Bonitas Medical Fund: Understanding Your Mental Health Benefits

Table of Contents | Jump Ahead

The Bonitas Mental Health Programme

A Breakdown of Your Bonitas Mental Health Benefits

How to Access Your Bonitas Mental Health Benefits

Network vs Non-Network Providers: A Detailed Comparison

How to Claim for Therapy Sessions

The Verdict: Is Bonitas a Good Choice for Mental Health?

Global Helplines & Emergency Services

References

The Bonitas Mental Health Programme

How to Join the Mental Health Programme

1. Contact Bonitas: To find out more about the programme and to be assessed for eligibility, you can call Bonitas on 0860 106 155.
2. Assessment: You will be assessed to determine your eligibility to join the programme.
3. Nominate Your Doctor: You will need to nominate the doctor you want to continue looking after your mental health condition.

A Breakdown of Your Bonitas Mental Health Benefits

In-Hospital Treatment

Like all medical aids, Bonitas provides unlimited cover for PMB conditions, including major affective disorders (such as unipolar and bipolar depression) and schizophrenic and paranoid delusional disorders, as long as you use a network hospital. For other mental health conditions, your in-hospital cover will depend on your plan. Most of the higher-end plans, like the BonComprehensive and BonComplete options, offer generous in-hospital benefits for mental health.

Key Points for In-Hospital Care:

• Pre-authorisation is crucial. You must get approval from Bonitas before being admitted to a hospital for mental health treatment.
• Use a network hospital. To ensure you are fully covered, it is always best to use a hospital in the Bonitas network.
• Co-payments may apply. If you choose to use a non-network hospital, you may have to pay a co-payment.

Out-of-Hospital Treatment

Psychology and Psychiatry

Medication

If you are registered on the Mental Health Programme for depression, you will receive a benefit for chronic medication of up to R160 per beneficiary per month. This medication must be obtained from a Designated Service Provider (DSP) pharmacy. For other chronic mental health conditions, your medication will be covered under the Chronic Medication Benefit, provided you have registered your condition with the scheme.

Prescribed Minimum Benefits (PMBs) - Covered on ALL Plans

How to Access Your Bonitas Mental Health Benefits

• Enrol in the Mental Health Programme: This is the best way to ensure you get the most out of your benefits. Call Bonitas on 0860 106 155 to get started.
• Get Pre-Authorisation: For any planned hospital admissions, make sure you get pre-authorisation from Bonitas.
• Use Network Providers: To avoid co-payments, use hospitals, doctors, and pharmacies in the Bonitas network.
• Submit Your Claims: Your healthcare provider will usually submit claims directly to Bonitas. You can track your claims and benefits on the Bonitas member portal or app.

Network vs Non-Network Providers: A Detailed Comparison

What is a Designated Service Provider (DSP)? A DSP is a healthcare provider (doctor, hospital, or pharmacy) that has a special agreement with Bonitas to provide services at a pre-negotiated rate. For PMB conditions, you must use a DSP to get full cover. If you choose to use a non-DSP for a PMB condition, you may have to pay a significant co-payment.

Why We Recommend Network Providers For most members, using a network provider is the most cost-effective and hassle-free option. You will have lower out-of-pocket costs, less paperwork, and access to the full range of your benefits, including the Mental Health Programme. While non-network providers offer more choice, this comes at a significant financial cost.

How to Claim for Therapy Sessions

Understanding the claims process can save you time and ensure you get reimbursed quickly:

Option 1: Network Provider (Recommended)

• Book with a network provider who accepts Bonitas
• Show your Bonitas card at the appointment
• Provider submits claim directly to Bonitas (bulk billing)
• You pay only your portion (co-payment if applicable)

Option 2: Non-Network Provider

• Pay the full session fee upfront to your therapist
• Get a detailed invoice with the following information:
  • Your membership number
  • Provider's practice number
  • Date of service
  • ICD-10 diagnosis code
  • Procedure code (usually 0134 for psychology consultation)
  • Amount charged
• Submit your claim within 4 months via:
  • Bonitas app (fastest)
  • Online member portal
  • Email to claims@bonitas.co.za
  • Post to Bonitas Claims Department, PO Box 74, Vereeniging, 1930

Required Documentation for Claims

• Detailed tax invoice from your therapist
• Proof of payment (if paying upfront)
• Referral letter (if required by your plan)
• Diagnosis confirmation (may be requested)

Claims Processing Time

• Electronic claims: 5-7 working days
• Manual claims: 10-15 working days
• Complex claims: Up to 30 days

The Verdict: Is Bonitas a Good Choice for Mental Health?

Global Helplines & Emergency Services

• Find a helpline, suicide hotline, or crisis line in your country: https://www.therapyroute.com/article/helplines-suicide-hotlines-and-crisis-lines-from-around-the-world
• Find an emergency ambulance number in your country: https://www.therapyroute.com/article/ambulance-emergency-numbers-worldwide-list-by-therapyroute

References

Bonitas Annual Report 2021

Bonitas News Article - Record Financial Results

Bonitas Medical Fund. (2024). Mental Health Programme 2025

Disclaimer: The information in this article is based on 2024/2025 policy documents. Benefit amounts and contact details can change. Always verify current details with your medical aid scheme before making any healthcare decisions.