

MAXILLO-FACIAL SURGERY R13 500 per family, included in surgical procedures


ALTERNATIVES TO HOSPITALISATION (STEP DOWN OR HOME NURSING) Limited to R11 000 per family per annum, pre-authorisation required

PHYSICAL REHABILITATION PMBs only

1 All members enrolled in clinical trials should inform the scheme2 Subject to BonCap medicine formulary. For a complete list of chronic conditions refer to page 32

CHRONIC MEDICINE BENEFITS2

Prescribed Minimum Benefits only, subject to the designated service provider, Pharmacy Direct and the Network option chronic medicine programme and formulary.

Chronic Disease List (CDL) plus applicable chronic DTPs as per the Prescribed Minimum Benefits (PMB), at the Designated Service Provider (DSP).


26 PMBsRESTRICTIVEFORMULARY

Pharmacy Direct

Covers day-to-day medical expenses incurred out of hospital, for example: GP consultations, acute medication, pathology, radiology, optometry and dentistry.


DAY-TO-DAY BENEFITS

GP CONSULTATIONS12 consultations per beneficiary per annum subject to the BonCap GP network. Authorisation is required after the 12th visit. PMBs only after the 12th visit, subject to managed care protocols

OUT-OF-NETWORK CONSULTATIONS1 visit per beneficiary or 2 visits per family to a maximum of R800 and 20% co-payment (except emergencies). No benefit for facility fees

ACUTE MEDICATION Subject to the BonCap Acute Medicine Formulary

Benefits 2014

OVER-THE-COUNTER MEDICATION Limited to R205 per beneficiary, maximum of R70 per script

SPECIALIST CONSULTATIONS3 visits per beneficiary limited to R2 400 or 5 visits per family limited to R3 550. Subject to referral from a network GP and pre-authorisation

OCCUPATIONAL THERAPY AND PHYSIOTHERAPY PMBs only, on referral from a network GP

GENERAL RADIOLOGY List of approved investigations. On referral from a network GP

PATHOLOGY List of approved investigations. On referral from a network GP

BASIC DENTISTRY1 Subject to DENIS managed care protocols and approved codes.

Covered at Bonitas Dental Rate:

• 1 consultation p.b.p.a.

• 1 emergency consultation p.b.p.a for pain and sepsis

• 1 preventative treatment p.b.p.a.

• Extractions (removal of teeth) in dental rooms

• 4 fillings and 4 X rays p.b.p.a.

• Plastic dentures: 1 set per family in a 2 year period for beneficiaries 21 years and older. 20% co-payment applies

SPECIALISED DENTISTRY No benefit

OPTOMETRY 2 year benefit, per beneficiary. Benefit commenced 1 Jan 2013. Subject to DSP at PPN network:

• 1 pair of spectacles every 24 months at a PPN provider

• 1 optometric examination per beneficiary

• PPN frame, No benefit at a non-network provider

• 1 pair of clear Aquity single vision lenses or 1 pair of clear Aquity

bifocal lenses

• Clear Aquity multifocal lenses covered up to the cost of the

bifocal lenses


MATERNITY CARE* PER EVENT (ANTE- AND POST NATAL)Subject to BonCap GP network.Neonatal care limited to R35 000 per family

IMMUNE DEFICIENCY RELATED TO HIV INFECTION*Subject to managed care protocols and registration on the BonCap HIV/AIDS programme

MENTAL HEALTH BENEFITS* PMBs only. Subject to the BonCap GP network

SPECIALISED RADIOLOGY* (JOINT LIMIT IN AND OUT OF HOSPITAL) R8 900 per family, included in the OAL and subject to pre-authorisation


PROSTHESES INTERNAL* (IN HOSPITAL) PMBs only

PROSTHESES EXTERNAL No benefit

APPLIANCES (INCLUDES GENERAL APPLIANCES, WHEELCHAIRS, STOMA PRODUCTS, CPAP*, HEARING AIDS)

R4 200 per family, in and out of hospital, included in theOAL and subject to pre-authorisation

OXYGEN THERAPY AND HOME VENTILATION Subject to pre-authorisation


Additional benefits, medical expenses incurred in or out of hospital. All of the following benefits are paid from the Overall Annual Limit and are subject to benefit limits:


This 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.

1 Dental benefits. Refer to page 35 to 36.* Subject to pre-authorisation.* All benefits are per annum, unless otherwise stated. * Prescribed Minimum Benefits are provided on all options in accordance with the Medical Schemes Act and Regulations.


Benefits 2014

26 PMBsBONSAVE, PRIMARY, BONESSENTIAL, BONCAP

BONCOMPREHENSIVE STANDARD BONCLASSIC

PMBs as per Chronic Disease Listincluding 270 Diagnosis and treatment Pairs (DTP) as indicated in regulation 29.(1) (0) of the Medical Schemes Act.

In addition to the 26 PMB conditions the following 27 diseases are covered, including applicable chronic Diagnosis and treatment Pairs (DTP) as indicated in regulation 29(1)(0) of the Medical Schemes Act.

In addition to the 26 PMB conditions the following 16 diseases are covered including applicable chronic Diagnosis and treatment Pairs (DTP) as indicated in regulation 29(1)(0) of the Medical Schemes Act.

In addition to the 26 PMB conditions the following 37 diseases are covered including applicable chronic Diagnosis and treatment Pairs (DTP) as indicated in regulation 29(1)(0) of the Medical Schemes Act.

26 PMBs1. Addison’s Disease2. Asthma3. Bipolar Mood Disorder4. Bronchiectasis5. Cardiac Failure6. Cardiomyopathy7. Chronic Renal Disease8. Chronic Obstructive

Pulmonary Disease9. Coronary Artery Disease10. Crohn’s Disease11. Diabetes Insipidus12. Diabetes Mellitus Type 113. Diabetes Mellitus Type 214. Dysrhythmias15. Epilepsy16. Glaucoma17. Haemophilia18. Hyperlipidaemia19. Hypertension20. Hypothyroidism21. Multiple Sclerosis22. Parkinson’s Disease23. Rheumatoid Arthritis24. Schizophrenia25. Systemic Lupus

Erythematosus26. Ulcerative Colitis

1. Acne2. Allergic Rhinitis3. Ankylosing Spondylitis4. Attention Deficit Disorder5. Behcet’s Disease6. Barrett’s Oesophagus7. Dermatitis8. Eczema9. Generalised Anxiety Disorder10. Gastro-Oesophageal Reflux

(GORD)11. Gout12. Huntington’s Disease13. Hypoparathyroidism14. Myaesthenia Gravis15. Narcolepsy16. Neuropathies17. Obsessive Compulsive

Disorder18. Osteoporosis19. Paget’s Disease20. Panic Disorder21. Pemphigus22. Polyarteritis Nordosa23. Post-Traumatic Stress

Syndrome24. Pulmonary Interstitial Fibrosis25. Systemic Sclerosis26. Tourette’s Syndrome27. Zollinger-Ellison Syndrome

+ 26 PMBs

1. Acne2. Allergic Rhinitis3. Ankylosing Spondylitis4. Attention Deficit Disorder5. Barrett’s Oesophagus6. Behcet’s Disease7. Dermatitis8. Eczema9. Gastro-Oesaphageal Reflux

(GORD)10. Gout11. Narcolepsy12. Obsessive Compulsive

Disorder13. Panic Disorder14. Post-Traumatic Stress

Syndrome15. Tourette’s Syndrome

16. Zollinger-Ellison Syndrome

+ 26 PMBs

1. Alzheimer disease (early onset)

2. Angina3. Ankylosing Spondylitis4. Attention Deficit Disorder –

in children 5 to 18 years old5. Benigen Prostatic

Hypertrophy6. Barrett’s Oesophagus7. Bulimia Nervosa8. Cancer9. Cardiac Arrhythmias10. Chronic Bronchitis11. Cushing Syndrome12. Cystic Fibrosis13. Deep Vein Thrombosis14. Depression15. Dermatomyositis16. Eczema17. Emphysema18. Gastro-Oesaphageal Reflux

(GORD)19. Generalised Anxiety

Disorder20. Gout21. Hormone Replacement

Therapy22. Hypoparathyroidism23. Infective Endocarditis24. Ischeamic heart disease25. Motor Neuron Disease26. Obsessive Compulsive

Disorder27. Osteoporosis28. Paget’s Disease29. Panic Disorder30. Paraplegia/Quadriplegia31. Polyarteritis Nordosa32. Post-Traumatic Stress

Syndrome33. Pulmonary Interstitial

Fibrosis34. Scleroderma35. Thromboangitis Obliterans36. Tourette’s Syndrome37. Zollinger-Ellison Syndrome

+ 26 PMBs

CHRONIC DISEASE LIST

CHRONIC MEDICINE MANAGEMENTTo apply for chronic medicine authorisation the member, doctor or pharmacist can call chronic medicine management on 0860 100 608. Alternatively, members, doctors or pharmacists may apply for chronic medication online by logging onto the Medscheme website www.medscheme.co.za

Designated service provider for chronic medication - Pharmacy DirectTo apply for the delivery of chronic medication, phone Pharmacy Direct (0860 027 800) or visit the website (www.pharmacydirect.co.za) and request an application form.


Benefits 2014

General informationDENIS, a fully accredited managed care organisation, manages your dental benefits on behalf of your medical scheme. There is a pre-defined benefit per procedure which is paid at the published Bonitas Dental Rate (see www.denis.co.za for the list of dental rates).Your dentist will also be able to provide information regarding your benefits, as DENIS supplies all dentists with a Chairside Guide, which illustrates the dental benefits. Benefits for dentistry are paid on a fee for service basis. This means that for every procedure done by a dentist, there is a fee that is charged. These fees may differ from dentist to dentist. Your fund pays a benefit for each procedure which may differ from the fee charged by your dentist. It is your right to negotiate this difference with your dentist. Please refer to the dental benefit table on pages 37 to 44 for the benefits per option and per treatment category. Familiarise yourself with the defined benefits as well as listed exclusions in the dental benefit table before visiting your dentist. By doing so, you will be fully aware of what your fund will pay towards your treatment.

Conservative dentistryAll conservative dental benefits, as set out in the dental benefit table, are covered at the Bonitas Dental Rate (BDT).

Specialised dentistryAll specialised dental benefits, as set out in the dental benefit table, are covered at the Bonitas Dental Rate (BDT). The following specialised dental benefits must be pre-authorised:• Crown and Bridge procedures;• Orthodontics;• Implants;• Intravenous Conscious Sedation; and• Periodontics.

What is pre-authorisation?Benefit pre-authorisation is the prior approval of any of the above-listed specialised dental treatments.

How do I get pre-authorisation?• Call: 0860 336 346• Have the following information ready when you phone DENIS: - Your Bonitas membership number - Name of the practitioner and his/her telephone number and practice registration number - A treatment plan including all relevant procedure codes and applicable tooth numbers, including diagnostic codesOnce authorisation has been obtained, cover for the treatment is subject to fund rules, exclusions and benefit protocols.

What happens if I fail to apply for pre-authorisation?Procedures and treatment not pre-authorised will not attract a benefit with the exception of crown and bridge procedures where a 20% penalty will apply if authorisation is applied after the treatment has been done. Penalties do not apply to emergency hospital admission. Failure to pre-authorise orthodontic treatment will result in a payment ONLY from date of authorisation for the remaining months of treatment, provided that the treatment is clinically indicated. Co-payments for specialised dentistry are levied for orthodontics on the Standard option.

How do I get pre-authorisation for crown and bridge procedures?• Call: 0860 336 346 • Send your treatment plan and clear clinical records together with the laboratory invoice to [email protected] or alternatively post to: Denis, Private Bag X 1, Century City, 7446, Cape Town

BONITAS DENTAL BENEFIT INFORMATION

DENTAL BENEFITS (DENIS)

Benefits 2014

• Further information may be requested in order to process your application.• Assessment of a treatment plan and radiographic documentation is required for consideration of crown and bridge benefits. Should the benefit be approved, an authorisation letter will be sent to your treating dental practitioner.

How do I get pre-authorisation for implant procedures?• Call: 0860 336 346 • Send your treatment plan (including all three phases) to [email protected] or alternatively fax it to 0866 770 336 or post to: Denis, Private Bag X 1, Century City, 7446, Cape Town • Further information may be requested in order to process your application. • Assessment of a treatment plan is required for consideration of implant benefits. Should the benefit be approved, an authorisation letter will be sent to your treating dental practitioner.

How do I get pre-authorisation for orthodontic procedures?• Call: 0860 336 346 • Send your treatment plan and clear clinical records to [email protected] or alternatively post to: Denis, Private Bag X 1, Century City, 7446, Cape Town • Further information may be requested in order to process your application. • Assessment of a treatment plan and radiographic documentation is required for consideration of orthodontic benefits. Should the benefit be approved, an authorisation letter will be sent to your treating dental practitioner. • Pre-authorisation is required for removable appliance therapy, functional appliance therapy, partial fixed appliance therapy (preliminary treatment) and comprehensive fixed appliance therapy.

How do I apply for registration on the Periodontal Programme? • This benefit is only available to those members on the Standard, BonClassic and BonComp options who are registered on the periodontal programme. • To apply for the Periodontal Programme, submit your CPITN score (supplied to you by your dental practitioner), together with your periodontal treatment plan to [email protected], or alternatively fax to 0866 770 336. • Further clinical records may be requested to process your application. • Benefit is limited to conservative, non-surgical therapy only and will only be applied to members who are registered on the Periodontal Programme.

General anaesthetic and hospitalisationHospitalisation benefit for dentistry is not automatically covered and is subject to pre-authorisation, where admission protocols apply.

