Bonitas Primary Medical Aid Plan
Overall, the Bonitas Primary Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers Prescribed Minimum Benefits to up to 4 Family Members. The Bonitas Primary Medical Aid Plan starts from R2,993 ZAR.
| 👤 Main Member Contribution | R2,993 ZAR |
| 👥 Adult Dependent Contribution | R2,341 ZAR |
| 💙 Child Dependent Contribution | R952 ZAR |
| 🌎 International Cover | R10 million ZAR |
| 🔁 Gap Cover | ☑️ Yes |
| 🏥 Hospital Cover | Unlimited |
| 🏠 Home Care | ☑️ Yes |
| 💶 Prescribed Minimum Benefits (PMB) | ☑️ Yes |
| 📉 Screening and Prevention | ☑️ Yes |
| 🔎 Medical Savings Account | None |
Bonitas Primary Plan Review – 11 Key Point Quick Overview
- ☑️ Bonitas Primary Plan Overview
- ☑️ Bonitas Primary Plan Contributions
- ☑️ Bonitas Primary Benefits and Cover Comprehensive Breakdown
- ☑️ Bonitas Primary Out-of-Hospital Benefits
- ☑️ Bonitas Primary Plan Chronic Benefits
- ☑️ Bonitas Primary Plan Additional Benefits
- ☑️ Bonitas Primary In-Hospital Benefits
- ☑️ Bonitas Primary Plan Exclusions and Waiting Periods
- ☑️ Bonitas Primary Plan vs. Other Bonitas Medical Fund Plan Options
- ☑️ Our Verdict on the Bonitas Primary Plan
- ☑️ Bonitas Primary Plan Frequently Asked Questions
Bonitas Primary Plan Overview
The Bonitas Primary Plan starts from R2,993 and includes cover for maternity, in- and out-of-hospital, international travel, PMBs, and more.
Gap Cover is available on the Bonitas Primary Plan, along with 24/7 medical emergency assistance. According to the Trust Index, Bonitas Medical Fund has a trust rating of 4.5.
Bonitas Primary Plan Contributions
| 👤 Main Member | 👥 +1 Adult Dependent | 💙 +1 Child Dependent |
| R2,993 ZAR | R2,341 ZAR | R952 ZAR |
Bonitas Primary Benefits and Cover Comprehensive Breakdown
The Bonitas Primary Plan offers access to overall day-to-day limits, chronic benefits, additional benefits, and much more.
Bonitas Primary Out-of-Hospital Benefits
Bonitas Primary Plan members must note that once they complete the wellness screening or the online questionnaire, the Benefit Booster is activated and can be used to pay for out-of-hospital expenses first.
Overall Day-to-Day Limits on the Bonitas Primary Plan
Up to the overall day-to-day limit, subject to the applicable sub-limit per category, the out-of-hospital medical expenses covered by the day-to-day benefits include doctor and specialist visits, acute medicine, X-rays, blood tests, and other similar procedures.
| 🔎 Member | 💶 Day-to-Day Benefits |
| 👤 Main Member (Only) | R5,330 ZAR |
| 👥 Main Member + 1 Dependent | R8,520 ZAR |
| ➡️ Main Member + 2 Dependents | R10,650 ZAR |
| 💙 Main Member + 3 (or more) Dependents | R11,720 ZAR |
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The sub-limits below represent the maximum allowed for each category, subject to the total daily limit.
| 🔎 Service | 📌 GP and Specialist Consultations | 📌 Acute and OTC Medicine | 📌 Radiology and Pathology | 📌 Auxiliary Services |
| ➡️ Service Overview | Specialist consultations require GP referral (Including virtual consults) | Avoid a 20% co-payment using a Bonitas Pharmacy Network or formulary medicine.
