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Bonitas FAQs

QUESTION TOPICS

The purpose of a medical aid is to make sure that you are able to pay for treatment received from either a private GP, specialist or hospital. It is very important to have health cover to insure you can get the care you need when you need it. You and your family's health are unpredictable and accidents can happen.

No, it is legislated that you may only belong to one medical scheme.

It is illegal to belong to more than one medical scheme because claiming more than once for the same medical expenses is seen as fraud.

When changing medical schemes it is important to make sure to terminate your membership with the current medical scheme before the membership of the new medical scheme starts.

In terms of the Medical Schemes Act, medical schemes may apply waiting periods to new members or dependants joining the Scheme. This depends on the beneficiary’s health risk status and their previous medical scheme membership history.

If a 3-month general waiting period is applied, you must wait 3 months from the date that your membership commences before you can claim from your medical scheme benefits.

A 12-month waiting period may also be applied to specific medical conditions. If this waiting period is applied, you must wait 12 months from the date your medical scheme membership starts before you can claim benefits for the condition.

To qualify as a dependant, a person needs to be the member's spouse, child or financially dependent on the main member. In all instances you will require paperwork to prove the dependant's relationship to the member.

For certain procedures, or if you or any of your dependants are admitted to hospital, pre-authorisation must be obtained from the Scheme.

You can get pre-authorisation for in-hospital benefits such as hospital admissions, specialised radiology, and doctor’s room procedures in any of the following ways:

  • Website
  • WhatsApp
  • Call
  • Email

For hospital admissions, specialised radiology, and doctor’s room procedures, you need the following details:

  • Your membership number.
  • The name and details of the patient.
  • The reason for hospital admission, procedure, or specialised scan.
  • The procedure code (CPT), diagnosis code (ICD-10), and tariff code.
  • Date of admission.
  • The contact details and practice number of the referring GP.
  • The contact details and practice number of the specialist.
  • The name and practice number of the hospital or day clinic.

The Prescribed Minimum Benefit (PMB) list of conditions lists all of the conditions which all medical schemes need to cover on all the health plans they offer to their members. This cover includes funding for the diagnosis, treatment and ongoing care for the listed conditions.

According to the Medical Schemes Act 131 of 1998 and its Regulations, all medical schemes have to cover the costs related to the diagnosis, treatment and care of:

  1. Any life-threatening emergency medical condition
  2. A defined set of 271 diagnoses
  3. 27 chronic conditions (Chronic Disease List (CDL) conditions)

The 271 diagnoses and 27 chronic conditions (Chronic Disease List (CDL) conditions) that qualify for Prescribed Minimum Benefit (PMB) cover are diagnosis-specific and include a range of ailments that are divided into 15 broad categories.

This information is directly available from the Council for Medical Schemes (CMS) at www.medicalschemes.co.za. This list may change from time to time, please refer to the CMS website for a full list of the 271 diagnostic treatment pairs.

These are healthcare professionals or providers that Bonitas Medical Fund has selected as the first choice for the diagnosis and treatment of members' healthcare needs. Designated Service Providers must be used for both Prescribed Minimum Benefit (PMB) and non-PMB situations.

In South Africa, employers do not have to subsidise an employee's medical aid contributions, but some employers choose to do so.

The Medical Schemes Act makes provision for schemes to apply a late-joiner penalty to members over the age of 35. Depending on the number of years that you have not belonged to a registered South African medical scheme, the late joiner penalty is calculated as a percentage of your monthly contribution and will be added to your monthly contribution.

On our network options we have negotiated favourable tariffs with our network providers so that members can avoid out-of-pocket expenses and get more value. Using networks also means you can reduce or eliminate co-payments. On a network option members need to make use of a network of hospitals, doctors and/or other service providers in order to be covered.

This also keeps the costs for the medical scheme down, which allows the contributions to be more affordable.

  1. Evaluate you and your dependants' state of health. Your medical needs should be considered first, but also look at your family's medical history.
  2. Decide what you can afford.
  3. Keep in mind that you will have the opportunity to change your option at the end of every year as your needs change.

You can speak to a financial advisor or contact Bonitas Medical Fund to get more information before you choose. When looking at plans try to choose the option that will give you the best cover for your needs.

You can send us your claim in one of the following ways:

  • Email your claims to claims@bonitas.co.za
  • Simply use the Bonitas Member App
  • Make use of the member self-service option on the Bonitas WhatsApp line
  • Log in and submit your claims online through the Bonitas Member Zone
  • Post your claims to Bonitas Claims Department, PO Box 74, Vereeniging, 1930
  • Submit your claims in person at one of our walk-in centres.

To make sure we process your claim as quickly and as accurately as possible, please include the following information when submitting your claim:

  • Your membership number.
  • The principal member’s surname, initials, and first name.
  • The patient’s surname, initials, first name and dependant code.
  • Date of treatment.
  • The amount charged.
  • The ICD–10 code (code to indicate what condition you’ve been diagnosed with), tariff code (product-specific code for procedures and claims), and NAPPI code (unique identifier for a given ethical, surgical, or consumable product).
  • The service provider’s name and practice number.
  • Proof of payment if you’ve paid the claim out of pocket.

All medical aid claims must be submitted to the Scheme within 4 months of the treatment date.

A co-payment is a portion of the cost of a procedure for which the member is responsible.

Some medical scheme options make use of medical savings. This is a percentage of your monthly contribution, up to a maximum of 25% and is used to pay for day-to-day medical expenses.

When your savings are depleted, you must pay for your day-to-day medical expenses from your own pocket.

Funds in your savings that are not utilised are carried over to the following year. If you resign from the Scheme and still have savings left, this will be paid out to you.

An emergency medical condition means the sudden and, at the time, unexpected onset of a health condition that requires immediate medical or surgical treatment, where failure to provide medical or surgical treatment would result in serious impairment to bodily functions or serious dysfunction of a bodily organ or part or would place the person’s life in serious jeopardy.

Yes, Bonitas SOS offers emergency medical services for Bonitas members and their dependants.

Bonitas SOS covers you for the following:

  • Emergency medical response by road or air from the scene of the medical emergency.
  • Tansfer to the closest appropriate medical facility by road or air
  • Instructions on how to manage the emergency while waiting for the ambulance (e.g. start CPR)
  • Inter-hospital tansfers (subject to authorisation) in accordance with Scheme Rules
  • Virtual Doctor consultations via the Bonitas Member App (Available 24/7)

Call 0860 555 505 or request an ambulance via our website or app. Provide your name, telephone number and medical aid number.

Give a brief description of the incident and the severity of it. Provide the address/location (road name, number and nearest crossroad) of the scene of the incident. Ensure that Bonitas SOS has all the details of the incident.

Download the Bonitas App from Google Play, Apple App Store or Huawei AppGallery.

The Bonitas Member app provides convenience and flexibility to manage your medical aid membership wherever you are.

With the Bonitas Member App you can:

  • Consult with a doctor through virtual care
  • See the balance of your savings and/or day-to-day benefits
  • Find doctors, hospitals and pharmacies on our network easily
  • Access and download documents such as tax certificates and monthly statements
  • View your plan brochure
  • Chat to a skilled agent in real-time to get information and solve queries
  • Access your digital membership card, everywhere you go
  • Update important information for you and everyone on your plan
  • Upload and search for claims
  • Complete a wellness questionnaire to unlock your Benefit Booster
  • View and request hospital and chronic authorisations
  • Activate your international travel cover when you are planning to travel internationally
  • Complete mental health assessments
  • Access October Health (previously Panda) for mental health support
  • Access the Avo store for great deals

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