How to get authorisation before going to hospital and for intra-venous conscious sedationContact us on 0860 336 346, at least 48 hours prior to the planned procedure. Have the following information ready when you phone us: • your Bonitas membership number• the date of admission• name of the practitioner and his/her telephone number and practice registration number• the anaesthetist’s practice number and contact details• the name and telephone number of the hospital • all relevant procedure codes and applicable tooth numbers, including diagnostic codes

• in certain instances an X-ray, clinical report or additional information will be requested in order to process your pre-authorisation• if the hospital admission is authorised, you will be supplied with an authorisation number, via your preferred method (fax or email)• the hospital account will be paid according to the time allocated on the authorisation letter. Hospital accounts exceeding this time will be the member’s liability• in the event of an emergency after hours, let DENIS know about your hospitalisation as soon as possible.

Note: If you do not obtain authorisation before your hospital admission, the associated costs (hospital and anaesthetic accounts) will not be paid.

Dental Wellness ProgrammeAs a Bonitas member, you are automatically a member of the Dental Wellness Programme. You will receive various treatment-related information leaflets and at your company’s Wellness Days oral screenings, advice and dental products are provided.

Get your dental claims to Denis!Post the original copies of your dental claims to: Denis, Private Bag X 1, Century City, 7446, Cape TownAlternatively, you can email your dental claims to [email protected]

When submitting a claim, please ensure the following details are clearly visible:• Your membership number. • The dentist’s details and practice registration number. • The correct dependant name and code (see your membership card). • The treatment date. • The relevant procedure codes. • The applicable tooth numbers. • The relevant ICD-10 codes. • If you have already paid for the treatment, ensure that the appropriate receipt is attached.

DENIS contact detailsCall centre: 0860 336 346 Call centre fax: 0866 770 336Email (enquiries): [email protected] (claims): [email protected] (hospital authorisations): [email protected] (orthodontic and implant authorisations): [email protected] Email (crown and bridge authorisations): [email protected] Email (periodontal authorisations): [email protected]

Stale claimsIn terms of the Medical Schemes Act, claims that are not received within four months from the end of the month in which the service was provided, are regarded as stale and will not be eligible for benefit. In the event of a dispute regarding the benefit information illustrated in the benefit table, following, the rules of the fund will prevail.

Benefits 2014

Dental benefits are managed by DENIS at the Bonitas Dental rate (BDT) and are subject to a DENIS Designated Service Provider Network for conservative out of hospital services. If there is no Designated Service Provider in the member’s area, the member needs to contact DENIS prior to treatment. This option does not provide benefits for any specialised dentistry, with the exception of limited maxillo-facial dentistry. Dental benefits are subject to managed care protocols and managed care interventions which may include the requirement of treatment plans and/or radiographs prior to benefit application. Only the dental codes listed in the table below will be covered under this option except in the case of authorised hospitalisation and authorised PMB events. In the event of a dispute, the registered rules of the scheme prevail.

There is no overall annual limit on BonCap for 2014. The Maxillo-Facial benefit resides under the benefit for Surgical Procedures. The Surgical

Procedure benefit has a limit of R13 500 per family per year. Access to a Maxillo-facial specialist is ONLY on referral from a dentist on the DENIS Designated Service Provider Network and authorised by DENIS. All dental-related hospitalisation, including PMBs, must be pre-authorised* by DENIS and is subject to the BonCap Hospital Network. Hospital procedures not pre-authorised will be subject to a co-payment of R5 000 on the hospital account for both private and public hospitals if authorisation is applied for after the treatment has been done. If authorisation is obtained for an elective procedure in a non-network hospital, a co-payment of R5 000 is applicable on the hospital account. Emergencies require authorisation within 48 hours of the first working day.

Please note that ALL dental claims (out of hospital dentistry, in hospital dentistry and related anaesthetics) will be processed by Medscheme.

BONCAP DENTAL BENEFIT TABLE 2014

CODE BENEFIT DENIS BENEFIT INFORMATION

8101 Consultation 1 check-up per beneficiary per year

8104 Specific Consultation (emergency) 1 specific (emergency) consultation for pain and sepsis per beneficiary per year

8107 and/or 8112 Intra-Oral X-rays 4 X-rays in total per beneficiary per year

8115 Extra-Oral X-rays 1 per beneficiary in a 3 year period for Maxillo-facial related treatment ONLY. Extra-oral X-ray to be submitted to DENIS for review

81558159

8161 or 8162

8163

Polishing of TeethScaling and Polishing

Fluoride Treatment

Fissure Sealant

1 polish OR 1 scaling and polishing per beneficiary per year. 1 treatment per year for beneficiaries from 5 years of age and under 16 years of age.(8161: 5 - 12 years of age; 8162: 13 - 15 years of age)

1 per tooth in a 3 year period for beneficiaries younger than 16 years of age

810981108145

Infection ControlInstrument SterilisationLocal Anaesthetic

1 set per beneficiary per visit. (A Set: 8109 x 2, 8110 x 1 and 8145 x 1)

81418143

Inhalation Sedation(Laughing gas in dental rooms)

Inhalation sedation limited to extensive dental treatment only:• 8141 First 15 minutes• 8143 Each additional 15 minutes

8131 81328133

Emergency Root Canal Therapy Benefit for emergency treatment only. Recement inlay, onlay, crown or veneer.NOTE: Root canal treatment on 3rd molar is not covered.

8307 Pulp Treatments Benefit for amputation of pulp of primary teeth

8201

8202

8935

Extractions(Removal of teeth)

Code 8201 is charged for the first extraction in a quadrant.Code 8202 is charged for each additional extraction in a quadrant.Treatment of septic sockets

Benefits 2014

CODE BENEFIT DENIS BENEFIT INFORMATION

834183428343834483518352835383548367836883698370

Dental Fillings Benefit for 4 fillings per beneficiary per year.Benefit for fillings are granted once per tooth in 365 days. Benefit for re-treatment of a tooth is subject to managed care protocols.

82318232823382348235823682378238823982408241

Plastic Dentures One set of plastic dentures (an upper and a lower) per family in a 2 year period for beneficiaries 21 years and older. 20% co-payment applies. The appropriate laboratory codes will be covered. 20% co-payment applies.

8259 Denture Rebase Rebase of dentures once per family per year for beneficiaries 21 years and older. 20% co-payment applies. The appropriate laboratory codes will be covered. 20% co-payment applies.

8263826982718273

Denture Repairs Repairs to existing dentures twice per family per year for beneficiaries 21 years and older. 20% co-payment applies. The appropriate laboratory codes will be covered. 20% co-payment applies..

8937821382148953894189438945

Maxillo-facial Surgery in dental chair* Surgery in the dental chair – DENIS Designated Service Provider; access to a maxillo-facial specialist by DENIS pre-authorisation ONLY. A limit of R13 500 per family per year.Surgical removal of tooth.Surgical removal of residual roots.Surgical removal of impacted teeth.Cover for PMB treatment.

NOTE: No benefit for Osseo-integrated implants and Orthognathic surgery.

8144 IV Conscious Sedation in the rooms* Pre-authorisation from DENIS is required.Benefit is limited to extensive dental treatment.

Hospitalisation*(General anaesthetic)

Pre-authorisation from DENIS is required, subject to a preferred provider network.General anaesthetic benefits are only available for the following: • Extensive dental treatment for children younger than 5 years of age• For the removal of impacted teeth • PMB admissions

Benefits 2014

BON

ITAS

DEN

TAL

BEN

EFIT

TAB

LE 2

014

DEN

TAL

BEN

EFIT

TA

BLE

BON

CLAS

SIC*

**ST

AND

ARD

BO

NSA

VE A

ND

PRI

MAR

Y

CONSERVATIVE

DENTISTRY

CON

SULT

A-TI

ON

S2

annu

al c

heck

-ups

per

be

nefic

iary

(onc

e in

6 m

onth

s).

Bene

fit is

sub

ject

to

man

aged

car

e pr

otoc

ols.

Co

vere

d at

the

BD

T

2 an

nual

che

ck-u

ps p

er

bene

ficia

ry (o

nce

in 6

mon

ths)

.Be

nefit

is s

ubje

ct t

o m

anag

ed c

are

prot

ocol

s.Co

vere

d at

the

BD

T

2 an

nual

che

ck-u

ps p

er

bene

ficia

ry (o

nce

in 6

mon

ths)

Be

nefit

is s

ubje

ct t

o m

anag

ed c

are

prot

ocol

s Co

vere

d at

the

BD

T

X-RA

YS: I

N-

TRA-

ORA

L

Bene

fit is

sub

ject

to

man

aged

car

e pr

otoc

ols.

Co

vere

d at

the

BD

T

Bene

fit is

sub

ject

to

man

aged

car

e pr

otoc

ols.

Cove

red

at t

he B

DT

Bene

fit is

sub

ject

to

man

aged

car

e pr

otoc

ols.

Cove

red

at t

he B

DT

X-RA

YS: E

X-TR

A-O

RAL

1 pe

r ben

efici

ary

in a

3 y

ear p

erio

d Be

nefit

is s

ubje

ct t

o m

anag

ed c

are

prot

ocol

s.

Addi

tion

al b

enefi

t m

ay b

e co

nsid

ered

w

here

spe

cial

ised

den

tal t

reat

men

t is

re

quire

d.Co

vere

d at

the

BD

T

1 pe

r ben

efici

ary

in a

3 y

ear p

erio

dBe

nefit

is s

ubje

ct t

o m

anag

ed c

are

prot

ocol

s.

Addi

tion

al b

enefi

t m

ay b

e co

nsid

ered

w

here

spe

cial

ised

den

tal t

reat

men

t is

re

quire

d.Co

vere

d at

the

BD

T

1 pe

r ben

efici

ary

in a

3 y

ear p

erio

d.Be

nefit

is s

ubje

ct t

o m

anag

ed c

are

prot

ocol

s.

Cove

red

at t

he B

DT

ORA

L H

YGIE

NE

2 an

nual

sca

le a

nd p

olis

h tr

eatm

ents

pe

r ben

efici

ary

(onc

e in

6 m

onth

s).

Bene

fit is

sub

ject

to

man

aged

car

e pr

otoc

ols.

Be

nefit

for fi

ssur

e se

alan

ts is

lim

ited

to

ben

efici

arie

s yo

unge

r tha

n 16

yea

rs

of a

ge.

Bene

fit fo

r flu

orid

e is

lim

ited

to

bene

ficia

ries

you

nger

tha

n 16

yea

rs

of a

ge.

Cove

red

at t

he B

DT

2 an

nual

sca

le a

nd p

olis

h tr

eatm

ents

pe

r ben

efici

ary

(onc

e in

6 m

onth

s).

Bene

fit is

sub

ject

to

man

aged

car

e pr

otoc

ols.

Be

nefit

for fi

ssur

e se

alan

ts is

lim

ited

to

ben

efici

arie

s yo

unge

r tha

n 16

yea

rs

of a

ge.

Bene

fit fo

r flu

orid

e is

lim

ited

to

bene

ficia

ries

you

nger

tha

n 16

yea

rs

of a

ge.

Cove

red

in B

DT

2 an

nual

sca

le a

nd p

olis

h tr

eatm

ents

pe

r ben

efici

ary

(onc

e in

6 m

onth

s).

Bene

fit is

sub

ject

to

man

aged

car

e pr

otoc

ols.

Be

nefit

for fi

ssur

e se

alan

ts is

lim

ited

to

ben

efici

arie

s yo

unge

r tha

n 16

yea

rs

of a

ge.

Bene

fit fo

r flu

orid

e is

lim

ited

to

bene

ficia

ries

you

nger

tha

n 16

yea

rs

of a

ge.

Cove

red

in B

DT

Den

tal b

enefi

ts a

re p

aid

at t

he B

onit

as D

enta

l rat

e (B

DT)

. Hos

pita

lisat

ion

and

cert

ain

spec

ialis

ed

dent

istr

y pr

oced

ures

and

tre

atm

ent

mus

t be

pre

-aut

hori

sed*

. Pro

cedu

res

and

trea

tmen

t no

t

pre-

auth

oris

ed w

ill n

ot a

ttra

ct a

ben

efit,

wit

h th

e ex

cept

ion

of c

row

n an

d br

idge

pro

cedu

res

whe

re

a 20

% p

enal

ty w

ill a

pply

if a

utho

risa

tion

is a

pplie

d fo

r aft

er t

he t

reat

men

t ha

s be

en d

one.

Fai

lure

to

pre-

auth

oris

e or

thod

onti

c tr

eatm

ent

will

resu

lt in

a p

aym

ent

ON

LY fr

om d

ate

of a

utho

risa

tion

for t

he

rem

aini

ng m

onth

s of

tre

atm

ent,

pro

vide

d th

at t

he t

reat

men

t is

clin

ical

ly in

dica

ted.

Pen

alti

es d

o no

t ap

ply

to e

mer

genc

y ho

spit

al a

dmis

sion

. Co-

paym

ents

are

levi

ed fo

r Ort

hodo

ntic

s on

the

St

anda

rd o

ptio

n.

Den

tal b

enefi

ts a

re s

ubje

ct t

o m

anag

ed c

are

prot

ocol

s an

d m

anag

ed c

are

inte

rven

tion

s w

hich

may

in

clud

e th

e re

quire

men

t of

tre

atm

ent

plan

s an

d/or

radi

ogra

phs

prio

r to

bene

fit a

pplic

atio

n.

Sche

me

excl

usio

ns a

pply

to

dent

al b

enefi

ts. I

n th

e ev

ent

of a

dis

pute

, the

regi

ster

ed ru

les

of t

he

sche

me

prev

ail.

BonC

ompr

ehen

sive

opt

ion*

*Th

e de

ntal

ben

efits

of t

he B

onCo

m o

ptio

n w

ill b

e pa

id fr

om t

he m

embe

r’s

avai

labl

e sa

ving

s an

d/or

thr

esho

ld li

mit

. The

den

tal b

enefi

ts a

s pu

blis

hed

belo

w w

ill a

pply

, sub

ject

to

DEN

IS m

anag

ed

care

pro

toco

ls a

nd m

anag

ed c

are

inte

rven

tion

s w

hich

incl

ude

pre-

auth

oris

atio

n w

here

nec

essa

ry.

