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KVdM
Kirsty Van der Merwe

1 reviews | Active since Dec 2017

11 May 2026, 19:53

BONITAS DOES NOT CARE! CHEAPER IS NOT ALWAYS BETTER

I switched to Bonitas Medical Fund with NO break in medical aid cover from my previous scheme, yet Bonitas imposed a waiting period. I specifically queried this and was advised that the waiting period would NOT apply to emergencies or PMB-related treatment.

Shortly thereafter, my family and I were involved in a serious motor vehicle accident. My children sustained injuries and we required emergency medical treatment at hospital and from attending doctors.

I am now shocked to discover that Bonitas is rejecting the hospital, doctor, and radiology claims despite previously advising that emergencies and PMB events would still be covered. This is deeply concerning, especially considering that emergency medical treatment following a traumatic car accident is exactly the type of unforeseen event medical aid exists for. Diagnostic radiology and scans formed part of the emergency assessment and treatment process after the accident, yet these claims are also allegedly being declined.

What has made this even more upsetting is that the hospital was allegedly advised by Bonitas that we should rather seek treatment at a government institution — despite the fact that I pay monthly medical aid premiums specifically to access private emergency medical care when my family needs it most. Being told to use a state facility during a traumatic emergency while actively paying for private medical cover is extremely difficult to accept.

To make matters worse, this situation is now placing severe financial strain on my family. I am being forced to personally cover substantial hospital, radiology, and doctor accounts out of pocket while still remaining obligated to pay full monthly medical aid premiums to Bonitas. It is extremely difficult to understand why members are expected to continue paying premiums in full during a period where critical emergency claims are allegedly being denied.

I would like Bonitas to explain:

• Why a waiting period was imposed despite there being no break in cover between schemes • Why emergency and PMB-related treatment following a motor vehicle accident is allegedly not covered • Why radiology claims linked to emergency trauma care are also being rejected • Why the hospital was allegedly instructed to refer us to a government institution despite active medical aid membership • Why conflicting information was provided by Bonitas representatives regarding emergency benefits • Whether Bonitas is complying with its obligations under the Medical Schemes Act and PMB regulations

At this stage I am requesting an urgent review and written clarification before escalating the matter further to the Council for Medical Schemes and other relevant consumer protection channels.

This entire experience has unfortunately left a very bitter taste in my mouth regarding how Bonitas appears to operate when members face genuine emergencies. I am now seriously reconsidering whether I want to remain with a medical aid that handles emergency trauma claims in this manner, especially after continuing to faithfully pay monthly premiums.

I hope Bonitas resolves this matter promptly and in good faith, as this situation has caused significant distress — emotionally and financially — during an already traumatic time for my family.

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Replies (3)
Bonitas Medical Fund
Bonitas Medical Fund's reply12 May 2026, 09:27
Official
Hello Kirsty V 

Thank you for bringing this to our attention. We’re sorry to hear about your experience and appreciate you reaching out.  

We will investigate this matter.

We appreciate your patience while we are resolving this query for you. 
 
Kind Regards
 
Bonitas Team 
KVdM
Kirsty Van der Merwe's update14 May 2026, 09:45
Reviewer Update
It has now been two days since your last response, and despite the urgency of this matter, nobody from Bonitas has made any attempt to contact me or provide meaningful assistance.
In the meantime, both the hospital and radiology department have confirmed that claims continue to be rejected, and they have further advised that Bonitas is refusing to engage with them directly regarding payment or resolution. This situation is becoming entirely unacceptable.
I joined Bonitas on the clear understanding that emergency medical treatment arising from unforeseen incidents, including motor vehicle accidents, would be covered notwithstanding the applicable waiting period provisions. However, I am now faced with substantial outstanding medical expenses approaching R75,000, while claim after claim is being declined on the basis that “it is not a PMB,” despite the treatment arising from an emergency situation following a serious car accident.
This has placed me and my family under severe financial strain. I continue to pay monthly premiums in good faith while simultaneously being expected to personally carry the burden of emergency medical costs that I reasonably believed would be covered under the representations made when my membership was accepted. Given the extent of the outstanding medical costs and the continued lack of assistance from Bonitas, I am now being placed in an impossible financial position. I cannot reasonably be expected to continue paying monthly premiums while simultaneously funding substantial emergency medical expenses personally due to claims being rejected.
Should this matter remain unresolved, I will be forced to reconsider continuing premium payments and may have no practical alternative but to redirect those funds toward settling the outstanding hospital and radiology accounts arising directly from this emergency incident.
At this stage, I require:
  • A formal written explanation for each rejected claim;
  • Clarification of the basis upon which Bonitas considers these emergency-related treatments not to qualify for coverage;
  • Confirmation as to whether the claims have been reviewed correctly in light of the emergency nature of the incident;
  • Immediate engagement with the hospital and radiology providers to avoid further prejudice and collection action against me.
Should this matter continue to remain unresolved, I will have no option but to consider escalating it formally through the appropriate regulatory and dispute resolution channels, including lodging a complaint with the Council for Medical Schemes.
I trust Bonitas will now treat this matter with the seriousness and urgency it deserves.

KVdM
Kirsty Van der Merwe's update01 Jul 2026, 12:17
Reviewer Update
I am officially escalating Bonitas to the medical ombudsman!