Over-the-counter medicine is limited to R500 per beneficiary and R2,000 per family. | This category includes blood, lab, X-ray, and ultrasound tests. | This category includes physiotherapy, podiatry, biokinetics, allied medical professionals (dieticians, speech, and occupational therapists), and alternative healthcare (20% co-payment for homeopathic medicine). |
| 👤 Main Member | R2,130 ZAR | R1,600 ZAR | R2,130 ZAR | R2,130 ZAR |
| 👥 Main Member + 1 Dependent | R3,730 ZAR | R2,6600 ZAR | R2,660 ZAR | R2,660 ZAR |
| 👩👧👧 Main Member + 2 Dependents | R4,790 ZAR | R3,200 ZAR | R3,200 ZAR | R3,200 ZAR |
| 💙 Main Member + 3 Dependents or more | R4,790 ZAR | R3,200 ZAR | R3,200 ZAR | R3,200 ZAR |
Additional Overall Day-to-Day Sub-Limits on the Bonitas Primary Plan
The sub-limits below represent the maximum allowed for each category, subject to the total daily limit.
| 🔎 General Medical Appliances | Stoma Care and CPAP machines have a daily limit of R7 820 per family.
Managed Care CPAP machines
Managed Care protocols limit frequency.
Use the preferred supplier.
The Benefit is subject to the overall daily limit. |
| 📌 MRIs and CT scans | There is a limit of R15,170 per family, in and out of the hospital.
Pre-authorization is needed.
There is a co-payment of R2,130 per scan event where needed, except for PMB. |
| 📍 Mental Health Consultations | The mental health hospitalization benefit covers consultations in and out of the hospital.
The benefit is limited to R11,630 per family. |
| ✔️ Optometry | R5,695 per family every two years (based on your last claim).
Beneficiaries must choose either glasses or contacts. |
| 👁️ Eye Tests | Each beneficiary is entitled to one combined consultation with a network provider.
Alternatively, they can have an eye examination at a non-network provider for a fee of R380. |
| 👁️🗨️ Single Vision Lenses | The cost of lenses is covered up to 100% according to network rates.
There is a limit of R215 per beneficiary per lens if an out-of-network provider is used. |
| 👓 Bifocal Lenses | The cost of lenses is covered up to 100% according to network rates.
There is a limit of R460 per beneficiary per lens if an out-of-network provider is used. |
| 🤓 Multifocal Lenses | The cost of base lenses is covered up to 100%.
Alternatively, it is limited to R860 per designer lens per beneficiary regardless of whether it is in or out-of-network. |
| ➡️ Frames | R605 per recipient at a network provider or R454 per recipient at a non-network provider. |
| 📈 Contact Lenses | R1,430 per person (included in the family limit) |
| 🦷 Basic Dentistry | Covered by the Bonitas Dental Tariff if the Bonitas Dental Management Program is followed. |
| 🪥 Consultations | 2 check-ups per recipient per year (once every 6 months) |
| ✳️ Intra-Oral X-Rays | The Bonitas Managed Care Protocols will apply. |
| 📌 Extra-Oral X-Rays | One allowed per beneficiary every 3 years. |
| 📍 Preventative Care | 2 scale and polish treatments per recipient per year (once every 6 months).
Crack fillers are only covered for kids younger than 16 years old.
Fluoride treatments are only paid for kids under 16 and under 5 years old. |
| 🚩 Fillings | Benefits for fillings are given once every two years for each tooth.
Protocols for Managed Care decide whether a tooth can be treated again or not.
If you need more than one filling, you may need a treatment plan and X-rays. |
| ☑️ Root Canal Therapy and Extractions | The rules for Managed Care apply. |
| ✅ Plastic Dentures and Various Laboratory Costs | One set of plastic dentures (upper and lower) every 4 years for each beneficiary 21 years and older.
Pre-authorization required. |
| ✒️ Surgery in the dentist’s rooms | Bonitas’ Managed Care Protocols Apply |
| 😷 Hospitalization and general anesthetic | A co-payment of R3,500 per hospital admission for children younger than 5 years of age and R5,000 for all other admissions and the application of admission protocols are required.
For extensive dental treatment, children under five may only receive general anesthesia once in their lifetime.
General anesthesia is covered for the extraction of impacted teeth.
Utilize a hospital within the applicable network to avoid a 30% co-payment.
Managed Care protocols apply.
Pre-authorization is required for this procedure. |
| 💤 Inhalation sedation in the dentist’s room | Managed Care Protocols will apply. |
| 😴 Moderate/Deep Sedation in the dentist’s room | This is according to the extensive dental treatment limit.
The Bonitas Managed Care Protocols will apply.