Pre-

auth

oris

atio

n is

requ

ired

for c

row

ns, o

rtho

dont

ics,

impl

ants

, per

iodo

ntic

s, h

ospi

tal a

nd IV

co

nsci

ous

seda

tion

. A 2

5% c

o-pa

ymen

t in

thr

esho

ld a

pplie

s to

all

cons

erva

tive

and

spe

cial

ised

de

ntal

pro

cedu

res

and

trea

tmen

t. C

o-pa

ymen

ts a

re n

ot a

pplic

able

to

max

illo-

faci

al s

urge

ry a

nd

hosp

ital

isat

ion.

Ple

ase

note

tha

t M

edsc

hem

e w

ill b

e re

spon

sibl

e fo

r the

pay

men

t of

all

dent

al c

laim

s on

the

Bon

Com

opt

ion.

BonC

lass

ic**

* Co

nser

vati

ve d

enti

stry

lim

ited

to

R3 6

00 p

er fa

mily

per

ann

um.

Spec

ialis

ed d

enti

stry

lim

ited

to

R4 3

00 p

er fa

mily

per

ann

um.

Benefits 2014

DEN

TAL

BEN

EFIT

TA

BLE

BON

COM

PREH

ENSI

VEBO

NCL

ASSI

CST

AND

ARD

BO

NSA

VE A

ND

PRI

MAR

Y

ORA

L H

YGIE

NE

Sche

me

excl

usio

ns:

• O

ral h

ygie

ne in

stru

ctio

ns•

Ora

l hyg

iene

eva

luat

ion

• Pr

ofes

siona

lly a

pplie

d flu

orid

e fo

r

bene

ficia

ries 1

6 ye

ars a

nd o

lder

• D

enta

l ble

achi

ng

Sche

me

excl

usio

ns:

• O

ral h

ygie

ne in

stru

ctio

ns•

Ora

l hyg

iene

eva

luat

ion

• Pr

ofes

siona

lly a

pplie

d flu

orid

e

for b

enefi

ciar

ies 1

6 ye

ars a

nd o

lder

• D

enta

l ble

achi

ng

Sche

me

excl

usio

ns:

• Ora

l hyg

iene

inst

ruct

ions

• Ora

l hyg

iene

eva

luat

ion

• Pro

fess

iona

lly a

pplie

d fl

uori

de fo

r be

nefic

iari

es 1

6 ye

ars

and

olde

r• D

enta

l ble

achi

ng

Sche

me

excl

usio

ns:

• Ora

l hyg

iene

inst

ruct

ions

• Ora

l hyg

iene

eva

luat

ion

• Pro

fess

iona

lly a

pplie

d fl

uori

de fo

r b

enefi

ciar

ies

16 y

ears

and

old

er• D

enta

l ble

achi

ng

FILL

INGS

Bene

fit fo

r filli

ngs a

re g

rant

ed o

nce

per

toot

h in

365

day

s.Be

nefit

for r

e-tr

eatm

ent o

f a to

oth

is su

bjec

t to

man

aged

care

pro

toco

ls.

Cove

red

at th

e BD

T.A

trea

tmen

t pla

n an

d X-

rays

may

be

requ

ired

for m

ultip

le fi

lling

s.Sc

hem

e ex

clus

ions

:•

Filli

ngs t

o re

stor

e te

eth

dam

aged

due

to

toot

hbru

sh a

bras

ion,

att

ritio

n, e

rosio

n an

d

flu

oros

is

• Re

sin b

ondi

ng fo

r res

tora

tions

that

are

ch

arge

d as

a se

para

te p

roce

dure

to th

e

rest

orat

ion

• Th

e po

lishi

ng o

f res

tora

tions

•

Gold

foil r

esto

ratio

ns

• O

zone

ther

apy

Bene

fit fo

r filli

ngs i

s gra

nted

onc

e pe

r too

th

in 3

65 d

ays.

Bene

fit fo

r re-

trea

tmen

t of a

toot

h is

subj

ect

to m

anag

ed ca

re p

roto

cols.

Co

vere

d at

the

BDT.

A tr

eatm

ent p

lan

and

X-ra

ys m

ay b

e re

quire

d fo

r mul

tiple

filli

ngs.

Sche

me

excl

usio

ns:

• Fi

lling

s to

rest

ore

teet

h da

mag

ed d

ue to

to

othb

rush

abr

asio

n, a

ttrit

ion,

ero

sion

and

flu

oros

is

• Re

sin b

ondi

ng fo

r res

tora

tions

that

are

ch

arge

d as

a se

para

te p

roce

dure

to th

e

rest

orat

ion

• Th

e po

lishi

ng o

f res

tora

tions

•

Gold

foil r

esto

ratio

ns

• O

zone

ther

apy

Bene

fit fo

r filli

ngs i

s gra

nted

onc

e pe

r too

th

in 3

65 d

ays.

Bene

fit fo

r re-

trea

tmen

t of a

toot

h is

subj

ect

to m

anag

ed ca

re p

roto

cols.

Co

vere

d at

the

BDT.

A tr

eatm

ent p

lan

and

X-ra

ys m

ay b

e re

quire

d fo

r mul

tiple

filli

ngs.

Sche

me

excl

usio

ns:

• Fi

lling

s to

rest

ore

teet

h da

mag

ed d

ue to

to

othb

rush

abr

asio

n, a

ttrit

ion,

ero

sion

and

flu

oros

is

• Re

sin b

ondi

ng fo

r res

tora

tions

that

are

ch

arge

d as

a se

para

te p

roce

dure

to th

e

rest

orat

ion

• Th

e po

lishi

ng o

f res

tora

tions

•

Gold

foil r

esto

ratio

ns

• O

zone

ther

apy

Bene

fit fo

r filli

ngs i

s gra

nted

onc

e pe

r too

th

in 3

65 d

ays.

Bene

fit fo

r re-

trea

tmen

t of a

toot

h is

subj

ect

to m

anag

ed ca

re p

roto

cols.

Co

vere

d at

the

BDT.

A tr

eatm

ent p

lan

and

X-ra

ys m

ay b

e re

quire

d fo

r mul

tiple

filli

ngs.

Sche

me

excl

usio

ns:

• Fi

lling

s to

rest

ore

teet

h da

mag

ed d

ue to

to

othb

rush

abr

asio

n, a

ttrit

ion,

ero

sion

and

flu

oros

is

• Re

sin b

ondi

ng fo

r res

tora

tions

that

are

ch

arge

d as

a se

para

te p

roce

dure

to th

e

rest

orat

ion

• Th

e po

lishi

ng o

f res

tora

tions

•

Gold

foil r

esto

ratio

ns

• O

zone

ther

apy

ROO

T CA

NAL

TH

ERAP

Y AN

DEX

TRAC

TIO

NS

Bene

fit is

sub

ject

to

man

aged

car

e pr

otoc

ols.

Co

vere

d at

the

BDT.

Bene

fit is

sub

ject

to

man

aged

car

e pr

otoc

ols.

Co

vere

d at

the

BDT.

Bene

fit is

sub

ject

to

man

aged

car

e pr

otoc

ols.

Co

vere

d at

the

BDT.

Bene

fit is

subj

ect t

o m

anag

ed ca

re p

roto

cols.

Bene

fit fo

r roo

t can

al in

clud

es a

ll tee

th

exce

pt p

rimar

y te

eth

and

perm

anen

t mol

ars.

Cove

red

at th

e BD

T.

Sche

me

excl

usio

ns:

• Ro

ot ca

nal t

hera

py o

n pr

imar

y (m

ilk) t

eeth

• Ro

ot ca

nal t

hera

py o

n w

isdom

teet

h

(3rd

mol

ars)

• D

irect

and

indi

rect

pul

p ca

ppin

g

pr

oced

ures

Sche

me

excl

usio

ns:

• Ro

ot ca

nal t

hera

py o

n pr

imar

y (m

ilk) t

eeth

• Ro

ot ca

nal t

hera

py o

n w

isdom

teet

h

(3rd

mol

ars)

• D

irect

and

indi

rect

pul

p ca

ppin

g

pr

oced

ures

Sche

me

excl

usio

ns:

• Ro

ot ca

nal t

hera

py o

n pr

imar

y (m

ilk) t

eeth

• Ro

ot ca

nal t

hera

py o

n w

isdom

teet

h

(3rd

mol

ars)

• D

irect

and

indi

rect

pul

p ca

ppin

g

pr

oced

ures

Sche

me

excl

usio

ns:

• Ro

ot ca

nal t

hera

py o

n pr

imar

y (m

ilk) t

eeth

• Ro

ot ca

nal t

hera

py o

n w

isdom

teet

h

(3rd

mol

ars)

• D

irect

and

indi

rect

pul

p ca

ppin

g

pr

oced

ures

PLAS

TIC

DEN

TURE

S AN

DAS

SOCI

ATED

LA

BORA

TORY

CO

STS

1 se

t of p

last

ic d

entu

res (

an u

pper

and

a

low

er) p

er b

enefi

ciar

y in

a 4

year

per

iod.

Bene

fit is

subj

ect t

o m

anag

ed ca

re

prot

ocol

s.

Cove

red

at th

e BD

T**

1 se

t of p

last

ic d

entu

res (

an u

pper

and

a

low

er) p

er b

enefi

ciar

y in

a 4

year

per

iod

Bene

fit is

subj

ect t

o m

anag

ed ca

re

prot

ocol

s.

Cove

red

at th

e BD

T

1 se

t of p

last

ic d

entu

res (

an u

pper

and

a

low

er) p

er b

enefi

ciar

y in

a 4

year

per

iod

Bene

fit is

subj

ect t

o m

anag

ed ca

re

prot

ocol

s.

Cove

red

at th

e BD

T

1 se

t of p

last

ic d

entu

res (

an u

pper

and

a

low

er) p

er b

enefi

ciar

y in

a 4

year

per

iod

Ben

efit i

s sub

ject

to m

anag

ed ca

repr

otoc

ols.

Co

vere

d at

the

BDT

Benefits 2014

DEN

TAL

BEN

EFIT

TA

BLE

BON

COM

PREH

ENSI

VEBO

NCL

ASSI

CST

AND

ARD

BO

NSA

VE A

ND

PRI

MAR

Y

PLAS

TIC

DEN

TURE

S AN

DAS

SOCI

ATED

LA

BORA

TORY

CO

STS

Bene

fit is

not

ava

ilabl

e fo

r the

clin

ical

fe

e of

den

ture

repa

irs,

den

ture

too

th

repl

acem

ents

and

the

add

itio

n of

a s

oft

base

to

new

den

ture

s; t

he la

bora

tory

fe

e w

ill b

e co

vere

d.Be

nefit

is n

ot a

vaila

ble

for t

he

labo

rato

ry fe

e of

mou

thgu

ards

; th

e cl

inic

al fe

e w

ill b

e co

vere

dSc

hem

e ex

clus

ions

:•

Dia

gnos

tic

dent

ures

and

ass

ocia

ted

la

bora

tory

cos

ts•

Snor

ing

appl

ianc

es a

nd a

ssoc

iate

d

la

bora

tory

cos

ts

• H

igh

impa

ct a

cryl

ic•

The

cost

of g

old,

pre

ciou

s m

etal

,

sem

i-pre

ciou

s m

etal

and

pla

tinu

m fo

il•

Labo

rato

ry d

eliv

ery

fees

• Pr

ovis

iona

l den

ture

s an

d as

soci

ated

labo

rato

ry c

osts

Plea

se n

ote:

Bene

fit fo

r pla

stic

den

ture

s an

d as

soci

ated

labo

rato

ry c

osts

is p

ayab

le

from

the

ava

ilabl

e Co

nser

vati

ve

dent

istr

y lim

it.

Bene

fit is

not

ava

ilabl

e fo

r the

clin

ical

fe

e of

den

ture

repa

irs,

den

ture

too

th

repl

acem

ents

and

the

add

itio

n of

a s

oft

base

to

new

den

ture

s; t

he la

bora

tory

fe

e w

ill b

e co

vere

d.Be

nefit

is n

ot a

vaila

ble

for t

he

labo

rato

ry fe

e of

mou

thgu

ards

; th

e cl

inic

al fe

e w

ill b

e co

vere

d.Sc

hem

e ex

clus

ions

:•

Dia

gnos

tic

dent

ures

and

ass

ocia

ted

la

bora

tory

cos

ts•

Snor

ing

appl

ianc

es a

nd a

ssoc

iate

d

la

bora

tory

cos

ts

• H

igh

impa

ct a

cryl

ic•

The

cost

of g

old,

pre

ciou

s m

etal

,

sem

i-pre

ciou

s m

etal

and

pla

tinu

m fo

il•

Labo

rato

ry d

eliv

ery

fees

• Pr

ovis

iona

l den

ture

s an

d as

soci

ated

labo

rato

ry c

osts

Bene

fit is

not

ava

ilabl

e fo

r the

clin

ical

fe

e of

den

ture

repa

irs,

den

ture

too

th

repl

acem

ents

and

the

add

itio

n of

a s

oft

base

to

new

den

ture

s; t

he la

bora

tory

fe

e w

ill b

e co

vere

d.Be

nefit

is n

ot a

vaila

ble

for t

he

labo

rato

ry fe

e of

mou

thgu

ards

; th

e cl

inic

al fe

e w

ill b

e co

vere

dSc

hem

e ex

clus

ions

:•

Dia

gnos

tic

dent

ures

and

ass

ocia

ted

la

bora

tory

cos

ts•

Snor

ing

appl

ianc

es a

nd a

ssoc

iate

d

la

bora

tory

cos

ts

• H

igh

impa

ct a

cryl

ic•

The

cost

of g

old,

pre

ciou

s m

etal

,

sem

i-pre

ciou

s m

etal

and

pla

tinu

m fo

il•

Labo

rato

ry d

eliv

ery

fees

• Pr

ovis

iona

l den

ture

s an

d as

soci

ated

labo

rato

ry c

osts

Bene

fit is

not

ava

ilabl

e fo

r the

clin

ical

fe

e of

den

ture

repa

irs,

den

ture

too

th

repl

acem

ents

and

the

add

itio

n of

a s

oft

base

to

new

den

ture

s; t

he la

bora

tory

fe

e w

ill b

e co

vere

d.Be

nefit

is n

ot a

vaila

ble

for t

he

labo

rato

ry fe

e of

mou

thgu

ards

; th

e cl

inic

al fe

e w

ill b

e co

vere

d.Sc

hem

e ex

clus

ions

:•

Dia

gnos

tic

dent

ures

and

ass

ocia

ted

la

bora

tory

cos

ts•

Snor

ing

appl

ianc

es a

nd a

ssoc

iate

d

la

bora

tory

cos

ts•

Hig

h im

pact

acr

ylic

• Th

e co

st o

f gol

d, p

reci

ous

met

al,

se

mi-p

reci

ous

met

al a

nd p

lati

num

foil

• La

bora

tory

del

iver

y fe

es•

Prov

isio

nal d

entu

res

and

asso

ciat

ed

la

bora

tory

cos

ts

PART

IAL

MET

AL F

RAM

E D

ENTU

RES

AND

AS

SOCI

ATED

LA

BORA

TORY

CO

STS

2 pa

rtia

l fra

mes

(an

uppe

r and

a lo

wer

) pe

r ben

efici

ary

in a

5 y

ear p

erio

d.Be

nefit

is s

ubje

ct to

man

aged

car

e pr

otoc

ols.

