Bonitas Medical Fund
Maximise your benefit - Visit an In Network Provider
Your benefits are contractually better at a network provider - Scheme rules apply
To confirm that you or a dependent is entitled to optical benefit, SMS your request to 45119 with the following details:
Benefit,MembershipNumber,Surname,BirthDateDependent,MainMemberID,DependantNumber, UniqueMedicalAid Key
Example: SMS 45119 Message details: Benefit 277323232 Botha 19721220 7212205065089 0 12
Important information:
Replace each comma with a space in your SMS and ensure the details are accurate and only one space is between each requirement. Kindly make sure the birthdate is in the correct format as per the example. The information will return within 1 minute on a new SMS. The full benefit breakdown per dependent is available by logging in to the PPN website or a guideline is given below. Your schemes unique medical key is 12.
Boncap
2021 Optical benefit design
Each beneficiary is entitled to the following benefits within a two year benefit cycle from last claiming date.
Forensic protocols and AI screening included in design - The benefits are a guideline and scheme rules apply
Negotiated Tariff: PPN 1 (Lenses are dispensed in network at an agreed network rate. The same product out of network may result in co-payments if an out of network provider dispenses at industry rates.)
One Composite Examination
- One pair of either clear standard Single Vision or Bifocal lenses or Multifocal lenses
- IN NETWORK : A Frame to the value of R 225.00 towards an alternative Frame and or Lens enhancements
- OR
- OUT OF NETWORK/REFUND VALUE : A Frame to the value of R 163.00 towards an alternative Frame and or Lens enhancements
- Contact lenses to the value of R1 140.00
- 2 Yearly Benefit
BonClassic
2021 Optical Benefit Design
Each beneficiary can claim once every 24 months from last claiming date
Forensic protocols and AI screening included in design - The benefits are a guideline and scheme rules apply
PPN 1 negotiated tariff structure applicable (Lenses are dispensed in network at an agreed network rate. The same product out of network may result in co-payments if an out of network provider dispenses at industry rates.)
Subject to a bi-annual Family limit of R5 845 - Sub-limits for each beneficiary defined below:
One Comprehensive Consultation
One pair of clear standard Single vision lenses or Bifocal lenses or Multifocal lenses
IN NETWORK : A Frame to the value of R 1 110.00 towards an alternative Frame and or Lens enhancements
OR
OUT OF NETWORK/REFUND VALUE : A Frame to the value of R 805.00 towards an alternative Frame and or Lens enhancements
Contact lenses to the value of R 1 880.00
2 year limit
BonComplete
2021 Optical benefits:
Each beneficiary is entitled to the following benefits within a two year benefit cycle from last date of claiming.
Forensic protocols and AI screening included in design - The benefits are a guideline and scheme rules apply
Negotiated Tariff : PPN 1 (Lenses are dispensed in network at an agreed network rate. The same product out of network may result in co-payments if an out of network provider dispenses at industry rates.)
Benefits are subject to available savings.
One Comprehensive consultation
A Frame and or Lens enhancements to the value of R 815.00 and one pair of lenses:
Either clear standard Single vision lenses or Bifocal lenses or Multifocal lenses
Contact lenses to the value of R 2005
2 Yearly limit
BonComprehensive
2021 Optical Benefit
Each beneficiary can claim once in a 24 month cycle from last claiming date up to the limit of R 3 330.00 from available savings
Forensic protocols and AI screening included in design - The benefits are a guideline and scheme rules apply
Negotiated tariff : PPN 1 (Lenses are dispensed in network at an agreed network rate. The same product out of network may result in co-payments if an out of network provider dispenses at industry rates.)
One Comprehensive Consultation
One pair of clear standard spectacle lenses : Single vision or Bifocal or Multifocal
One frame subject to available savings
Contact lenses are subject to the available savings limit
BonFit
2021 Optical Benefit Design
Each beneficiary can claim once in a 12 month cycle subject to available savings
PPN 1 tariffs applicable In Network Forensic protocols and AI screening included in design - The benefits are a guideline and scheme rules apply
One Comprehensive Consultation
One pair of clear standard spectacle lenses : Single Vision or Bifocal or Multifocal
Frame subject to available savings
Contact lenses subject to available savings
BonSave
2021 Optical Benefit Design
Each beneficiary can claim once in a 12 month cycle subject to available savings
PPN 1 limits applicable In Network Forensic protocols and AI screening included in design - The benefits are a guideline and scheme rules apply
One Comprehensive Consultation
One pair of clear standard spectacle lenses : Single vision or Bifocal or Multifocal
A frame subject to available savings
Contact lenses subject to available savings
BonStart
2021 Optical benefits:
Each beneficiary is entitled to a consultation within a 2 year cycle.
Forensic protocols and AI screening included in design - The benefits are a guideline and scheme rules apply
Negotiated Tariff : PPN 1 (Lenses are dispensed in network at an agreed Scheme rate regardless of member paying cash for materials)
One Comprehensive consultation in network or a Refraction out of network
(Member is liable for a co-payment of R110 on the consultation in and out of network)
In Network : Spectacles at Scheme rate
Out of Network: Spectacles at Industry rate
Member to pay cash for materials, claim to be submitted to the scheme for Tax purposes
In Network : Contact Lenses at Scheme rate
Out of Network: Contact Lenses at Industry rate
Member to pay cash for materials, claim to be submitted to the scheme for Tax purposes
Primary / Primary Select
2021 Optical benefit design
Each beneficiary is entitled to the following sub-limits within a two year benefit cycle from the last claiming date subject to available family limit.
Bi-annual Family limit of R 4 955.00
Negotiated Tariff: PPN 1 (Lenses are dispensed in network at an agreed network rate. The same product out of network may result in co-payments if an out of network provider dispenses at industry rates.)
Forensic protocols and AI screening included in design - The benefits are a guideline and scheme rules apply
One Composite Examination
- One pair of either clear standard Single Vision or Bifocal lenses or Multifocal lenses
- IN NETWORK : A Frame to the value of R 525.00 towards an alternative Frame and or Lens enhancements
- OR
- OUT OF NETWORK/REFUND VALUE : A Frame to the value of R 381.00 towards an alternative Frame and or Lens enhancements
- Contact lenses: R 1 295.00
- 2 Yearly Benefit
Standard / Standard Select
2021 Optical benefit design
Each beneficiary is entitled to the following benefits within a two year benefit cycle from the last claiming date.
Bi-annual Family limit of R 6 430.00
Beneficiary sub-limits subject to family limit and defined below - Forensic protocols and AI screening included in design - The benefits are a guideline and scheme rules apply
Negotiated Tariff: PPN 1 (Lenses are dispensed in network at an agreed network rate. The same product out of network may result in co-payments if an out of network provider dispenses at industry rates.)
One Composite Examination
- One pair of either clear standard Single Vision or Bifocal lenses or Multifocal lenses
- IN NETWORK : A Frame to the value of R 1 275.00 towards frame and lens enhancements
- OR
- OUT OF NETWORK/REFUND VALUE : A Frame to the value of R 924.00 towards an alternative Frame and or Lens enhancements
- Contact lenses: R 1 965.00
- 2 Yearly Benefit
- Boncap
- BonClassic
- BonComplete
- BonComprehensive
- BonFit
- BonSave
- BonStart
- Primary / Primary Select
- Standard / Standard Select
