You will face a 30% co-payment of the hospital bill if you use a hospital that is not on the BonEssential network. The plan uses a list of specific private hospitals, and this penalty applies unless it's a PMB emergency. Network specialists are covered in full at the Bonitas Rate, while non-network specialists are paid at 100% of the Bonitas Rate. Strategy reference: gle-2026.

Yes, but with strict limits. Depression medication is covered up to R165 per beneficiary per month (total R1,980 annually). This is listed as the 28th chronic condition covered. You must use Pharmacy Direct (the Designated Service Provider) to get your medicine. If you don't use Pharmacy Direct or choose medicine not on the formulary, you will pay a 30% co-payment. Strategy reference: gle-2026.

Yes. Colonoscopies and gastroscopies both have a R2,020 co-payment per procedure. This applies to in-hospital scopes. Cystoscopies, flexible sigmoidoscopies, and hysteroscopies also have the same R2,020 co-payment. These co-payments do not apply to PMB conditions. Strategy reference: gle-2026.

Yes. The plan charges a R2,800 co-payment per MRI or CT scan, even though the annual family limit is R15,960. This co-pay does not apply if the scan is confirmed as a Prescribed Minimum Benefit (PMB). Out-of-hospital MRI and CT scans are only covered for PMBs. Strategy reference: gle-2026.

Internal and external prostheses (including joint replacements) are covered for PMB conditions only. There is no specific Rand limit stated for non-PMB prosthesis cover - it is simply excluded. If your joint replacement qualifies as a PMB, it will be covered subject to Managed Care protocols and the use of network hospitals to avoid the 30% co-payment. Strategy reference: gle-2026.

Yes, but with limits. The Emergency Room Benefit covers only 2 emergency consultations per family per year at a casualty ward or emergency room facility of a hospital. The benefit is strictly limited to emergencies only. If your visit is not classified as an emergency, it will be paid from the available Benefit Booster amount (R1,160 per family if activated). Strategy reference: gle-2026.

The Benefit Booster is an extra R1,160 per family per year for out-of-hospital expenses like GP visits, over-the-counter medicine, X-rays, and blood tests. To activate it, you must complete an online mental health assessment and a wellness screening at a Bonitas wellness day or participating pharmacy. Once activated, out-of-hospital claims pay from this amount first. Strategy reference: gle-2026.

Yes. Preventative care includes 1 flu vaccine per beneficiary, pneumococcal vaccines (schedule-based), 2-3 doses of the HPV vaccine for females aged 9-26 (limited to 1 course per lifetime), and dental fissure sealants for children under 16. The wellness benefit also includes paediatric screenings and a 24/7 Babyline helpline for children under 3 years. Strategy reference: gle-2026.

Cancer treatment is unlimited for PMB conditions at a Designated Service Provider (DSP), but you must register on the Oncology Management Programme. However, if you use a non-DSP hospital, you face a 30% co-payment. Cancer medicine requires a 20% co-payment if you don't use a DSP pharmacy. Brachytherapy has a sub-limit of R63,110 per beneficiary. PET scans are PMB-only with a 25% co-payment for non-network providers. Strategy reference: gle-2026.

Cataract surgery is covered, but you can avoid a R9,800 co-payment by using the Designated Service Provider (DSP). If you choose a non-DSP provider for cataract surgery, the R9,800 co-payment applies per procedure. Pre-authorisation is required for all procedures. Strategy reference: gle-2026.