This procedure requires pre-authorization. |
Bonitas Primary Plan Chronic Benefits
Bonitas Primary Plan covers the 27 Preferred Minimum Benefits from the relevant formulary. Therefore, the only acceptable method of obtaining your prescribed medication is through Pharmacy Direct, a designated service provider. A 40% co-payment will be required if you choose not to use Pharmacy Direct or if you use a medication that is not on the formulary. Furthermore, The Bonitas Primary Plan Covers the following PMBs.
- ✅ Addison’s Disease
- ✅ Asthma
- ✅ Bipolar Mood Disorder
- ✅ Bronchiectasis
- ✅ Cardiac Failure
- ✅ Cardiomyopathy
- ✅ Chronic Obstructive Pulmonary Disease
- ✅ Chronic Renal Disease
- ✅ Coronary Artery Disease
- ✅ Crohn’s Disease
and many more.
Bonitas Primary Plan Additional Benefits
Available upon completion of a wellness questionnaire or screening. There is an R3,500 limit per family that can be used for a range of out-of-hospital claims, including the following:
- ✅ GP and specialist consultations.
- ✅ Acute and over-the-counter medicine.
- ✅ Biokineticists and physiotherapists consultations and treatment.
- ✅ Paramedical services include dietician, speech and occupational therapy consultations, and treatment.
- ✅ Alternative healthcare such as homeopathic consultations, treatment, and acupuncture.
- ✅ X-rays
- ✅ Blood tests
When an adult recipient has completed a wellness screening or online wellness questionnaire, dependent children are eligible for the Benefit Booster.
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Bonitas Primary Plan Maternity Care
This benefit offers the following:
- ✅ Six antenatal consultations with a gynecologist, GP, or midwife.
- ✅ Two 2D ultrasound scans.
- ✅ One amniocentesis
Four postpartum consultations with a midwife (1 can be used for a consultation with a lactation specialist).
Bonitas Primary Plan Maternity Programme
With this benefit, members can get the following benefits:
- ✅ Access to a maternity advice line available around the clock.
- ✅ Dedicated maternity nurse/midwife to support and advise you during your pregnancy.
- ✅ Access to articles on prevalent pregnancy issues.
- ✅ You receive weekly pregnancy education emails and text messages.
- ✅ Online prenatal classes prepare you for childbirth and what to expect at home.
A Baby bag containing baby care necessities.
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Bonitas Primary Plan Wellness Benefit
There is one wellness examination per recipient at a participating pharmacy, biokinetics, or Bonita’s wellness day. The health examination includes the following tests:
- ✅ Blood pressure
- ✅ Glucose
- ✅ Cholesterol
- ✅ Body Mass Index
- ✅ Waist-to-hip ratio
Bonitas Primary Plan Preventative Care
This benefit includes the following:
- ✅ One HIV test and counseling for each recipient.
- ✅ One flu vaccine per beneficiary.
- ✅ One complete lipogram every 5 years for individuals aged 20 and older.
- ✅ One mammogram every two years for women over 40.
- ✅ Women aged 21 to 65 should undergo a pap smear every three years.
- ✅ Men between 45 and 69 qualify for one prostate screening antigen test yearly.
- ✅ Members 65 and older receive 1 pneumococcal vaccine every 5 years.
- ✅ One stool test for colon cancer for individuals aged 50 to 75.
- ✅ Dental fissure sealants prevent tooth decay in permanent teeth in children younger than 16 years.
Covid-19 vaccinations and boosters as directed by the National Health Service.
Bonitas Primary Plan Contraceptives
- ✅ R1,870 per household for the Bonitas Primary Plan (for women aged up to 50).
- ✅ It would help if you used the Designated Service Provider for contraceptives dispensed by a pharmacy.
A 40% co-payment applies if you choose not to use a Designated Service Provider.
Bonitas Primary Plan Africa Benefit
This benefit is subject to authorization but provides in-hospital and out-of-hospital treatment at 100% of Bonita’s Rate.
Bonitas Primary Plan Childcare
This benefit offers the following benefits:
- ✅ Hearing screening for infants up to 8 weeks of age, in or outside the hospital.
- ✅ Screening for congenital hypothyroidism in infants younger than one month.
- ✅ Babyline: 24-hour medical advice line for children younger than 3 years.
- ✅ One pediatrician or general practitioner visit per child under one year.