Cove

red

at t

he B

DT.

Sche

me

excl

usio

ns:

• Th

e m

etal

bas

e to

full

dent

ures

and

asso

ciat

ed la

bora

tory

cos

ts•

Hig

h im

pact

acr

ylic

• Th

e co

st o

f gol

d, p

reci

ous

met

al, s

emi-

pr

ecio

us m

etal

and

pla

tinu

m fo

il•

Labo

rato

ry d

eliv

ery

fees

2 pa

rtia

l met

al fr

ames

(an

uppe

r and

a

low

er) p

er b

enefi

ciar

y in

a 5

yea

r per

iod.

Bene

fit is

sub

ject

to m

anag

ed c

are

prot

ocol

s.Co

vere

d at

the

BD

T.Sc

hem

e ex

clus

ions

:•

The

met

al b

ase

to fu

ll de

ntur

es a

nd

as

soci

ated

labo

rato

ry c

osts

• H

igh

impa

ct a

cryl

ic•

The

cost

of g

old,

pre

ciou

s m

etal

, sem

i-

prec

ious

met

al a

nd p

lati

num

foil

• La

bora

tory

del

iver

y fe

es

1 pa

rtia

l met

al fr

ames

(an

uppe

r and

a

low

er) p

er b

enefi

ciar

y in

a 5

yea

r per

iod.

Bene

fit is

sub

ject

to

man

aged

car

e pr

otoc

ols.

Cove

red

at t

he B

DT.

Sche

me

excl

usio

ns:

• Th

e m

etal

bas

e to

full

dent

ures

and

asso

ciat

ed la

bora

tory

cos

ts•

Hig

h im

pact

acr

ylic

• Th

e co

st o

f gol

d, p

reci

ous

met

al,

se

mi-p

reci

ous

met

al a

nd p

lati

num

foil

• La

bora

tory

del

iver

y fe

es

No

bene

fit

CRO

WN

AN

D

BRID

GE*

AN

D

ASSO

CIAT

ED

LABO

RATO

RY

COST

S.A

BRID

GE

COM

PRIS

ES

2 O

R M

ORE

CR

OW

N U

NIT

S.

EACH

CRO

WN

IS

PAY

ABLE

FR

OM

TH

E AV

AILA

BLE

CRO

WN

AN

D B

RID

GE

BEN

EFIT

.

Pre-

auth

oris

atio

n is

requ

ired.

3

crow

ns p

er fa

mily

per

yea

r. Be

nefit

is s

ubje

ct t

o m

anag

ed c

are

prot

ocol

s.

Cove

red

at t

he B

DT.

Bene

fits

for c

row

ns w

ill b

e gr

ante

d on

ce p

er t

ooth

in a

5 y

ear p

erio

dA

trea

tmen

t pl

an a

nd X

-ray

s m

ay b

e

requ

este

d

Pre-

auth

oris

atio

n is

requ

ired.

1

crow

n pe

r fam

ily p

er y

ear.

Bene

fit is

sub

ject

to

man

aged

car

e pr

otoc

ols.

Co

vere

d at

the

BD

T.Be

nefit

s fo

r cro

wns

will

be

gran

ted

once

per

too

th in

a 5

yea

r per

iod

A tr

eatm

ent

plan

and

X-r

ays

may

be

re

ques

ted

Pre-

auth

oris

atio

n is

requ

ired.

1

crow

n pe

r fam

ily p

er y

ear.

Bene

fit is

sub

ject

to

man

aged

car

e pr

otoc

ols.

Co

vere

d at

the

BD

T.Be

nefit

s fo

r cro

wns

will

be

gran

ted

once

per

too

th in

a 5

yea

r per

iod

A tr

eatm

ent

plan

and

X-r

ays

may

be

re

ques

ted

No

bene

fit

Benefits 2014

DEN

TAL

BEN

EFIT

TA

BLE

BON

COM

PREH

ENSI

VEBO

NCL

ASSI

CST

AND

ARD

BO

NSA

VE

AND

PR

IMAR

YCR

OW

N A

ND

BR

IDG

E* A

ND

AS

SOCI

ATED

LA

BORA

TORY

CO

STS

A BR

IDG

E CO

MPR

ISES

2

OR

MO

RE

CRO

WN

U

NIT

S. E

ACH

CR

OW

N IS

PA

YABL

E FR

OM

TH

E AV

AILA

BLE

CRO

WN

AN

D B

RID

GE

BEN

EFIT

.

Sche

me

excl

usio

ns:

• Cr

owns

or c

row

n re

tain

ers

on w

isdo

m

te

eth

(3rd

mol

ars)

• Po

ntic

s on

2nd

mol

ars

• Cr

own

and

brid

ge p

roce

dure

s for

cosm

etic

reas

ons

and

asso

ciat

ed

la

bora

tory

cos

ts•

Full

mou

th re

habi

litat

ions

and

asso

ciat

ed la

bora

tory

cos

ts•

Prov

isio

nal c

row

ns a

nd a

ssoc

iate

d

labo

rato

ry c

osts

• Po

rcel

ain

vene

ers

and

inla

ys a

nd

as

soci

ated

labo

rato

ry c

osts

• Em

erge

ncy

crow

ns t

hat

are

not

pl

aced

for t

he im

med

iate

pro

tect

ion

in

too

th in

jury

and

ass

ocia

ted

labo

rato

ry c

osts

.•

The

cost

of g

old,

pre

ciou

s m

etal

,

sem

i-pre

ciou

s m

etal

and

pla

tinu

m fo

il•

Labo

rato

ry d

eliv

ery

fees

Sche

me

excl

usio

ns:

• Cr

owns

or c

row

n re

tain

ers

on w

isdo

m

te

eth

(3rd

mol

ars)

• Po

ntic

s on

2nd

mol

ars

• Cr

own

and

brid

ge p

roce

dure

s for

cosm

etic

reas

ons

and

asso

ciat

ed

la

bora

tory

cos

ts•

Full

mou

th re

habi

litat

ions

and

as

soci

ated

labo

rato

ry c

osts

• Pr

ovis

iona

l cro

wns

and

ass

ocia

ted

labo

rato

ry c

osts

• Po

rcel

ain

vene

ers

and

inla

ys a

nd

as

soci

ated

labo

rato

ry c

osts

• Em

erge

ncy

crow

ns t

hat

are

not

pl

aced

for t

he im

med

iate

pro

tect

ion

in

too

th in

jury

and

ass

ocia

ted

labo

rato

ry c

osts

.•

The

cost

of g

old,

pre

ciou

s m

etal

,

sem

i-pre

ciou

s m

etal

and

pla

tinu

m fo

il•

Labo

rato

ry d

eliv

ery

fees

Sche

me

excl

usio

ns:

• Cr

owns

or c

row

n re

tain

ers

on w

isdo

m

te

eth

(3rd

mol

ars)

• Po

ntic

s on

2nd

mol

ars

• Cr

own

and

brid

ge p

roce

dure

s for

cosm

etic

reas

ons

and

asso

ciat

ed

la

bora

tory

cos

ts•

Full

mou

th re

habi

litat

ions

and

asso

ciat

ed la

bora

tory

cos

ts•

Prov

isio

nal c

row

ns a

nd a

ssoc

iate

d

la

bora

tory

cos

ts•

Porc

elai

n ve

neer

s an

d in

lays

and

asso

ciat

ed la

bora

tory

cos

ts•

Emer

genc

y cr

owns

tha

t ar

e no

t

plac

ed fo

r the

imm

edia

te p

rote

ctio

n

in t

ooth

inju

ry a

nd a

ssoc

iate

d

la

bora

tory

cos

ts.

• Th

e co

st o

f gol

d, p

reci

ous

met

al,

se

mi-p

reci

ous

met

al a

nd p

lati

num

foil

• La

bora

tory

del

iver

y fe

es

No

bene

fit

IMPL

ANTS

* AN

D

ASSO

CIAT

ED

LABO

RATO

RY

COST

S

Pre-

auth

oris

atio

n is

requ

ired.

2

impl

ants

per

ben

efici

ary

in a

5 y

ear p

erio

d.

Bene

fit is

sub

ject

to m

anag

ed c

are

prot

ocol

s.

Cove

red

at t

he B

DT.

Cost

of i

mpl

ant

com

pone

nts

is li

mit

ed to

R2

000

per

impl

ant.

Sc

hem

e ex

clus

ions

:•

Impl

ants

on

wis

dom

teet

h

(3rd

mol

ars)

• D

olde

r bar

s an

d as

soci

ated

abu

tmen

ts

on

impl

ants

incl

udin

g th

e as

soci

ated

labo

rato

ry c

osts

• La

bora

tory

del

iver

y fe

es

No

bene

fitN

o be

nefit

No

bene

fit

ORT

HO

DO

N-

TICS

*AN

D

ASSO

CIAT

ED

LABO

RATO

RY

COST

S

Pre-

auth

oris

atio

n is

requ

ired.

Be

nefit

is s

ubje

ct t

o m

anag

ed c

are

prot

ocol

s.O

n pr

e-au

thor

isat

ion,

cas

es w

ill b

e cl

inic

ally

as

sess

ed b

y us

ing

an o

rtho

dont

ic n

eeds

an

alys

is. B

enefi

t al

loca

tion

is s

ubje

ct t

o th

e ou

tcom

e of

the

nee

ds a

naly

sis

and

fund

ing

can

be g

rant

ed u

p to

100

% o

f BD

T

Pre-

auth

oris

atio

n is

requ

ired.

Bene

fit is

sub

ject

to

man

aged

car

e pr

otoc

ols.

O

n pr

e-au

thor

isat

ion

case

s w

ill b

e cl

inic

ally

asse

ssed

by

usin

g an

ort

hodo

ntic

nee

ds

anal

ysis

.

Pre-

auth

oris

atio

n is

requ

ired.

Be

nefit

is s

ubje

ct t

o m

anag

ed c

are

prot

ocol

s.

On

pre-

auth

oris

atio

n ca

ses

will

be

clin

ical

ly a

sses

sed

by

usin

g an

ort

hodo

ntic

nee

ds a

naly

sis

No

bene

fit

Benefits 2014

DEN

TAL

BEN

EFIT

TA

BLE

BON

COM

PREH

ENSI

VEBO

NCL

ASSI

CST

AND

ARD

BO

NSA

VE

AND

PR

IMAR

YO

RTH

OD

ON

-TI

CS*

AND

AS

SOCI

ATED

LA

BORA

TORY

CO

STS

Bene

fit fo

r ort

hodo

ntic

tre

atm

ent

will

be

gran

ted

whe

re fu

ncti

on is

impa

ired.

Be

nefit

will

not

be

gran

ted

whe

re

orth

odon

tic

trea

tmen

t is

requ

ired

for

cosm

etic

reas

ons.

The

asso

ciat

ed la

bora

tory

cos

ts w

ill a

lso

not

be c

over

ed.

Onl

y on

e fa

mily

mem

ber m

ay c

omm

ence

O

rtho

dont

ic t

reat

men

t in

a c

alen

dar y

ear.

Bene

fit is

lim

ited

to in

divi

dual

s you

nger

than

18

yea

rs o

f age

.Sc

hem

e ex

clus

ions

:•

Ort

hogn

athi

c (ja

w c

orre

ctio

n) a

nd o

ther

orth

odon

tic-

rela

ted

surg

ery

and

any

re

late

d ho

spit

al a

nd la

bora

tory

cos

ts

• In

visi

ble

reta

iner

mat

eria

l•

Labo

rato

ry d

eliv

ery

fees

• O

rtho

dont

ic re

-tre

atm

ent

and

any

rela

ted

labo

rato

ry c

ost

Bene

fit a

lloca

tion

is s

ubje

ct t

o th

e ou

tcom

e of

th

e ne

eds

anal

ysis

and

fund

ing

can

be g

rant

ed

up t

o 10

0% o

f BD

T.Be

nefit

for o

rtho

dont

ic t

reat

men

t w

ill b

e gr

ante

d w

here

func

tion

is im

paire

d.

Bene

fit w

ill n

ot b

e gr

ante

d w

here

orth

odon

tic

trea

tmen

t is

requ

ired

for

cosm

etic

reas

ons.

Th

e as

soci

ated

Lab

orat

ory

cost

s w

ill a

lso

not

be c

over

ed.

