South Africa’s second largest open medical scheme, Bonitas Medical Scheme (‘Bonitas’), launched their benefit and contribution changes for 2020 on Wednesday, 18 September 2019. An average contribution of 9.9% was announced.
Bonitas has noted the following as contributing factors to their 2020 increase: unregulated pricing on healthcare services, an increase on claim utilisation, an ageing membership, prevalence of life-style related conditions and high hospital tariffs.
Bonitas’ solvency of 25.2% (2018) remains above the current regulated standard of 25% which is an indication that the scheme is in a healthy condition.
ASI Financial Services’ (‘ASI’) has analysed the changes to your benefits and summarized them herein below.
ASI will be conducting member information sessions during which we will unpack all the changes and assist members with their choice of plan for 2020.
KEY BENEFIT HIGHLIGHTS
- BonFit renamed to BonFit Select
- Maternity benefit enhancements
- Mother and baby programme introduced
- Wellness Extender Benefit enhanced
- Bonitas Pharmacy Network
- Auxiliary benefits for non-PMB paid from day-to-day and savings
- General appliances paid from savings
- Hospital reimbursement rate on BonComprehensive and BonSave reduced
- Hearing aid benefit available every five (5) years
- Paramedical benefits paid from savings
- Spinal surgery co-payment increased to R10,000
- BonSave savings increased to 19.5%
- BonFit Select savings increased to 16%
- Amendments on the dentistry benefit
- Additional GP consultations available on BonFit Select
- Primary and Primary Select day-to-day increased by 14.7%
- Out of hospital Specialised Radiology benefit available on BonEssential and BonEssential Select
2020 WEIGHTED AVERAGE CONTRIBUTION INCREASE 9.9%
- BonFit renamed to BonFit Select
- Maternity benefit enhanced to allow new mothers to substitute their postnatal consultation with a lactation specialist consultation
- Up to 70% discounted vouchers at Baby City for new mothers on the Maternity benefit
- A new mother and baby support programme will be launched at the end of the first quarter for 2020
- The Wellness Extender benefit has been enhanced to provide cover for basic radiology and pathology, however these will be subject to the annual limit
- Dischem and Clicks clinics have been included as screening partners for the Wellness Extender benefit.
- The Bonitas Pharmacy Network was introduced, whereby all Bonitas members will be required to make use of the network for their chronic, acute, over-the-counter and oncology medication in order to avoid co-payments
- Auxiliary benefits will be paid from the in-hospital benefit for Prescribed Minimum Benefits (‘PMB’). Non-PMB benefits for BonComprehensive, BonClassic, BonComplete, BonSave and BonFit Select will be paid from savings and the Standard, Standard Select, Primary and Primary Select will pay non-PMB benefits from day-to-day
- The hospital reimbursement rate for BonComprehensive has been reduced from 300% to 150%
- General appliances will now be paid from savings on BonComprehensive, BonSave and BonClassic options. This benefit will not be available when member reaches the threshold
- The hearing aid benefit will only be available on a five (5) year cycle from the date of last claim on the BonComprehensive, BonComplete, BonClassic, Standard and Standard Select options
- BonClassic will pay for Paramedical services from the savings or available day-to-day and no longer the in-hospital benefit
- Members on the BonComprehensive, BonClassic, BonComplete, Standard and Standard Select will have a R10,000 co-payment for spinal surgery should the member not complete the back and neck programme prior to the surgery, another R10,000 co-payment will be applicable should these members make use of a non-network provider
- BonSave members will have a 19.5% savings account as opposed to 16% in 2019
- BonFit Select members will have a 16% savings account as opposed to 15% in 2019
- The hospital reimbursement rate for BonSave has been reduced from 150% to 100%
- The dentistry benefit has been amended as follows:
- BonSave – No cover for plastic dentures
- BonFit Select – No cover for X-rays, fillings, root canal therapy and extractions from the risk benefit
- All options (excluding BonCap and BonComprehensive) – one (1) filling per tooth only available every two (2) year
- BonFit Select members will have two (2) additional GP consultations per family should their savings be depleted
- Primary and Primary Select day-to-day benefits have increased by 14.7%
- Specialised Radiology benefit enhanced on the BonEssential and BonEssential Select whereby out-of-hospital Specialised radiology will be covered from the in-hospital benefit
- BonCap income bands have increased by 6%
VALUE ADDED PRODUCTS HIGHLIGHTS
- Run/Walk for Life introduced as a partner on the free Bonitas Value-added product model whereby members will save 70% when joining the fitness programme.
- Should mothers-to-be join Run/Walk for Life then their partner will join the programme for free
- Bonitas members will receive a 5% discount on any insurance premium quoted as well as a free crash detection unit when joining MiWay
- EssentialMed introduced as the Primary healthcare partner for 2020.