- ✅ One consultation with a pediatrician or general practitioner per child aged 1 to 2.
- ✅ One doctor visit per child between the ages of 2 and 12.
Immunization according to South Africa’s Expanded Programme on Immunization until the age of 12.
Bonitas Primary Plan International Travel Benefit
Before departure, you must register for this benefit. The Bonitas Primary Plan International Travel Benefit covers up to R10 million in medical emergency cover per family when traveling outside South Africa. Furthermore, an additional benefit for medical quarantine is up to R10,000 per recipient if Covid-19 is detected.
Bonitas Primary Plan Hospital-at-Home
This benefit offers the following:
- ✅ Care for any acute condition deemed necessary by your treating physician, such as pneumonia or Covid-19.
- ✅ Alternative to general ward admission and step-down facilities, enabling patients to receive quality, safe healthcare in the comfort of their own homes.
- ✅ Remote patient monitoring, including round-the-clock monitoring of vital signs from our clinical command center, continuous virtual visits and clinical support, continuous care from a physician, short-term oxygen (as prescribed), and emergency ambulance services.
- ✅ In addition to remote patient monitoring, daily visits, laboratory services, blood tests, wound dressings, medication/fluids via a drip, allied healthcare services, and physiotherapy, Bonita’s hospital setup at home also includes remote patient monitoring (as prescribed)
- ✅ A team of trained medical professionals, including skilled nurses, will bring all the essential elements of hospital care to your home.
- ✅ Re-admissions can be reduced with the help of a transitional care program.
Hospital-at-Home requires prior authorization.
Bonitas Primary Plan Cancer Cover
The Bonitas Primary Plan Cancer Cover benefit works in the following ways:
- ✅ Provides you with emotional and medical support.
- ✅ Consults your physician to confirm that your treatment plan is clinically appropriate for your needs.
- ✅ Social worker access for you and your loved ones.
- ✅ Utilizes the Bonitas Oncology Medicine Network. Non-network providers are subject to a 20% co-payment.
- ✅ Matches your treatment plan to your insurance benefits to ensure you have the necessary coverage.
Specialists from the Bonitas Oncology Network are utilized.
Bonitas Primary Plan HIV / AIDS Benefit
This benefit works in the following ways:
- ✅ Offers appropriate treatment and the means to live your best life.
- ✅ Provides HIV-related consultations to monitor your doctor’s clinical status.
- ✅ Provides access to telephone support from physicians.
- ✅ Includes drugs to prevent mother-to-child transmission and infection following a sexual assault or a needle-stick injury.
- ✅ Covers routine blood tests to monitor disease progression, therapy response, and possible treatment side effects.
- ✅ Provides ongoing patient support through a team of skilled and seasoned counselors.
- ✅ Prevention and treatment of opportunistic infections such as pneumonia, tuberculosis, and influenza.
Finds a registered therapist for face-to-face emotional support.
Bonitas Primary Diabetes Management
This benefit works in the following ways:
- ✅ Enables you to make the best decisions to maintain your health.
- ✅ Offers cover tests necessary for managing diabetes and other chronic conditions.
- ✅ Provides access to diabetes specialists, dietitians, and podiatrists.
- ✅ Provides access to a Health Coach who will respond to any questions.
- ✅ Offers a tailored care plan to meet your specific requirements.
Provides education to improve your understanding of your condition.
Bonitas Primary Back and Neck Programme
This benefit works in the following ways:
- ✅ Evaluation of back and neck pain to determine the level of care necessary before surgery for the best possible outcome.
- ✅ Provides a customized treatment plan for up to six weeks.
- ✅ Contains care from physicians, physiotherapists, and biokinetics.
- ✅ Provides access to a home care plan for long-term results maintenance and aids in managing severe back and neck pain.
- ✅ Highly efficient and low risk, with a high rate of success.
- ✅ Excluding X-rays, Bonitas will cover the cost of the program.
Members can use the DBC network.
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Bonitas Primary In-Hospital Benefits
This benefit provides cover for major medical events that result in hospitalization of the beneficiary. In addition, members have access to private hospital coverage. Authorization in advance is required. A co-payment may be required for admissions and or procedures. Members should note that Managed Care Protocols will apply to these benefits.
| 📌 GP Consultations in-hospital | Unlimited, with 100% cover according to Bonita’s Rate.
