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Learn more about Bonitas Medical Aid
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:
For hospital admissions, specialised radiology, and doctor’s room procedures, you need the following details:
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:
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.
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:
To make sure we process your claim as quickly and as accurately as possible, please include the following information when submitting your claim:
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:
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: