BonEssential-Details

BonEssential

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Are you young and vibrant? Are you looking for a hospital plan with a difference – one that has dentistry benefits and is also affordable? Then BonEssential is for you. Simple. So before you continue with your punching bag, isn’t it a treat to know in these tough times, there’s a solution that is unique and won’t put you out of limb?

Major medical expenses are covered at 200% of Bonitas tariff. This benefit includes major medical events. All hospital admissions, oncology treatment plans and renal dialysis require pre-authorisation by Hospital Management except in case of emergencies.

Overall Annual Limit - Unlimited

Benefits payable at 200% of the Bonitas rate

Sub-limits applicable:
GP & Specialist Consultants	Unlimited, 200% Bonitas rate
Pathology	Unlimited
Radiology (Specialised & General)	Unlimited
Paramedical Services (Allied Medical Unlimited Professions)e.g. speech therapy, occupational therapy, audiology, physiotherapy	Unlimited
Oncology	Unlimited, sub-limit of R250 000 for medicine
Organ Transplants	Unlimited
Chronic Renal Dialysis	Unlimited
Maxillo Facial Surgery	Unlimited, excluding orthognatic surgery
Medication to take out (TTO)	R250 per beneficiary, per admission
Physical Rehabilitation	R30 000 per family

R1000 deductible	R2500 deductible	R5000 deductible
Colonoscopy Conservative Back Treatment Cystoscopy Facet Joint Injections Flexible sigmoidoscopy Functional Nasal Surgery Gastroscopy Umbilical Hernia Repair Hysteroscopy (but not endometrial ablation) Myringotomy Tonsillectomy & Adenoidectomy(except PMB’s) Varicose Vein Surgery	Arthroscopy Diagnostic Laparoscopy Hysterectomy(except cancer & PMB’s) Percutaneous Radiofrequency Ablations(percutaneous rhizotomies)	Nissen Fundoplication (Reflux Surgery) Back Surgery including spinal fusion Joint replacements e.g. Hip & Knee replacements (except PMB’s)

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

Chronic Disease List (CDL) as per the Prescribed Minimum Benefits (PMB), at the Designated Service Provider (DSP), subject to pre-authorisation

PMBs as per Chronic Disease List

Addison’s Disease
Asthma
Bipolar Mood Disorder
Bronchiectasis
Cardiac Failure
Cardiomyopathy
Chronic Renal Disease
Chronic Obstructive Pulmonary Disease
Coronary Artery Disease
Crohn’s Disease
Diabetes Insipidus
Diabetes Mellitus Type 1
Diabetes Mellitus Type 2
Dysrhythmias
Epilepsy
Glaucoma
Haemophilia
Hyperlipidaemia
Hypertension
Hypothyroidism
Multiple Sclerosis
Parkinson’s Disease
Rheumatoid Arthritis
Schizophrenia
Systemic Lupus Erythematosus
Ulcerative Colitis

Out of Hospital Benefits

No benefits for out of hospital expenses, except for the diagnosis, treatment and care of Prescribed Minimum Benefits where appropriate.

In Addition: Dental Benefits
Basic Dentistry	Subject to clinical protocols & Bonitas Dental Tariff (BDT)
Advanced Dentistry	Subject to clinical protocols & Bonitas Dental Tariff (BDT)

Additional benefits; medical expenses incurred in or out of hospital

Maternity Care per event (ante- and postnatal)	Unlimited hospitalisation (subject to pre-authorisation) and midwifery services Antenatal classes to the value of R750 and private ward for post-delivery 12 antenatal consultations, 2 X 2D scans and 4 postnatal consultations with midwife
Immune deficiency related to HIV infection	R22 000 per beneficiary Subject to Aid for AIDS (AfA) registration and clinical protocols
Mental Health Benefits	R20 000 per family, subject to pre-authorisation Sub-limit of R10 000 for in & out of hospital consultations
Specialised Radiology (out of hospital)	R16 000 per family, subject to pre-authorisation
Emergency Medical Transportation	Unlimited, subject to Netcare 911
Endoscopies in practitioners’ rooms	Unlimited, subject to preauthorisation
Prostheses Internal and External	R27 000 per family, subject to pre-authorisation
HIV test and Flu vaccine	Free, 1 per beneficiary per annum
International cover	R5 million per trip
Appliances General appliances Wheelchairs & large orthopaedic appliances Stoma products & CPAP machines Hearing aids Oxygen: Home ventilation	R4 600 per family Included in the general appliance limit May exceed general appliance limit by R4 000 R6 500 per family, biennial benefit (Jan 2010 - Dec 2011) Unlimited, subject to pre-authorisation by Hospital Management

	Dental Benefit Table
	Consultations	2 annual check-ups per beneficiary. Covered at the NHRPL tariff.
	X-rays: Intra-oral	Covered at the NHRPL tariff
	X-rays: Extra-oral	1 in a 3 year period Additional benefit may be considered where specialised dental treatment planning/follow up is required.
	Oral Hygiene	2 annual scale and polish treatments per beneficiary. No benefit for oral hygiene instructions. No benefit for adult fluoride
	Fillings	Covered at the NHRPL tariff. Benefit for re-treatment of a tooth is subject to clinical protocols.
	Root Canal Therapy Extractions	Covered at the NHRPL tariff where clinical protocols apply.
	Plastic Dentures	One set of plastic dentures (an upper and a lower) per beneficiary in a 4 year period. Covered at the NHRPL tariff
	Partial Metal Frame Dentures	One partial frame (an upper or a lower) per beneficiary in a 5 year period. Covered at the NHRPL tariff. Full metal dentures are not covered.
	Crown and Bridge* A bridge comprises of two or more crown units, which are payable from the available Crown and Bridge benefit.	Pre-authorisation is required. 2 crown units per family per year. Benefits for crowns are granted once per tooth in a 5 year period. Covered at the NHRPL tariff.
	Implants*	No benefit
	Orthodontics*	Benefit on pre-authorisation will be applied to cases assessed as treatment mandatory, as per orthodontic indices. A 25 % copayment of the Scheme Orthodontic tariff applies. Benefit is limited to individuals younger than 18 years of age. Orthognathic surgery is not covered
	Periodontics*	Benefit is limited to conservative, non-surgical therapy only (root planing).Benefit will be applied to members who are registered on the Perio Programme. Surgical periodontics is a scheme exclusion.
	Maxillo-Facial Surgery	Surgery in the dental chair: Covered at the NHRPL tariff. See Surgery Exclusion Summary Surgery in hospital: See Hospitalisation* Note: Benefit for Temperomandibular Joint (TMJ)therapy is limited to non-surgical intervention/treatments.
	Hospitalisation (general anaesthetic) *	Pre-authorisation is required. Certain Maxillo Facial procedures are covered inhospital, subject to admission protocols. See Exclusion Summary. General anaesthetic benefits are available for very young children 0-5 years for extensive dental treatment. Multiple hospital admissions are not covered.
	Laughing gas in dental rooms	Covered at the NHRPL tariff.
	IV conscious sedation in rooms*	Pre-authorisation is required Benefit is limited to extensive dental treatment where clinical protocols apply.