Unlimited non-network specialists are compensated at 100% of Bonita’s Rate. |
| 📍 Specialist Consultations in-hospital | Unlimited, with 100% cover according to Bonita’s Rate. |
| ☑️ Blood Tests | Unlimited, with 100% cover according to Bonita’s Rate. |
| ✅ Blood Transfusions | Unlimited, with 100% cover according to Bonita’s Rate. |
| ❌ X-Rays and Ultrasounds | Unlimited, with 100% cover according to Bonita’s Rate. |
| ✔️ MRI and CT scans | There is an R15,170 limit per family in and out-of-hospital.
Pre-authorization is required for MRIs and CT scans.
There is an R2,130 co-payment per scan unless it is for a PMB. |
| 👁️ Cataract Surgery | Members can avoid an R7,050 co-payment by only using a DSP. |
| 😷 Allied Medical Professionals | Subject to a referral from a treating physician.
Subject to the Auxiliary Services Benefit Sub-limit unless it is a PMB. |
| ⚕️ Physiotherapy, Podiatry, and biokinetics | Subject to a referral from a treating physician.
Subject to the Auxiliary Services Benefit Sub-limit unless it is a PMB. |
| ➡️ Internal and External Prostheses | PMB only.
|
| 💙 Mental Health Hospitalization | There is coverage up to R18,120 per family.
Physiotherapy for mental health admissions is not covered. |
| 💊 Take-Home Medicine after discharge | Members receive up to 7 days’ supply, up to R445 per hospital stay |
| 💊 Physical Rehabilitation | There is a limit of up to R57,890 per family. |
| 🚑 Hospitalization Alternatives | There is a limit of R19,310 per household.
Managed Care rules apply. |
| 🚩 Palliative Care (Only for Cancer) | Unlimited but subject to the DSP.
Includes hospice and private nursing, oxygen at home, pain management, and support from a psychologist and a social worker. |
| 📌 Cancer Treatment | Unlimited for PMBs.
Bonitas covers up to R213,000 per family for non-PMBs, which is paid up to 80%, according to the DSP.
There is no cover for non-DSPs once the limit is reached.
There is a 30% co-payment when members use a non-DSP.
There is a sub-limit of R57,680 that applies per beneficiary for Brachytherapy. |
| 📍 Cancer Medicine | Subject to the Medicine Price List and the Preferred Product List
Use a Designated Service Provider to avoid a 20% co-payment. |
| ❤️ Organ Transplants | Only valid for PMBs |
| ☑️ Kidney Dialysis | Unlimited cover.
Members can avoid a 20% co-payment by using a DSP. |
| ✅ HIV/AIDS | If you register for HIV/AIDS, the cover is unlimited.
Buying chronic medicine from the Designated Service Provider avoids a 30% co-payment. |
| ➡️ Defined List of Day Surgery Procedures | Use a network day hospital to avoid an R2,590 co-payment. |
Bonitas Primary Plan Exclusions and Waiting Periods
Exclusions
The following is currently not covered by the Bonitas Primary Plan:
- ✅ Aromatherapy
- ✅ Ayurvedics
- ✅ Herbalists
- ✅ Iridology
- ✅ Reflexology
- ✅ Therapeutic Massage Therapy (Masseurs)
- ✅ Ambulance Services that are not authorized or already included in the contract with the provider
- ✅ Appliances, devices, and procedures not scientifically proven or appropriate
- ✅ Back rests and chair seats
- ✅ Bandages and dressings (except medicated dressings)
- ✅ Beds, mattresses, linen savers, pillows, and overlay
and many more.
Waiting Periods
Depending on pre-existing or existing conditions, the following might apply when you register for medical cover with the Bonitas Primary Plan:
- ✅ A 3-month general waiting period in respect of all benefits.
- ✅ A 12-month exclusion in respect of a pre-existing condition.
A late-joiner contribution penalty fee will apply.
