BONITAS Maternity Benefits Nightmare

Dear Ms MR Tshabalala,

Thank you for notifying us of your complaint. We strive to provide you with the best possible service, and when you feel that it fails to meet your expectations, it is important for us to know.

Please be advised that the Bonfit Select offer cover to maternity care benefits as follows:

6 consultations during pregnancy - 0ne (1) left
2 x 2D ultrasound scans (3615 -10 to 20 weeks, 3617- at 20 to 24 weeks) -funds depleted.
1 amniocentesis
Antenatal Classes
4 consultations with a midwife after delivery (1 of these can be with a lactation specialist)
Newborn hearing screening

Kindly note that the claim for ultrasound scan after 24 weeks code 5107, for service date 24/05/2021 and 07/06/2021 has been rejected as service is not covered by the plan. A motivation letter is required from your doctor for review. The motivation letter can be emailed to ***

On the BonFit Select option you must use a hospital on the BonFit Select Network or you will have to pay a 30% co-payment.

Claims will be paid as per scheme rules and based on available benefits at the time of processing. The fund will pay all claims at the Bonitas Scheme Rate. If your health care provider charges more than the Bonitas Scheme Rates, the member is liable to pay for the difference.

We value our members and sincerely apologise for any inconvenience caused to you.

Should you require any further information, please contact us on ***or email ***

Register on the member zone and manage your medical aid with ease:

Visit www.bonitas.co.za to register on the member zone and enjoy the convenience of accessing your medical aid benefits, tax certificates, claims statements and any other information relating to your membership 24 hours a day, 7 days a week.

Remember to regularly update your personal details and ensure you receive all the latest updates from Bonitas. To update your details, email us at ***

Regards,

Lammetjie Mthetwa

Hi Lammetjie Thank you for your response.

1. Attached is the motivational letter from my doctor that was sent to the medical.

On the issue of hospitals, in my query I made it clear that Midrand, Fourways and Sunninghill do not have hospitals where I can deliver my baby at because you don’t have a network hospital around those areas.

1. These are major suburbs where the scheme has removed all the 1Life and Netcare hospitals from their network list.
2. For those areas, only day hospitals are accessible for me and we all know I cannot deliver in a day hospital.
3. The scheme is incorrectly advertising their offering as covering hospitals whereas almost 80% of the hospitals are not covered in the plan. The plan should clearly state that in all hospitals co-payment of 30% is required for all hospitals stay.
4. Within the vicinity mentioned above, there are 4 hospitals, not even one of them is network hospital. Below is the only network hospital available for all the 3 suburbs that I have mentioned.

| PRACTICE_NUMBER | PRACTICE_NAME | NETWORK_TYPE | ADMINISTRATOR_CODE | SCHEME_CODE | OPTION_CODE | ORG_GROUP_NAME | SUBURB
| *** | Cure Day Clinics - Fourways | Hospital Network | MEDSCHEME | BON | PL475 | BONFIT SELECT HOSPITAL NETWORK | Fourways

1. Because of my complications and being 35 weeks pregnant at this stage, I cannot start looking around “outside of my area of residence and my service providers vicinity” for a gynae that will take my case at this stage. I am supposed to go through c-section 2 weeks.
   1. In your network hospitals, where will I find a gynae that will be able to attend me and deliver me in such a short notice?
2. I cannot be stressing about finding a doctor at the current stage when I am stressing about the development and health of my unborn baby. Is the money that you are trying to save more important for your organisation than my life and my babies life?

I will escalate this case to the medical ombudsman for the following reason:

1. The scheme has through the years made the options for the network hospital very limited “almost to day clinics only” without clear communication.
2. The monthly premium of the scheme increases yearly, however benefits decreases without clear communication. My network has become smaller and smaller but my premiums has mounted not matching up the service offered.
3. Adventisment of the option is not misleading as BonFit is now a 30% co-payment plan for all hospitals stays and that is also not clearly communicated.
4. It should be clearly stated in the manual that Bonfit provides cover for the day clinics only.

No, I don’t feel that my membership is valued as this response from you only told me to read my features and benefits guide and not attempt to try assist me and/or resolve the shortcomings that the scheme has implemented by removing services that they provided in the previous years.