BonCap Product Brochure

Transcription

1 2015 BonCap Product Brochure Bonitas Medical Fund I I

2 You can t put a price on experience With a proudly South African heritage spanning over 32 years, Bonitas has an intimate understanding of how the healthcare industry works. Our aim is to make quality healthcare accessible to all South Africans and add value to their lives. Affordable and generous, our benefits are designed to give our members more value for money. We have a wide range of products that are simple to understand so you know exactly what you re covered for. They re also easy to use, ensuring you get the support you need when you need it. Our members know that when things get tough, we re there to support them and take care of the little details so that they can receive the best of care and focus on getting better. Please note: The information contained in this brochure is subject to terms and conditions. Scheme Rules apply. Version CMS01/2015 BonCap Benefits 2015 Page 2

3 Why choose Bonitas? We re South Africa s second largest open medical scheme We cover main members and lives in total. Main members Dependants Our reputation speaks for itself Financially sound and reliable, we have over 32 years of experience in the healthcare industry. We support our members We aim to provide value-for-money healthcare benefits and add value to our members lives. We pay out more claims than any other open medical scheme 93% We re fully committed to making healthcare more affordable for all South Africans and pay out 93% of all claims the highest by an open medical scheme. We: Have the largest GP network in SA Are the only medical scheme to pay for dental benefits from risk Offer free flu vaccines and HIV tests on all options Pay supplementary benefits from risk so savings and day-to-day benefits last longer Check us out online Visit our website at to learn more about our products. BonCap Benefits 2015 Page 3

4 10 reasons to choose BonCap Your premiums are based on your earnings BonCap premiums are income-based. This means your premium will depend on the income-band you fall into. We require proof of earnings and will verify income to ensure there is no fraudulent activity. We look at the highest individual income in the family and not household income. Income reviews are done at the beginning of each benefit year. Unlimited hospitalisation * in the BonCap hospital network at 100% of the Bonitas Rate BonCap may be an entry-level plan, but we offer you cover when you really need it. Our hospital benefits include: R per family for pathology while in hospital R9 450 per family for CT scans and MRIs in hospital R3 500 for physical therapy and paramedical services in hospital Flexibility for GP consultations BonCap allows members to visit any GP on the BonCap Network, they do not have to elect a GP for all visits as is the case with other schemes. Cover when you need to visit a specialist We understand our members may require specialist care, that s why BonCap offers 3 specialist consultations per beneficiary (limited to R2 550) and up to 5 specialist consultations per family (limited to R3 770). Chronic cover for 26 PMB conditions and delivery of your medicine to you BonCap gives you and your dependants cover for 26 chronic conditions using the Restrictive Formulary. Your medicine will be delivered to you through Pharmacy Direct. MyCare is responsible for authorisation. Bring your baby into the world with the best possible start Our maternity benefits are rich and include R for neonatal care per family per year. You ll also be covered at 100% of the Bonitas Rate in a network hospital to give birth. Wellness benefits to keep you and your loved ones healthy BonCap offers each beneficiary one wellness assessment a year at a registered provider. This includes: A blood pressure test A glucose test A cholesterol test Cover for dentistry and optometry A BMI test A hip to waist ratio measurement We cover conservative dentistry for you and your family including 1 consultation and 1 preventative treatment per person per year. We also cover 1 set of plastic dentures per family every two years. In addition, we offer a pair of glasses per beneficiary and one eye examination per person once every two years. Supplementary benefits to help your other benefits last longer Our supplementary benefits are paid from risk so they don t impact on your other benefits. They include: Emergency medical transport from ER24 R4 450 per family for general appliances such as wheelchairs A flu vaccine and HIV test per person once a year Dedicated customer service channels We offer BonCap members access to a call centre which caters exclusively for them. This allows us to resolve queries and assist you quickly and easily. * Terms and conditions apply BonCap Benefits 2015 Page 4