Onl

y on

e fa

mily

mem

ber m

ay c

omm

ence

or

thod

onti

c tr

eatm

ent

in a

cal

enda

r yea

r. Be

nefit

is li

mit

ed t

o in

divi

dual

s yo

unge

r tha

n 18

yea

rs o

f age

. Sc

hem

e ex

clus

ions

:•

Ort

hogn

athi

c (ja

w c

orre

ctio

n) a

nd

ot

her o

rtho

dont

ic re

late

d su

rger

y

and

any

rela

ted

hosp

ital

cos

t

incl

udin

g as

soci

ated

labo

rato

ry c

osts

•

Ort

hodo

ntic

re-t

reat

men

t an

d an

y

rela

ted

labo

rato

ry c

osts

• In

visi

ble

reta

iner

mat

eria

l•

Labo

rato

ry d

eliv

ery

fees

Bene

fit a

lloca

tion

is s

ubje

ct t

o th

e ou

tcom

e of

the

ne

eds

anal

ysis

and

fund

ing

can

be g

rant

ed u

p to

80%

of

BD

T.Be

nefit

for o

rtho

dont

ic t

reat

men

t w

ill b

e gr

ante

d w

here

func

tion

is im

paire

d.

Bene

fit w

ill n

ot b

e gr

ante

d w

here

ort

hodo

ntic

tr

eatm

ent

is re

quire

d fo

r cos

met

ic re

ason

s.

The

asso

ciat

ed la

bora

tory

cos

ts w

ill a

lso

not

be

cove

red.

O

nly

one

fam

ily m

embe

r may

com

men

ce o

rtho

dont

ic

trea

tmen

t in

a c

alen

dar y

ear.

Bene

fit is

lim

ited

to

indi

vidu

als

youn

ger t

han

18 y

ears

of

age

. Sc

hem

e ex

clus

ions

:•

Ort

hogn

athi

c (ja

w c

orre

ctio

n) a

nd

ot

her o

rtho

dont

ic re

late

d su

rger

y

and

any

rela

ted

hosp

ital

and

labo

rato

ry c

osts

•

Ort

hodo

ntic

re-t

reat

men

t an

d an

y

rela

ted

labo

rato

ry c

osts

• In

visi

ble

reta

iner

mat

eria

l•

Labo

rato

ry d

eliv

ery

fees

No

bene

fit

PERI

OD

ON

TICS

*Pr

e-au

thor

isat

ion

is re

quire

d.

Bene

fit is

sub

ject

to

man

aged

car

e pr

otoc

ols.

Co

vere

d at

the

BD

T**.

Bene

fit is

lim

ited

to

cons

erva

tive

, no

n-su

rgic

al t

hera

py o

nly

and

will

onl

y be

ap

plie

d to

mem

bers

who

are

regi

ster

ed o

n th

e Pe

riod

onta

l Pro

gram

me.

Sche

me

excl

usio

ns:

• Su

rgic

al p

erio

dont

ics

whi

ch

in

clud

es g

ingi

vect

omie

s,

pe

riod

onta

l fla

p su

rger

y, t

issu

e gr

afti

ng

an

d th

e he

mis

ecti

on o

f a t

ooth

• Pe

rio

chip

pla

cem

ent

Pre-

auth

oris

atio

n is

requ

ired.

Be

nefit

is s

ubje

ct t

o m

anag

ed c

are

prot

ocol

s.

Cove

red

at t

he B

DT.

Bene

fit is

lim

ited

to

cons

erva

tive

, non

-sur

gica

l th

erap

y on

ly a

nd w

ill o

nly

be a

pplie

d to

m

embe

rs w

ho a

re re

gist

ered

on

the

Peri

odon

tal P

rogr

amm

e.Sc

hem

e ex

clus

ions

:•

Surg

ical

per

iodo

ntic

s w

hich

incl

udes

ging

ivec

tom

ies,

peri

odon

tal f

lap

surg

ery,

tis

sue

graf

ting

and

the

hem

isec

tion

of a

too

th•

Peri

o ch

ip p

lace

men

t

Pre-

auth

oris

atio

n is

requ

ired.

Be

nefit

is s

ubje

ct t

o m

anag

ed c

are

prot

ocol

s.

Cove

red

at t

he B

DT.

Bene

fit is

lim

ited

to

cons

erva

tive

, non

-sur

gica

l the

rapy

on

ly a

nd w

ill o

nly

be a

pplie

d to

mem

bers

who

are

regi

s-te

red

on t

he P

erio

dont

al P

rogr

amm

e.Sc

hem

e ex

clus

ions

:•

Surg

ical

per

iodo

ntic

s w

hich

incl

udes

gin

give

ctom

ies,

peri

odon

tal f

lap

surg

ery,

tis

sue

graf

ting

and

the

hem

isec

tion

of a

too

th•

Peri

o ch

ip p

lace

men

t

No

bene

fit

Benefits 2014

DEN

TAL

BEN

EFIT

TAB

LEBO

NCO

MPR

EHEN

SIVE

BON

CLAS

SIC

STAN

DAR

D

BON

SAVE

AN

D P

RIM

ARY

MAX

ILLO

-FAC

IAL

SURG

ERY

AND

O

RAL

PATH

OLO

GY

Surg

ery

in t

he d

enta

l cha

ir:

Bene

fit is

subj

ect t

o m

anag

ed c

are

prot

ocol

s.

Cove

red

at t

he B

DT*

*.Be

nefit

for T

empr

o-m

andi

bula

r Joi

nt

(TM

J) th

erap

y is

lim

ited

to n

on-s

urgi

cal

inte

rven

tion

/tre

atm

ents

.Th

e cl

aim

s for

ora

l pat

holo

gy

proc

edur

es (c

ysts

and

bio

psie

s, th

e su

rgic

al tr

eatm

ent o

f tum

ours

of t

he

jaw

and

soft

tiss

ue tu

mou

rs) w

ill o

nly

be c

over

ed if

supp

orte

d by

a la

bora

tory

re

port

that

con

firm

s dia

gnos

is.

Sche

me

excl

usio

ns:

• O

rtho

gnat

hic

(jaw

cor

rect

ion)

surg

ery

• Si

nus

lifts

• Bo

ne a

ugm

enta

tion

s•

Bone

and

tiss

ue re

gene

rati

on

pr

oced

ures

• Th

e co

st o

f bon

e re

gene

rati

on

m

ater

ial

• Th

e au

to-t

rans

plan

tati

on o

f tee

th

• Th

e cl

osur

e of

an

oral

-ant

ral o

peni

ng

(c

urre

ntly

cod

e 89

09) w

hen

clai

med

durin

g th

e sa

me

visi

t wit

h

im

pact

ed te

eth

(cur

rent

ly c

odes

8941

, 894

3 an

d 89

45) i

s a sc

hem

e

ex

clus

ion

Surg

ery

in h

ospi

tal;

See

Hos

pita

lisat

ion*

bel

ow

Surg

ery

in t

he d

enta

l cha

ir:

Bene

fit is

subj

ect t

o m

anag

ed c

are

prot

ocol

s.Co

vere

d at

the

BD

T.Be

nefit

for T

empr

o-m

andi

bula

r Joi

nt

(TM

J) th

erap

y is

lim

ited

to n

on-s

urgi

cal

inte

rven

tion

/tre

atm

ents

. Th

e cl

aim

s for

ora

l pat

holo

gy

proc

edur

es (c

ysts

and

bio

psie

s, th

e su

rgic

al tr

eatm

ent o

f tum

ours

of t

he

jaw

and

soft

tiss

ue tu

mou

rs) w

ill o

nly

be c

over

ed if

supp

orte

d by

a la

bora

tory

re

port

that

con

firm

s dia

gnos

is.

Sche

me

excl

usio

ns:

• O

rtho

gnat

hic

(jaw

cor

rect

ion)

surg

ery

• Si

nus

lifts

• Bo

ne a

ugm

enta

tion

s•

Bone

and

tiss

ue re

gene

rati

on

pr

oced

ures

• Th

e co

st o

f bon

e re

gene

rati

on

m

ater

ial

• Th

e au

to-t

rans

plan

tati

on o

f tee

th

• Th

e cl

osur

e of

an

oral

-ant

ral o

peni

ng

(c

urre

ntly

cod

e 89

09) w

hen

clai

med

durin

g th

e sa

me

visi

t wit

h

im

pact

ed te

eth

(cur

rent

ly c

odes

8941

, 894

3 an

d 89

45) i

s a sc

hem

e

ex

clus

ion

Surg

ery

in h

ospi

tal;

See

Hos

pita

lisat

ion*

bel

ow

Surg

ery

in t

he d

enta

l cha

ir:

Bene

fit is

subj

ect t

o m

anag

ed c

are

prot

ocol

s.Co

vere

d at

the

BD

T.Be

nefit

for T

empr

o-m

andi

bula

r Joi

nt

(TM

J) th

erap

y is

lim

ited

to n

on-s

urgi

cal

inte

rven

tion

/tre

atm

ents

.Th

e cl

aim

s for

ora

l pat

holo

gy

proc

edur

es (c

ysts

and

bio

psie

s, th

e su

rgic

al tr

eatm

ent o

f tum

ours

of t

he

jaw

and

soft

tiss

ue tu

mou

rs) w

ill o

nly

be c

over

ed if

supp

orte

d by

a la

bora

tory

re

port

that

con

firm

s dia

gnos

is.

Sche

me

excl

usio

ns:

• O

rtho

gnat

hic

(jaw

cor

rect

ion)

surg

ery

• Si

nus

lifts

• Bo

ne a

ugm

enta

tion

s•

Bone

and

tiss

ue re

gene

rati

on

pr

oced

ures

• Th

e co

st o

f bon

e re

gene

rati

on

m

ater

ial

• Th

e au

to-t

rans

plan

tati

on o

f tee

th

• Th

e cl

osur

e of

an

oral

-ant

ral o

peni

ng

(c

urre

ntly

cod

e 89

09) w

hen

clai

med

durin

g th

e sa

me

visi

t wit

h

im

pact

ed te

eth

(cur

rent

ly c

odes

8941

, 894

3 an

d 89

45) i

s a sc

hem

e

ex

clus

ion

Surg

ery

in h

ospi

tal;

See

Hos

pita

lisat

ion*

bel

ow

Surg

ery

in t

he d

enta

l cha

ir:

Bene

fit is

subj

ect t

o m

anag

ed c

are

prot

ocol

s.Co

vere

d at

the

BD

T.Be

nefit

for T

empr

o-m

andi

bula

r Joi

nt

(TM

J) th

erap

y is

lim

ited

to n

on-s

urgi

cal

inte

rven

tion

/tre

atm

ents

.Th

e cl

aim

s for

ora

l pat

holo

gy

proc

edur

es (c

ysts

and

bio

psie

s, th

e su

rgic

al tr

eatm

ent o

f tum

ours

of t

he

jaw

and

soft

tiss

ue tu

mou

rs) w

ill o

nly

be c

over

ed if

supp

orte

d by

a la

bora

tory

re

port

that

con

firm

s dia

gnos

is.

Sche

me

excl

usio

ns:

• O

rtho

gnat

hic

(jaw

cor

rect

ion)

surg

ery

• Si

nus

lifts

• Bo

ne a

ugm

enta

tion

s•

Bone

and

tiss

ue re

gene

rati

on

pr

oced

ures

• Th

e co

st o

f bon

e re

gene

rati

on

m

ater

ial

• Th

e au

to-t

rans

plan

tati

on o

f tee

th

• Th

e cl

osur

e of

an

oral

-ant

ral o

peni

ng

(c

urre

ntly

cod

e 89

09) w

hen

clai

med

durin

g th

e sa

me

visi

t wit

h

im

pact

ed te

eth

(cur

rent

ly c

odes

8941

, 894

3 an

d 89

45) i

s a sc

hem

e

ex

clus

ion

Surg

ery

in h

ospi

tal;

See

Hos

pita

lisat

ion*

bel

ow

Benefits 2014

DEN

TAL

BEN

EFIT

TAB

LEBO

NCO

MPR

EHEN

SIVE

BON

CLAS

SIC

STAN

DAR

D

BON

SAVE

AN

D P

RIM

ARY

HOSPITALISATON AND ANAESTHETIC

HO

SPIT

ALIS

ATIO

N

(GEN

ERAL

AN

AEST

HET

IC) *

Pre-

auth

oris

atio

n is

requ

ired.

Adm

issi

on p

roto

cols

app

ly.

Gen

eral

ana

esth

etic

ben

efits

are

av

aila

ble

for c

hild

ren

unde

r the

ag

e of

5 y

ears

for e

xten

sive

den

tal

trea

tmen

t.

Gen

eral

ana

esth

etic

ben

efits

are

av

aila

ble

for t

he re

mov

al o

f im

pact

ed

teet

h. B

enefi

t is

sub

ject

to

man

aged

ca

re p

roto

cols

.Th

e ho

spit

al a

nd a

naes

thet

ist

clai

ms

for t

he fo

llow

ing

proc

edur

es w

ill n

ot

be c

over

ed w

hen

perf

orm

ed u

nder

ge

nera

l ana

esth

esia

. The

pay

men

t of

the

den

tal p

roce

dure

will

be,

de

pend

ent

on a

vaila

ble

bene

fits

and

paya

ble

at B

DT

tari

ffs:

• Ap

icec

tom

ies

• D

ente

ctom

ies

• Fr

enec

tom

ies

• Im

plan

tolo

gy a

nd a

ssoc

iate

d

surg

ical

pro

cedu

res

• Co

nser

vati

ve d

enta

l tre

atm

ent

(filli

ngs,

ext

ract

ions

and

root

cana

l the

rapy

) for

adu

lts

• Pr

ofes

sion

al o

ral h

ygie

ne

proc

edur

es•

Surg

ical

too

th e

xpos

ures

for

or

thod

onti

c re

ason

sSc

hem

e ex

clus

ions

: •

Whe

re t

he o

nly

reas

on fo

r

ad

mis

sion

to

hosp

ital

is d

enta

l

fear

and

anx

iety

•

Mul

tipl

e ho

spit

al a

dmis

sion

s•

Whe

re t

he o

nly

reas

on fo

r the

adm

issi

on re

ques

t is

for a

ste

rile

faci

lity

• Th

e co

st o

f den

tal m

ater

ials

for

pr

oced

ures

per

form

ed u

nder

gen

eral

anae

sthe

sia

Pre-

auth

oris

atio

n is

requ

ired.

Adm

issi

on p

roto

cols

app

ly.

Gen

eral

ana

esth

etic

ben

efits

are

av

aila

ble

for c

hild

ren

unde

r the

ag

e of

5 y

ears

for e

xten

sive

den

tal

trea

tmen

t.

Gen

eral

ana

esth

etic

ben

efits

are

av

aila

ble

for t

he re

mov

al o

f im

pact

ed

teet

h. B

enefi

t is

sub

ject

to

man

aged

ca

re p

roto

cols

.Th

e ho

spit

al a

nd a

naes

thet

ist

clai

ms

for t

he fo

llow

ing

proc

edur

es w

ill n

ot

be c

over

ed w

hen

perf

orm

ed u

nder

ge

nera

l ana

esth

esia

. The

pay

men

t of

the

den

tal p

roce

dure

will

be

depe

nden

t on

ava

ilabl

e be

nefit

s an

d pa

yabl

e at

BD

T ra

tes:

• Ap

icec

tom

ies

• D

ente

ctom

ies

• Fr

enec

tom

ies

• Im

plan

tolo

gy a

nd a

ssoc

iate

d

surg

ical

pro

cedu

res

• Co

nser

vati

ve d

enta

l tre

atm

ent

(filli

ngs,

ext

ract

ions

and

root

cana

l the

rapy

) for

adu

lts

• Pr

ofes

sion

al o

ral h

ygie

ne

proc

edur

es•

Surg

ical

too

th e

xpos

ures

for

or

thod

onti

c re

ason

sSc

hem

e ex

clus

ions

: •

Whe

re t

he o

nly

reas

on fo

r

ad

mis

sion

to

hosp

ital

is d

enta

l

fear

and

anx

iety

•

Mul

tipl

e ho

spit

al a

dmis

sion

s•

Whe

re t

he o

nly

reas

on fo

r the

adm

issi

on re

ques

t is

for a

ste

rile

faci

lity

• Th

e co

st o

f den

tal m

ater

ials

for

pr

oced

ures

per

form

ed u

nder

gen

eral

anae

sthe

sia

Pre-

auth

oris

atio

n is

requ

ired.

Adm

issi

on p

roto

cols

app

ly.

Gen

eral

ana

esth

etic

ben

efits

are

av

aila

ble

for c

hild

ren

unde

r the

ag

e of

5 y

ears

for e

xten

sive

den

tal

trea

tmen

t.

Gen

eral

ana

esth

etic

ben

efits

are

av

aila

ble

for t

he re

mov

al o

f im

pact

ed

teet

h. B

enefi

t is

sub

ject

to

man

aged

ca

re p

roto

cols

.Th

e ho

spit

al a

nd a

naes

thet

ist

clai

ms

for t

he fo

llow

ing

proc

edur

es w

ill n

ot

be c

over

ed w

hen

perf

orm

ed u

nder

ge

nera

l ana

esth

esia

. The

pay

men

t of

the

den

tal p

roce

dure

will

be,

de

pend

ent

on a

vaila

ble

bene

fits

and

paya

ble

at B

DT

tari

ffs:

• Ap

icec

tom

ies

• D

ente

ctom

ies

• Fr

enec

tom

ies

• Im

plan

tolo

gy a

nd a

ssoc

iate

d

surg

ical

pro

cedu

res

• Co

nser

vati

ve d

enta

l tre

atm

ent

(filli

ngs,

ext

ract

ions

and

root

cana

l the

rapy

) for

adu

lts

• Pr

ofes

sion

al o

ral h

ygie

ne

proc

edur

es•

Surg

ical

too

th e

xpos

ures

for

or

thod

onti

c re

ason

sSc

hem

e ex

clus

ions

: •

Whe

re t

he o

nly

reas

on fo

r

ad

mis

sion

to

hosp

ital

is d

enta

l

fear

and

anx

iety

•

Mul

tipl

e ho

spit

al a

dmis

sion

s•

Whe

re t

he o

nly

reas

on fo

r the

adm

issi

on re

ques

t is

for a

ste

rile

faci

lity

• Th

e co

st o

f den

tal m

ater

ials

for

pr

oced

ures

per

form

ed u

nder

gen

eral

anae

sthe

sia

Pre-

auth

oris

atio

n is

requ

ired.

Adm

issi

on p

roto

cols

app

ly.

Gen

eral

ana

esth

etic

ben

efits

are

av

aila

ble

for c

hild

ren

unde

r the

ag

e of

5 y

ears

for e

xten

sive

den

tal

trea

tmen

t.

Gen

eral

ana

esth

etic

ben

efits

are

av

aila

ble

for t

he re

mov

al o

f im

pact

ed

teet

h. B

enefi

t is

sub

ject

to

man

aged

ca

re p

roto

cols

.Th

e ho

spit

al a

nd a

naes

thet

ist

clai

ms

for t

he fo

llow

ing

proc

edur

es w

ill n

ot

be c

over

ed w

hen

perf

orm

ed u

nder

ge

nera

l ana

esth

esia

. The

pay

men

t of

the

den

tal p

roce

dure

will

be

depe

nden

t on

ava

ilabl

e be

nefit

s an

d pa

yabl

e at

BD

T ra

tes:

• Ap

icec

tom

ies

• D

ente

ctom

ies

• Fr

enec

tom

ies

• Im

plan

tolo

gy a

nd a

ssoc

iate

d

surg

ical

pro

cedu

res

• Co

nser

vati

ve d

enta

l tre

atm

ent

(filli

ngs,

ext

ract

ions

and

root

cana

l the

rapy

) for

adu

lts

• Pr

ofes

sion

al o

ral h

ygie

ne

proc

edur

es•

Surg

ical

too

th e

xpos

ures

for

or

thod

onti

c re

ason

sSc

hem

e ex

clus

ions

: •

Whe

re t

he o

nly

reas

on fo

r

ad

mis

sion

to

hosp

ital

is d

enta

l

fear

and

anx

iety

•

Mul

tipl

e ho

spit

al a

dmis

sion

s•

Whe

re t

he o

nly

reas

on fo

r the

adm

issi

on re

ques

t is

for a

ste

rile

faci

lity

• Th

e co

st o

f den

tal m

ater

ials

for

pr

oced

ures

per

form

ed u

nder

gen

eral

anae

sthe

sia

Benefits 2014

ADD

ITIO

NAL

SCH

EME

EXCL

USI

ON

S:•

Elec

trog

nath

ogra

phic

reco

rdin

gs, p

anto

grap

hic

reco

rdin

gs a

nd o

ther

suc

h el

ectr

onic

ana

lyse

s•

Nut

riti

onal

and

tob

acco

cou

nsel

ling

• Ca

ries

sus

cept

ibili

ty a

nd m

icro

biol

ogic

al t

ests

• Fi

ssur

e se

alan

ts o

n pa

tien

ts 1

6 ye

ars

and

olde

r•

Pulp

tes

ts•

Cost

of M

iner

al T

riox

ide

• Co

st o

f pre

scri

bed

toot

hpas

tes,

mou

thw

ashe

s (e

.g. C

orso

dyl)

and

oint

men

ts•

Appo

intm

ent

not

kept

•

Spec

ial r

epor

t•

Den

tal t

esti

mon

y in

clud

ing

Den

to-le

gal f

ees

• Tr

eatm

ent

pla

n co

mpl

eted

(cur

rent

ly c

ode

8120

)•

Enam

el m

icro

abra

sion

• Be

havi

our m

anag

emen

t•

Intr

amus

cula

r or s

ubcu

tane

ous

inje

ctio

n•

Proc

edur

es t

hat

are

defin

ed a

s un

usua

l circ

umst

ance

s an

d pr

oced

ures

tha

t ar

e de

fined

as

unlis

ted

proc

edur

es

DEN

TAL

BEN

EFIT

TAB

LEBO

NCO

MPR

EHEN

SIVE

BON

CLAS

SIC

STAN

DAR

D

BON

SAVE

AN

D P

RIM

ARY

Laug

hing

gas

in d

enta

l ro

oms

Bene

fit is

sub

ject

to

man

aged

car

e pr

otoc

ols.

Co

vere

d at

the

BD

T

Bene

fit is

sub

ject

to

man

aged

car

e pr

otoc

ols.

Co

vere

d at

the

BD

T

Bene

fit is

sub

ject

to

man

aged

car

e pr

otoc

ols.

Co

vere

d at

the

BD

T

Bene

fit is

sub

ject

to

man

aged

car

e pr

otoc

ols.

Co

vere

d at

the

BD

T

IV c

onsc

ious

sed

atio

n in

room

s*Pr

e-au

thor

isat

ion

is re

quire

d.

Bene

fit is

sub

ject

to

man

aged

car

e pr

otoc

ols.

Cove

red

at t

he B

DT.

Bene

fit is

lim

ited

to

exte

nsiv

e de

ntal

tr

eatm

ent

Pre-

auth

oris

atio

n is

requ

ired.

Bene

fit is

sub

ject

to

man

aged

car

e pr

otoc

ols.

Co

vere

d at

the

BD

T.Be

nefit

is li

mit

ed t

o ex

tens

ive

dent

al

trea

tmen

t

Pre-

auth

oris

atio

n is

requ

ired.

Be

nefit

is s

ubje

ct t

o m

anag

ed c

are

prot

ocol

s.

Cove

red

at t

he B

DT.

Bene

fit is

lim

ited

to

exte

nsiv

e de

ntal

tr

eatm

ent

Pre-

auth

oris

atio

n is

requ

ired.

Be

nefit

is s

ubje

ct t

o m

anag

ed c

are

prot

ocol

s.

Cove

red

at t

he B

DT.

Bene

fit is

lim

ited

to

exte

nsiv

e de

ntal

tr

eatm

ent

Benefits 2014

NEW

GEN

ERAT

ION

MAJ

OR

MED

ICAL

BEN

EFIT

SBO

NCO

MPR

EHEN

SIVE

BO

NCL

ASSI

CBO

NSA

VEBO

NES

SEN

TIAL

OVE

RALL

AN

NU

AL L

IMIT

Unl

imit

edU

nlim

ited

Unl

imit

edU

nlim

ited

REIM

BURS

EMEN

T RA

TESu

rgic

al p

roce

dure

s an

d co

nsul

tati

ons

at 3

00%

Bon

itas

Rat

e10

0% B

onit

as R

ate

150%

Bon

itas

Rat

e10

0% B

onit

as R

ate

PRO

VID

ERAn

y ho

spit

alAn

y ho

spit

alAn

y ho

spit

alAn

y ho

spit

al

GPs

AN

D S

PECI

ALIS

TS, P

ATH

OLO

GY

AND

RAD

IOLO

GY,

PAR

AMED

ICAL

SE

RVIC

ES

Unl

imit

edU

nlim

ited

Unl

imit

edU

nlim

ited

ON

COLO

GY

- CH

EMO

AN

D

RAD

IATI

ON

R475

000

per

fam

ilyR3

15 0

00 p

er fa

mily

R264

500

per

fam

ilyR2

64 5

00 p

er fa

mily

ON

COLO

GY

- BIO

LOG

ICAL

DRU

GS

INCL

UD

ED IN

TH

E O

NCO

LOG

Y LI

MIT

R200

000

(10%

co-

paym

ent)

pe

r fam

ilyN

o be

nefit

No

bene

fitN

o be

nefit

ORG

AN T

RAN

SPLA

NTS

Unl

imit

ed, s

ubje

ct t

o pr

e-au

thor

isat

ion

Subj

ect

to p

re-a

utho

risa

tion

Unl

imit

ed, s

ubje

ct t

o pr

e-au

thor

isat

ion

Unl

imit

ed, s

ubje

ct t

o pr

e-au

thor

isat

ion

REN

AL D

IALY

SIS

Unl

imit

ed, s

ubje

ct t

o pr

e-au

thor

isat

ion

Subj

ect

to p

re-a

utho

risa

tion

PMBs

onl

yPM

Bs o

nly

MED

ICAT

ION

TO

TAK

E O

UT

R420

per

ben

efici

ary

per a

dmis

sion

R360

per

ben

efici

ary

per a

dmis

sion

R290

per

ben

efici

ary

per a

dmis

sion

R290

per

ben

efici

ary

per a

dmis

sion

AT A GLANCE

CHRO

NIC

BON

COM

PREH

ENSI

VE O

PTIO

NBO

NCL

ASSI

C O

PTIO

NBO

NSA

VE O

PTIO

NBO

NES

SEN

TIAL

OPT

ION

• 53

Chr

onic

Con

diti

ons

Co

mpr

ehen

sive

For

mul

ary

• R1

0 60

0 pe

r ben

efici

ary,

R21

150

pe

r fam

ily

• 63

con

diti

ons

R8 7

00 p

er

be

nefic

iary

, R18

000

pe

r fam

ily, p

er a

nnum

•• Re

stri

ctiv

e Fo

rmul

ary

at D

SP,

40

% c

o-pa

ymen

t ap

ply

at

no

n-D

SP

• 26

PM

Bs o

nly

• Re

stri

ctiv

e Fo

rmul

ary

at D

SP,

40

% c

o-pa

ymen

t ap

ply

at

no

n-D

SP

• 26

PM

Bs o

nly

• Re

stri

ctiv

e Fo

rmul

ary

at D

SP,

40

% c

o-pa

ymen

t ap

ply

at

no

n-D

SP

OU

T O

F H

OSP

ITAL

BEN

EFIT

S BON

COM

PREH

ENSI

VEBO

NCL

ASSI

CBO

NSA

VEBO

NES

SEN

TIAL

Savi

ngs

Thre

shol

d m

embe

rSe

lf-fu

ndin

g ga

pSa

ving

sSa

ving

sN

o be

nefit

MEM

BER

R6 4

92R7

400

R908

R3 0

24R3

180

-

MEM

BER

+AR1

2 62

4R1

4 10

0R1

476

R5 6

16R5

640

-

MEM

BER

+A +

CR1

3 94

4R1

6 05

0R2

106

R6 3

60R6

600

-

Benefits 2014

OU

T O

F H

OSP

ITAL

BEN

EFIT

S BON

COM

PREH

ENSI

VEBO

NCL

ASSI

CBO

NSA

VEBO

NES

SEN

TIAL

N

o be

nefit

S EX

CEPT

PM

Bs

MEM

BER

+A +

2CR1

5 26

4R1

8 00

0R2

736

R7 1

04R

7 56

0-

MEM

BER

+A +

3CR1

6 58

4R1

9 95

0R3

366

R7 8

48R

8 52

0

-

GP

CON

SULT

ATIO

NS

Subj

ect

to s

avin

gs a

nd/o

r thr

esho

ld, 2

5% c

o-pa

ymen

t in

thr

esho

ldSu

bjec

t to

sav

ings

Subj

ect

to s

avin

gs, o

nce

savi

ngs

exha

uste

d 3

visi

ts p

er b

enefi

ciar

y, u

p to

a m

axim

um o

f 6 v

isit

s pe

r fam

ily

No

bene

fit

SPEC

IALI

STS

CON

SULT

ATIO

NSu

bjec

t to

sav

ings

and

/or t

hres

hold

, 25%

co-

paym

ent

in t

hres

hold

Subj

ect

to s

avin

gsSu

bjec

t to

sav

ings

No

bene

fit

RAD

IOLO

GY,

PAT

HO

LOG

YSu

bjec

t to

sav

ings

and

/or t

hres

hold

GEN

ERAL

RAD

IOLO

GY:

R2

400

per

ben

efici

ary

limit

ed t

o R3

700

per

fam

ily

Path

olog

y R2

400

per

ben

efici

ary,

R5 3

00 p

er fa

mily

Subj

ect

to s

avin

gsN

o be

nefit

PARA

MED

ICAL

SER

VICE

SSu

bjec

t to

sav

ings

and

/or t

hres

hold

. 25%

co-

paym

ent

in t

hres

hold

Mem

ber =

R2

300

Mem

ber +

1 =

R3

500

Mem

ber +

2 =

R4

050

Mem

ber +

3 =

R4

300

Mem

ber +

4+

= R4

600

Subj

ect

to s

avin

gsN

o be

nefit

OPT

OM

ETRY

Subj

ect

to s

avin

gs a

nd/o

r thr

esho

ld, l

imit

ed t

o R2

450

per

ben

efici

ary.

25

% c

o-pa

ymen

t in

thr

esho

ld

R5 2

60 p

er fa

mily

, per

ann

umEy

e ex

amin

atio

n 10

0% o

f cos

t.Fr

ames

/len

s add

ons

R70

0 p.

b.Si

ngle

vis

ion

lens

R18

5 pe

r len

s, p

.b.

Bifo

cal l

ens

R430

per

lens

, p.b

. M

ulti-

foca

l lens

es R

750

per l

ens,

p.b

. Co

ntac

t le

ns R

1 63

5 p.

b.

Subj

ect

to s

avin

gsN

o be

nefit

ACU

TE M

EDIC

ATIO

NS

AND

PAT

Subj

ect

to s

avin

gs a

nd/o

r thr

esho

ld, 1

00%

of B

onit

as ra

tes

accr

ues

to t

hres

hold

, 25

% c

o-pa

ymen

t in

thr

esho

ldSu

bjec

t to

sav

ings

Subj

ect

to s

avin

gsN

o be

nefit

DEN

TIST

RY

BASI

C D

ENTI

STRY

Subj

ect

to s

avin

gs a

nd/o

r thr

esho

ld. 2

5% c

o-pa

ymen

t in

thr

esho

ld.

Cove

red

acco

rdin

g to

DEN

IS C

linic

al P

roto

cols

and

Bon

itas

Den

tal T

ariff

R3 6

00 p

er fa

mily

per

ann

um

Subj

ect

to c

linic

al p

roto

cols

and

Bo

nita

s D

enta

l Tar

iff (B

DT)

1

Cove

red

acco

rdin

g to

D

ENIS

Clin

ical

Pro

toco

ls

and

Boni

tas

Den

tal T

ariff

No

bene

fit

ADVA

NCE

D D

ENTI

STRY

Subj

ect

to s

avin

gs a

nd/o

r thr

esho

ld. 2

5% c

o-pa

ymen

t in

thr

esho

ld.

Cove

red

acco

rdin

g to

DEN

IS C

linic

al P

roto

cols

and

Bon

itas

Den

tal T

ariff

R4 3

00 p

er fa

mily

per

ann

um

Subj

ect

to c

linic

al p

roto

cols

and

Bo

nita

s D

enta

l Tar

iff (B

DT)

1

No

bene

fitN

o be

nefit

Benefits 2014

SUPP

LEM

ENTA

RY

BEN

EFIT

SBO

NCO

MPR

EHEN

SIVE

BON

CLAS

SIC

BON

SAVE

BON

ESSE

NTI

AL

MAT

ERN

ITY

CARE

12 a

nte-

nata

l con

sult

atio

ns, 2

x 2

D

scan

s, 4

pos

t-na

tal c

onsu

ltat

ions

wit

h a

mid

wif

e. A

nte-

nata

l cla

sses

R1

000

and

post

con

finem

ent

in a

pri

vate

war

d

R980

for a

nte-

nata

l cla

sses

. 12

ante

-na

tal c

onsu

ltat

ions

, 2 X

2D

sca

ns a

nd 4

po

st-n

atal

con

sult

atio

ns w

ith

a m

idw

ife

6 an

te-n

atal

con

sult

atio

ns, 2

x 2

D

scan

s, 4

pos

t-na

tal c

onsu

ltat

ions

wit

h a

mid

wif

e. A

nte-

nata

l cla

sses

R95

0

6 an

te-n

atal

con

sult

atio

ns, 2

x 2

D

scan

s, 4

pos

t-na

tal c

onsu

ltat

ions

wit

h a

mid

wif

e

REFR

ACTI

VE S

URG

ERY

R15

900

per f

amily

No

bene

fitN

o be

nefit

No

bene

fit

HIV

Unl

imit

ed s

ubje

ct t

o Ai

d fo

r AID

S re

gist

rati

onPM

Bs o

nly

Subj

ect

to A

id fo

r AID

S re

gist

rati

onR2

4 80

0 pe

r ben

efici

ary

subj

ect

to A

id

for A

IDS

regi

stra

tion

R24

800

per b

enefi

ciar

y su

bjec

t to

Aid

fo

r AID

S re

gist

rati

onM

ENTA

L H

EALT

H

(SU

BJEC

T TO

PRE-

AUTH

ORI

SATI

ON

BY

HBM

)

R36

000

per f

amily

, sub

-lim

it o

f R12

000

in

and

out

of h

ospi

tal c

onsu

ltat

ions

R31

700

per f

amily

. R12

400

sub

-lim

it

for c

onsu

ltat

ions

in a

nd o

ut o

f hos

pita

l. R2

4 80

0 pe

r fam

ily, s

ub-li

mit

of R

12 1

50

in a

nd o

ut o

f hos

pita

l con

sult

atio

nsR2

4 80

0 pe

r fam

ily. I

n ho

spit

al o

nly

SPEC

IALI

SED

RAD

IOLO

GY

(SU

BJEC

T TO

PRE-

AUTH

ORI

SATI

ON

BY

HBM

)

R24

000

per f

amily

(o

ut o

f hos

pita

l onl

y)R2

2 20

0 in

and

out

of h

ospi

tal

Incl

uded

in t

he h

ospi

tal b

enefi

tR1

7 00

0 pe

r fam

ily

(out

of h

ospi

tal o

nly)

No

bene

fit

AMBU

LAN

CE -

EMER

GEN

CYER

24ER

24ER

24ER

24

END

OSC

OPI

ES IN

D

OCT

ORS

RO

OM

S*U

nlim

ited

Unl

imit

ed, s

ubje

ct t

o pr

e-au

thor

isat

ion

Unl

imit

edN

o be

nefit

PRO

STH

ESES

INTE

RNAL

R42

300

per f

amily

R42

000

per f

amily

, sub

ject

to

pre-

auth

oris

atio

nPM

Bs o

nly

PMBs

onl

y

PRO

STH

ESES

EXT

ERN

ALR4

2 30

0 pe

r fam

ilyIn

clud

ed in

the

inte

rnal

pro

sthe

sis

PMBs

onl

yPM

Bs o

nly

COCH

LEAR

IMPL

ANTS

R158

000

per

fam

ilyR1

58 0

00 p

er fa

mily

No

bene

fitN

o be

nefit

INTE

RNAL

NER

VE

STIM

ULA

TORS

R127

000

per

fam

ilyN

o be

nefit

No

bene

fitN

o be

nefit

HIV

TES

T AN

D F

LU

VACC

INE

1 ea

ch p

er b

enefi

ciar

y, p

er a

nnum

1 ea

ch p

er b

enefi

ciar

y, p

er a

nnum

1 ea

ch p

er b

enefi

ciar

y, p

er a

nnum

1 ea

ch p

er b

enefi

ciar

y, p

er a

nnum

INFA

NT

PAED

IATR

IC

BEN

EFIT

3 co

nsul

tati

ons

befo

re t

he a

ge o

f 1 y

ear.

2 co

nsul

tati

ons

betw

een

the

ages

of 1

an

d 2

year

sN

o be

nefit

2 co

nsul

tati

ons

befo

re t

he a

ge o

f 1 y

ear.

1 co

nsul

tati

on b

etw

een

the

ages

of 1

an

d 2

year

sN

o be

nefit

CHIL

DH

OO

D IL

LNES

S BE

NEF

ITN

o be

nefit

1 G

P co

nsul

tati

on b

etw

een

the

ages

of

2 an

d 12

yea

rs1

GP

cons

ulta

tion

bet

wee

n th

e ag

es o

f 2

and

12 y

ears

1 G

P co

nsul

tati

on b

etw

een

the

ages

of 2

an

d 12

yea

rs

WO

MEN

’S H

EALT

H

• 1

mam

mog

ram

eve

ry 3

yea

rs fo

r

fem

ales

age

d 50

to

74

year

s•

1 pa

p sm

ear e

very

3 y

ears

for f

emal

es

age

21 t

o 65

yea

rs

No

bene

fitN

o be

nefit

No

bene

fit

AT A GLANCE

Benefits 2014

NEW

GEN

ERAT

ION

PREV

ENTA

TIVE

CAR

E BE

NEF

ITBO

NCO

MPR

EHEN

SIVE

BON

CLAS

SIC

BON

SAVE

BON

ESSE

NTI

AL

CARD

IAC

HEA

LTH

• 1

full

lipog

ram

per

ben

efici

ary

No

bene

fitN

o be

nefit

No

bene

fit

ELD

ERLY

HEA

LTH

• 1

Pneu

moc

coca

l vac

cina

tion

abo

ve

age

65 y

ears

• 1

Faec

al o

ccul

t bl

ood

test

p.b

.p.a

be

twee

n th

e ag

es o

f 50

and

75 y

ears

• 1

Bone

Den

sito

met

ry S

cree

ning

tes

t

fo

r fem

ales

abo

ve t

he a

ge o

f 65

year

s

No

bene

fitN

o be

nefit

No

bene

fit

CHIL

DRE

N’S

HEA

LTH

• 1

TSH

tes

t fo

r inf

ants

bel

ow 1

mon

th

of a

ge•

Imm

unis

atio

n fo

r chi

ldre

n up

to

age

12,

as

spec

ified

in t

he E

xten

ded

Pr

ogra

mm

e on

Imm

unis

atio

n (E

PI)

No

bene

fitN

o be

nefit

No

bene

fit

GEN

ERAL

APP

LIAN

CES

APPL

IAN

CES

R6 8

00 p

er fa

mily

R6 3

00 p

er fa

mily

R5 6

00 p

er fa

mily

No

bene

fit, e

xcep

t PM

Bs

WH

EELC

HAI

RS A

ND

LA

RGE

ORT

HO

APAE

DIC

AP

PLIA

NCE

SIn

clud

ed in

Gen

eral

App

lianc

e lim

itIn

clud

ed in

G

ener

al A

pplia

nce

limit

Incl

uded

in G

ener

al A

pplia

nce

bene

fitN

o be

nefit

, exc

ept

PMBs

STO

MA

PRO

DU

CTS

AND

CP

AP*

SU

BJEC

T TO

PR

E-AU

THO

RISA

TIO

N

May

exc

eed

Gen

eral

App

lianc

e lim

it

by R

4 75

0In

clud

ed in

the

G

ener

al A

pplia

nce

limit

May

exc

eed

Gen

eral

App

lianc

e by

R5

000

No

bene

fit

HEA

RIN

G A

IDS

R21

000

Bien

nial

per

fam

ilyR1

3 80

0 pe

r fam

ily p

er a

nnum

ove

r a 3

ye

ar c

ycle

(cyc

le c

omm

ence

d

(1 Ja

n 20

13 -

31 D

ec 2

015)

No

bene

fitN

o be

nefit

OXY

GEN

: HO

ME

VEN

TILA

TIO

NU

nlim

ited

sub

ject

to

pre-

auth

oris

atio

n by

Hos

pita

l Ben

efit

Man

agem

ent

Incl

uded

in t

he G

ener

al A

pplia

nce

limit

Unl

imit

ed s

ubje

ct t

o pr

e-au

thor

isat

ion

by H

ospi

tal B

enefi

t M

anag

emen

tN

o be

nefit

, exc

ept

PMBs

AT A GLANCE

CON

TRIB

UTI

ON

SBO

NCO

MPR

EHEN

SIVE

BO

NCL

ASSI

CBO

NSA

VEBO

NES

SEN

TIAL

MEM

BER

R3 6

07R2

513

R1 5

58R1

085

MEM

BER

+ A

R7 0

09R4

671

R2 7

65R1

915

MEM

BER

+A +

CR7

743

R5 2

91R3

233

R2 2

33

MEM

BER

+ A

+2C

R8 4

77R5

911

R3 7

01R2

551

MEM

BER

+ A

+3C

R9 2

11R6

531

R4 1

69R2

869

Benefits 2014

TRAD

ITIO

NAL

OPT

ION

S

MAJ

OR

MED

ICAL

BEN

EFIT

SST

AND

ARD

PRIM

ARY

OVE

RALL

AN

NU

AL L

IMIT

Unl

imit

edU

nlim

ited

REIM

BURS

EMEN

T RA

TE10

0% B

onit

as R

ate

100%

Bon

itas

Rat

e

PRO

VID

ERAn

y ho

spit

alAn

y ho

spit

al

GPs

AN

D S

PECI

ALIS

TS, P

ATH

OLO

GY

AND

RAD

IOLO

GY,

PA

RAM

EDIC

AL S

ERVI

CES

Unl

imit

edU

nlim

ited

ON

COLO

GY

- CH

EMO

AN

D R

ADIA

TIO

NR2

64 5

00 p

er fa

mily

R127

000

per

fam

ily

ORG

AN T

RAN

SPLA

NTS

, REN

AL D

IALY

SIS

Unl

imit

edPM

Bs, c

over

ed a

s pe

r sta

te p

roto

col

MED

ICAT

ION

TO

TAK

E O

UT

R360

per

ben

efici

ary

per a

dmis

sion

R290

per

ben

efici

ary

per a

dmis

sion

CHRO

NIC

STAN

DAR

DPR

IMAR

Y

• 42

Chr

onic

Con

diti

ons

R7 4

00 p

.b. o

r R14

800

p.f.

