Misrepresentation of Benefits on Member Profile

Misrepresentation of Benefits on Member Profile

I wish to raise a serious concern regarding the way Bonitas Medical Aid presents member benefits on its online platform versus the actual benefits made available when members attempt to use them.

On my profile, several benefit categories (such as Alternative Health Care and Medication & Injectable Material) are clearly shown with defined annual limits and available balances. For example, the platform reflects an available balance of R3,180.00 under Alternative Health Care.

However, when contacting Bonitas to confirm usage, I was advised that despite the displayed availability, these benefits are in fact not accessible because my Day-to-Day Benefits allocation has been exhausted. This effectively renders the displayed benefit balances misleading, as they create the impression that funds are available when in practice they are blocked by unrelated benefit categories.

This raises two critical issues:

Transparency: Members are being shown benefit balances that they cannot access, which constitutes misrepresentation of available cover.

Fairness: It is unclear how Bonitas can legally advertise separate benefit categories with set limits, yet deny access to them based on a completely different pool (Day-to-Day Benefits).

I request the following:

A full written explanation of how benefits are structured and why balances are displayed as available when they are in fact restricted.

Confirmation of whether this practice complies with the Medical Schemes Act and industry regulations on disclosure and transparency.

Urgent corrective action to ensure members are not misled regarding their actual benefit availability.

Should this matter not be resolved satisfactorily, I will escalate it to the Council for Medical Schemes Ombudsman, as I believe this practice is both unfair and misleading to members who rely on accurate information to make healthcare decisions.