5 BonCap is our entry-level product that offers access to network providers and hospitals. Designed to help us achieve our aim of making private healthcare more affordable for all South Africans, BonCap offers basic day-to-day benefits and hospital cover. What it costs You earn Main member Adult dependant Child dependant R500 or less R330 R313 R155 R501 to R6 100 R675 R640 R318 R6 101 to R9 950 R821 R776 R376 R9 951 to R R1 338 R1 192 R507 R or more R1 643 R1 463 R623 In-hospital benefits Unlimited hospitalisation in the BonCap hospital network at 100% of the Bonitas Rate Hospitalisation is covered at 100% of the Bonitas Rate at all hospitals on the BonCap Network. You must pre-authorise your stay (except for emergencies). A R5 350 co-payment must be paid if you use a non-network hospital (except for emergencies) or you do not get pre-authorisation. There is no overall limit on your hospital cover. You will have cover for medical admissions; childbirth (other than Caesarian sections done for non-medical reasons) and surgical admissions except for the procedures listed as not covered. We cover PMB surgical admissions which include procedures such as appendix removal, gallstone surgery, kidney stone treatment, heart surgery, trauma surgery, repair of broken bones, cancer surgery, as well as all medical emergencies. The pre-authorisation department will be able to assist you in determining whether or not a procedure qualifies for cover as a PMB. Surgeries that are not covered include back and neck surgery, joint replacements and repairs, colonoscopies and gastroscopies, hernia repair, Bunion surgery, laparoscopic surgery, nasal/sinus surgery and varicose vein surgery. Some procedures that will also not be covered are spine facet block injections, percutaneous rhizotomies, robotic surgery, dental surgery, transcatheter aortic valve implantation, implantable cardiac defibrillators and surgery for cosmetic reasons. You also get the following: Unlimited GP and Specialist consultations for network doctors while in hospital R per family for pathology in hospital R9 450 per family for CT scans and MRIs in hospital R3 500 for physical therapy (physiotherapy, occupational therapy and biokinetics) and paramedical services while in hospital Cover for organ transplants for Prescribed Minimum Benefit conditions Cover for general radiology in hospital Cover for HIV immune deficiency (subject to MyCare registration and protocols) Cover for physical rehabilitation (subject to using the contracted provider) R per family for alternatives to hospitalisation such as nursing and out-patient antibiotic therapy R310 per person for admission for medicine on discharge BonCap Benefits 2015 Page 5

6 Out-of-hospital benefits GP benefits that treat you right You and your dependants get 12 GP consultations to use on the BonCap network. A maximum of 2 visits per family (maximum of R850) may be out-of-network with a 20% co-payment. Non-GP pooled benefit This benefit is to be used for GP-referred radiology, pathology and acute medicine. Main member only R1 500 Main member + 1 R2 500 Main member + 2 R3 000 Main member + 3 R3 300 Main member + 4 or more R3 600 Specialist benefits for the best of care Specialist consultations are limited to 3 visits or R2 550 per beneficiary up to 5 visits or R3 770 per family. This limit must cover all associated claims prescribed by the specialist such as acute medicines, pathology, basic radiology and specialised radiology. Over-the-counter medicine is covered BonCap members get R215 per person per year for over-the-counter medicine at network providers. This is limited to a maximum of R75 per event, three times a year. Dental benefits to put a smile on your face We cover you and your family for conservative dentistry (such as cleaning and polishing) as follows: 1 consultation per person per year 1 preventative treatment per person per year 1 set of plastic dentures per family, every two years for beneficiaries over the age of 21 and a 20% co-payment applies Optical benefits to help you see clearly Optical benefits work on a 2-year cycle so you can only access your benefits once every two years. You get: 1 pair of glasses per person (for approved lenses and frames) 1 eye examination per person per year You must use the contracted provider. Paramedical services are also covered for Prescribed Minimum Benefits Paramedical services such as occupational therapy, speech therapy, dietetics and nursing services will be covered for Prescribed Minimum Benefit conditions only. Oncology is covered for Prescribed Minimum Benefits On BonCap, you get cover for oncology in and out of hospital. This must be pre-authorised and a preferred provider must be used. 100% cover for chronic renal dialysis We cover renal dialysis at 100% of the Bonitas rate for Prescribed Minimum Benefit conditions at a network provider. BonCap Benefits 2015 Page 6