Com

preh

ensi

ve F

orm

ular

y in

ben

efit

limit

• Re

stri

ctiv

e fo

rmul

ary

whe

n be

nefit

s ar

e ex

ceed

ed fo

r PM

Bs o

nly

at D

SP

• 40

% c

o-pa

ymen

t ap

plie

s at

a n

on-D

SP

• 26

PM

Bs

• Re

stri

ctiv

e Fo

rmul

ary

at D

SP, 4

0% c

o-pa

ymen

t ap

ply

at n

on-D

SP

OU

T O

F H

OSP

ITAL

BEN

EFIT

SST

AND

ARD

PRIM

ARY

GP

CON

SULT

ATIO

NIN

-NET

WO

RKO

UT-

OF-

NET

WO

RK: S

UB-

LIM

IT

INCL

UD

ED IN

NET

WO

RKIN

-NET

WO

RKO

UT-

OF-

NET

WO

RK: S

UB-

LIM

IT IN

CLU

DED

IN

NET

WO

RK

MEM

BER

R3 2

00R1

050

R1 5

00R5

00

MEM

BER

+1R4

700

R1 6

00R2

850

R950

MEM

BER

+A+C

R5 2

00R1

750

R3 3

00R1

100

MEM

BER

+A+2

CR5

500

R1

850

R3 6

00R1

200

MEM

BER

+A+3

CR5

900

R2 0

00R4

000

R1 3

50

Benefits 2014

AT A GLANCE O

UT

OF

HO

SPIT

AL B

ENEF

ITS

STAN

DAR

DPR

IMAR

Y

DAY

-TO

-DAY

LIM

ITD

AY-T

O-D

AY L

IMIT

DAY

-TO

-DAY

LIM

IT

MEM

BER

R3 6

00R1

600

MEM

BER

+ A

R5 5

00R2

900

MEM

BER

+A+C

R5 9

00R3

400

MEM

BER

+A+2

CR6

400

R3 7

00

MEM

BER

+A+3

CR6

950

R4 0

00

ACU

TE M

EDIC

ATIO

N

AND

PAT

SPEC

IALI

STS

CON

SULT

ATIO

NS,

RAD

IOLO

GY,

PAT

HO

LOG

Y,

PARA

MED

ICAL

SER

VICE

S, A

CUTE

M

EDIC

ATIO

N

Phar

mac

y Ad

vise

d Th

erap

y su

b-lim

it o

f R62

0 p.

b. a

nd R

1 90

0 p.

f. Al

l are

sub

ject

to

day-

to-d

ay b

enefi

t

Subj

ect

to d

ay-t

o-da

y be

nefit

PAT

sub-

limit

of R

380

p.b.

and

R1

100

per f

amily

. All

are

subj

ect

to d

ay-t

o-da

y be

nefit

Subj

ect

to d

ay-t

o-da

y be

nefit

OPT

OM

ETRY

: 2 Y

EAR

BEN

EFIT

FRO

M A

NN

IVER

SARY

OF

CLAI

MIN

G P

.B.

OPT

OM

ETRI

C EX

AMIN

ATIO

N10

0% o

f cos

t at

a n

etw

ork

prov

ider

, or R

295

at a

non

-net

wor

k pr

ovid

er.

100%

of c

ost

at n

etw

ork

prov

ider

, or R

295

at a

non

-net

wor

k pr

ovid

er

FRAM

ES A

ND

PRE

SCRI

PTIO

N

LEN

SES/

ADD

-ON

SR8

00 p

er b

enefi

ciar

yR3

00 p

er b

enefi

ciar

y at

a n

etw

ork

prov

ider

CLEA

R SI

NG

LE V

ISIO

NR1

50 p

er le

ns o

rR1

50 p

er le

ns o

r

CLEA

R AQ

UIT

Y FL

AT-T

OP

BIFO

CAL

R325

per

lens

or

R325

per

lens

or

CLEA

R AQ

UIT

Y M

ULT

IFO

CAL

(U

P TO

BIF

OCA

L LI

MIT

)R6

00 p

er le

ns o

rR6

00 p

er le

ns o

r

CON

TACT

LEN

SES

R1 5

50 p

er b

enefi

ciar

yR7

50 p

er b

enefi

ciar

y

DEN

TIST

RY

CON

SERV

ATIV

E D

ENTI

STRY

Bene

fits

are

subj

ect

to D

ENIS

clin

ical

pro

toco

ls.

Cove

red

at t

he B

DT*

(Bon

itas

Den

tal T

ariff

)Be

nefit

s ar

e su

bjec

t to

DEN

IS c

linic

al p

roto

cols

Co

vere

d at

the

BD

T* (B

onit

as D

enta

l Tar

iff)

SPEC

IALI

SED

DEN

TIST

RYBe

nefit

s ar

e su

bjec

t to

DEN

IS c

linic

al p

roto

cols

. Co

vere

d at

the

BD

T* (B

onit

as D

enta

l Tar

iff)

No

bene

fit

Benefits 2014

INFA

NT

PAED

IATR

IC B

ENEF

IT2

cons

ulta

tion

s be

fore

the

age

of 1

yea

r.

1 co

nsul

tati

ons b

etw

een

the

ages

of

1 an

d 2

year

s per

ben

efici

ary,

per

ann

um1

cons

ulta

tion

bef

ore

the

age

of 1

yea

r. 1

cons

ulta

tion

bet

wee

n th

e ag

es o

f 1 a

nd 2

yea

rs p

er b

enefi

ciar

y, p

er a

nnum

CHIL

DH

OO

D IL

LNES

S BE

NEF

IT2

GP

cons

ulta

tion

s be

twee

n th

e ag

es o

f 2 a

nd 1

2 ye

ars

1 G

P co

nsul

tati

on b

etw

een

the

ages

of 2

and

12

year

s

APPL

IAN

CES

GEN

ERAL

APP

LIAN

CES

R 6

200

per f

amily

R5 5

50 p

er fa

mily

WH

EELC

HAI

RS A

ND

LAR

GE

ORT

HAP

AED

IC A

PPLI

ANCE

SIn

clud

ed in

Gen

eral

App

lianc

es li

mit

Incl

uded

in G

ener

al A

pplia

nces

lim

it

STO

MA

PRO

DU

CTS

AND

CPA

P*M

ay e

xcee

d G

ener

al A

pplia

nces

lim

it b

y R5

000

May

exc

eed

Gen

eral

App

lianc

es l

imit

by

R5 0

00

HEA

RIN

G A

IDS

R13

000

Bien

nial

per

fam

ily

R7 4

00 B

ienn

ial p

er fa

mily

OXY

GEN

: HO

ME

VEN

TILA

TIO

NU

nlim

ited

sub

ject

to

pre-

auth

oris

atio

n by

HBM

Unl

imit

ed s

ubje

ct t

o pr

e-au

thor

isat

ion

by H

BM

SUPP

LEM

ENTA

RY B

ENEF

ITS

STAN

DAR

DPR

IMAR

Y

MAT

ERN

ITY

CARE

12 a

nte-

nata

l con

sult

atio

ns, 2

x 2

D s

cans

, 4 p

ost-

nata

l co

nsul

tati

ons

wit

h a

mid

wif

e. A

nte-

nata

l cla

sses

R95

06

ante

-nat

al c

onsu

ltat

ions

, 2 x

2D

sca

ns, 4

pos

t-na

tal

cons

ulta

tion

s w

ith

a m

idw

ife

HIV

R24

900

per b

enefi

ciar

y su

bjec

t to

Aid

for A

IDS

regi

stra

tion

R19

000

per b

enefi

ciar

y su

bjec

t to

Aid

for A

IDS

regi

stra

tion

MEN

TAL

HEA

LTH

R31

200

per f

amily

, sub

-lim

it o

f R12

200

in

and

out

of h

ospi

tal c

onsu

ltat

ions

R12

200

per f

amily

, sub

-lim

it o

f R7

400

in a

nd o

ut o

f hos

pita

l con

sult

atio

ns

SPEC

IALI

SED

RAD

IOLO

GY

R20

100

per f

amily

, sub

ject

to

pre-

auth

oris

atio

n. O

ut o

f hos

pita

l lim

itR9

500

per

fam

ily (j

oint

lim

it in

and

out

of h

ospi

tal),

sub

ject

to

pre-

auth

oris

atio

n

AMBU

LAN

CE –

EM

ERG

ENCY

ER24

ER24

END

OSC

OPI

ES IN

D

OCT

ORS

RO

OM

S*U

nlim

ited

Unl

imit

ed

PRO

STH

ESES

INTE

RNAL

AN

D

EXTE

RNAL

R33

900

per f

amily

PMBs

onl

y

COCH

LEAR

IMPL

ANTS

R158

000

per

fam

ilyN

o be

nefit

INTE

RNAL

NER

VE S

TIM

ULA

TORS

R127

000

per

fam

ilyN

o be

nefit

HIV

TES

T AN

D F

LU V

ACCI

NE

1 ea

ch p

er b

enefi

ciar

y, p

er a

nnum

1 ea

ch p

er b

enefi

ciar

y, p

er a

nnum

Benefits 2014

CON

TRIB

UTI

ON

S

MEM

BER

R2 1

86R1

412

MEM

BER

+ A

R4 0

77R2

517

MEM

BER

+ C

R2 8

25R1

862

MEM

BER

+A +

CR4

716

R2 9

67

MEM

BER

+ A

+ 2C

R5 3

55R3

417

MEM

BER

+ A

+ 3C

R5 9

94R3

867

Benefits 2014

AT A GLANCE BO

NCA

P

MAJ

OR

MED

ICAL

BEN

EFIT

SBO

NCA

P

OVE

RALL

AN

NU

AL L

IMIT

Unl

imit

ed

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Benefits 2014

BONITAS CONTACT DETAILS

BONITAS CUSTOMER SERVICE

E-MAIL

MON-FRI 08H30-17:00, 0860 002 108 (CHARGED AT LOCAL RATES WHEN IN SOUTH AFRICA) [email protected]

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FRAUD HOTLINE 0800 112 811

Discover more about how we can help you to get the best healthcare you need at a price you can afford.Visit www.bonitas.co.zaWe’re always there for you just a call away. You can visit, email or dial us anytime with any query or emergency and we’ll help you so you can live a better life while we take care of the details.

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DENTISTRY:08h00-16h30 Mon-FriE-mail: [email protected]: 086 677 0336Web:www.denis.co.za0860 336 346

CENTRE FOR DIABETES AND ENDOCRINOLOGY (CDE):08h30-17h00 Mon-FriFax: 011 712 6000 / 011 728 6661E-mail: [email protected]: www.cdecentr.co.za

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BLOEMFONTEIN: Shop C7, 1st Floor, Middestad Centre, C/O Charles and West Burger Street, BloemfonteinCAPE TOWN: Medscheme, Atterbury House, 15th Floor, 9 Riebeek Street, Cape Town DURBAN: 3rd Floor, 67 Old Fort Road, DurbanLEPHALALE: Onverwacht Business, Mienie Building, Block C, Walter Sisulu Avenue, LephalaleKATHU: 6 Rietbok Street, Kathu, Northern CapeNORTHAM: 180 Botha Steet, NorthamPORT ELIZABETH: Block 6, Greenacres Office Park, 2nd Avenue, Newton Park, Port ElizabethPOLOKWANE: Ground Floor, Bonitas House, 22 Hans van Rensburg Street, PolokwanePRETORIA: Ground Floor, Benstra Building, 473B Church Street, Arcadia, PretoriaROODEPOORT: 37 Conrad Road, Florida North, RoodepoortRUSTENBURG: 141 Fatima Bhayat Street, RustenburgSECUNDA: Grand Palace, Unit 82, 2302 Heinis Street, SecundaVEREENIGING: 36 Merriman Avenue, Ground floor, Vereeniging JOHANNESBURG: Mathomo Mall, 115 Main Street, Marshalltown, Johannesburg EAST LONDON: BSB Building, 7 Settlers Way, Gately Township, East LondonPRETORIA: Exxaro Corporate Centre, C/O Roger Dayson and Voortrekker Road, Pretoria West

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BENEFITS BROCHURE · BENEFITS BROCHURE Feel conrident that someone is always on your side. 2014

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Transcript of BENEFITS BROCHURE · BENEFITS BROCHURE Feel conrident that someone is always on your side. 2014