Bonitas Primary Plan vs. Other Bonitas Medical Fund Plan Options
| 🔎 Medical Plan | 🥇 Bonitas Primary Plan | 🥈 POLMED Aquarium | 🥉 Momentum Custom |
| 👤 Main Member Contribution | R2,993 ZAR | R117 – R1,800 ZAR | R2,149 ZAR |
| 👥 Adult Dependent Contribution | R2,341 ZAR | R117 – R1,800 ZAR | R1,626 ZAR |
| 💙 Child Dependent Contribution | R952 ZAR | R674 – R838 ZAR | R762 ZAR |
| 🔁 Gap Cover | ☑️ Yes | None | ☑️ Yes |
| 🏥 Hospital Cover | Unlimited | Unlimited | Unlimited |
| 🏠 Home Care | ☑️ Yes | None | ☑️ Yes |
| 💶 Prescribed Minimum Benefits (PMB) | ☑️ Yes | ☑️ Yes | ☑️ Yes |
| ➡️ Screening and Prevention | ☑️ Yes | ☑️ Yes | ☑️ Yes |
| 🍼 Maternity Benefits | ☑️ Yes | ☑️ Yes | ☑️ Yes |
Our Verdict on the Bonitas Primary Plan
The Bonitas Primary Plan is one of the most popular because it provides cover for in-hospital medical expenses, chronic medication, and everyday medical expenses. The Primary Plan is more affordable than other Bonita plans, making it an excellent option for individuals and families on a budget.
However, there are cover limitations, and members may be required to pay a portion of the costs.
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Bonitas Primary Plan Frequently Asked Questions
What does the Bonitas Primary Plan cover?
These plans provide a daily maximum with sub-limits for GP and specialist consultations, acute and over-the-counter medication, X-rays and blood tests, and other out-of-hospital medical expenses, in addition to risk-based benefits.
What are Bonitas Primary’s day-to-day benefits?
You can access day-to-day benefits such as unlimited GP consultations, virtual care layers, dental and optical consultations, a network of private hospitals, and more.
How much does the Bonitas Primary Plan cost?
The cost of the Bonitas Primary Plan depends on various factors, including the member’s age, the number of dependents, and the level of cover required. The Bonitas Primary plan is R2,993 for the main member, R2,341 for an adult-dependent, and R952 for a child dependent.
What is the Overall Annual Limit on Bonitas?
The overall limit is unlimited up to 100% of the Bonitas rate. However, there is a 20% – 40% co-payment if members use a non-designated provider for treatment or procedures.
How do I join the Bonitas Primary Plan?
To join the Bonitas Primary Plan, you can visit Bonita’s website and complete the online application form. You can also call their contact center or visit one of their branches.
Is Bonitas a good medical aid?
Bonitas is considered a fantastic medical aid and one of the most popular in South Africa.
Can I use any healthcare provider with the Bonitas Primary Plan?
The Bonitas Primary Plan has a network of healthcare providers, which includes doctors, specialists, and hospitals. Members can use any healthcare provider in the network and get the plan’s benefits. However, if they choose to use a healthcare provider outside the network, they may need to pay a portion of the costs.
Is depression a PMB condition with Bonitas?
Yes, depression is a PMB condition covered by the Prescribed Minimum Benefit under Developmental Traumatic Stress Disorder (DTD).
Does the Bonitas Primary Plan cover pre-existing conditions?
The Bonitas Primary Plan covers pre-existing conditions, but there may be waiting periods before the cover is provided. The waiting periods vary depending on the condition and the member’s history.
Does Bonitas cover wisdom teeth removal?
Yes, Bonitas covers wisdom tooth removal in-hospital, but this might be subject to a co-payment depending on your plan and available benefits.
Can I upgrade or downgrade my Bonitas Primary Plan?
Yes, members can upgrade or downgrade their Bonitas Primary Plan anytime, depending on their healthcare needs and budget. However, there may be waiting periods before the upgraded cover is provided.
How can I change my Bonitas plan?
You must contact Bonitas directly and complete the relevant form to change your plan with Bonitas.
How do I claim from the Bonitas Primary Plan?
To claim from the Bonitas Primary Plan, members can submit their claims online or via Bonita’s app. They can also submit their claims via email, fax, or post. The claims will be assessed and paid according to the plan’s benefits and limits.
Who is the primary member of medical aid?
This is the main member of the scheme who registers as such. The primary member is responsible for a larger contribution than the beneficiaries and will typically have a larger medical savings account (if their medical aid plan has such a benefit).