7 Maternity benefits that bring your baby into the world with the best start You get R for neonatal care per family per year. Your hospital stay will be covered at 100% of the Bonitas Rate provided that you pre-authorise it and use a network hospital. You ll also get the Bonitas baby pack which features a beautiful baby bag and goodies for both mom and baby. Caesarian sections for non-medical reasons are not covered. Wellness benefits to keep you in tip-top condition BonCap offers each member and their dependants one wellness assessment a year. This must be done by a registered provider and includes. A blood pressure test A glucose test A cholesterol test A BMI test A waist to hip ratio measurement Chronic cover for Prescribed Minimum Benefits at a DSP BonCap gives you and your dependants full cover for 26 chronic conditions and delivers your medicine to you through Pharmacy Direct. 1. Addison s disease 2. Asthma 3. Bipolar disorder 4. Bronchiectasis 5. Cardiac failure 6. Cardiomyopathy 7. Chronic obstructive pulmonary disease 8. Chronic renal disease 9. Coronary artery disease 10. Crohn s disease 11. Diabetes insipidus 12. Diabetes Type Diabetes Type Dysrhythmias 15. Epilepsy 16. Glaucoma 17. Haemophilia 18. Hyperlipidaemia 19. Hypertension 20. Hypothyroidism 21. Multiple sclerosis 22. Parkinson s disease 23. Rheumatoid arthritis 24. Schizophrenia 25. Systemic lupus erythematosus 26. Ulcerative colitis You will have to pay a 40% co-payment for medicine not listed on the formulary or if you do not use Pharmacy Direct. MyCare will be responsible for chronic and HIV medication authorisation subject to pre-authorisation. Supplementary benefits Our supplementary benefits are paid from risk so they won t impact your day-to-day or hospital benefits. They can be used for treatment in and out of hospital and are designed to give you more value for money. Ensure peace of mind with mental health benefits Mental health is covered for Prescribed Minimum Benefit conditions in and out of hospital at the contracted network providers. Benefits for appliances such as wheelchairs We offer the following benefits: R4 450 per family for general appliances such as wheelchairs and stoma products (excluding hearing aids, foot orthotics and CPAP machines) Unlimited cover for oxygen and home ventilation if pre-authorised You also get: Cover for internal prostheses for Prescribed Minimum Benefit conditions Emergency medical transport from ER24 If you re looking for basic cover and don t mind using a specific network, then BonCap is the option for you. BonCap Benefits 2015 Page 7

8 Contact us BonCap members have dedicated customer service channels We offer BonCap members access to a customer service centre which caters exclusively for them. This allows us to resolve queries and assist you quickly and easily. Call between 08:30 and 17:00, Monday to Friday. us at boncap@bonitas.co.za Visit one of our walk-in centres Resolve queries; get a new membership card and so much more at our walk-in centres. Pretoria Ground Floor, Benstra Building, 473B Church Street, Arcadia, Pretoria Polokwane Ground Floor, Bonitas House, 22 Hans van Rensburg Street, Polokwane Rustenburg 141 Fatima Bhayat Street, Rustenburg Roodepoort 37 Conrad Road, Florida North, Roodepoort Vereeniging 36 Merriman Avenue, Ground Floor, Vereeniging Johannesburg Mathomo Mall, 115 Main Street, Marshalltown, Johannesburg Cape Town The Icon Building, Ground Floor, Corner Lower Long Street and Hans Strydom Avenue, Cape Town Lephalale Onverwacht Business, Mienie Building, Block C, Walter Sisulu Avenue, Lephalale Secunda Grand Palace, Unit 82, 2302 Heinis Street, Secunda Northam 180 Botha Street, Northam Durban 3rd Floor, 67 Old Fort Road, Durban Kathu 6 Rietbok Street, Kathu, Northern Cape Bloemfontein Shop C7, 1st Floor, Middestad Centre, c/o Charles and West Burger Street, Bloemfontein Port Elizabeth Block 6, Greenacres Office Park, 2nd Avenue, Newton Park, Port Elizabeth Check us out online Visit our website at to learn more about our products. You can also join us on Facebook and get health tips, benefit information and much more. I Bonitas Medical Fund I I