South African Medical Association

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Bonitas BonCap Family Practitioners Network Rates for 2021

 

 

Bonitas BonCap Family Practitioners Network Rates for 2021
Dear Family Practitioner

Bonitas BonCap Family Practitioners Network Rates for 2021

Partnering with healthcare providers is critical to ensuring that we are able to deliver affordable, quality healthcare to our members. The service rendered to our BonCap members in 2020 has been excellent and we look forward to continuing our partnership in 2021.

As a contracted Bonitas BonCap Family Practitioner (FP), you are reimbursed according to your dispensing status. FPs with a dispensing license are remunerated at a higher rate as the consultation fee includes the cost of any medication that is dispensed.

Dispensing FPs should therefore not issue scripts for members to obtain their medication at a pharmacy, as these claims will be rejected.

Tariffs for 2021

Please be advised that from 1 January 2021, there will be a 3.4% increase in the Bonitas BonCap Family Practitioner tariff rates including virtual consultations with network FPs, as follows:


Please remember that members require pre-authorisation after their seventh consultation with you.

Tariff codes that can be billed in addition to the consultation code

To ensure the sustainability of the BonCap option, we encourage you to manage downstream costs while still ensuring quality care. We will reimburse you for performing certain procedures in your rooms instead of referring patients to hospital for these interventions.

The following tariffs can be charged in addition to a consultation (cost of material included) for these services:


Any tariff code not included in the above table will reject with reason code 8445 – service not part of fixed fee agreement.

For more information, please refer to the BonCap FP Network Guide for 2021, which can be viewed at www.medscheme.com. Log in as a Provider and click on communication library > GP Guides.

New Day Surgery Network

As of 1 January 2021, a new Day Surgery Network will be introduced and a co-payment of R10 000 will apply for the use of a non-network Day Surgery Clinic.

BonCap Family Practitioner Network nomination

As per the 2021 Bonitas Fund Rules, BonCap members are required to nominate a primary and secondary healthcare provider on the BonCap Family Practitioner Network by calling us on 0861 239 333 or emailing boncap@bonitas.co.za

Specialist network and referral

As you may be aware, the Bonitas Specialist Network comprises of specialists who have agreed to charge our members the Bonitas Rate. Your patients will, therefore, not incur co-payments when visiting these Providers.

We encourage all our BonCap members to consult their network FP before making an appointment with a specialist, to ensure that they are referred to the appropriate specialist. You can confirm which specialists are on the Bonitas Network by visiting the Medscheme website on www.medscheme.com

To obtain an automated authorisation when referring your patient to a Specialist, simply log in as a Provider, click on Specialist Referral and complete the required information. Alternatively, you may call the BonCap Contact Centre on 0861 239 333

Hospital network

BonCap members may only be admitted to a hospital on the BonCap network. Voluntary use of a non-network hospital will result in a R10 000 co-payment. Members are also required to pre-authorise any hospital stays to avoid co-payments.

We are pleased to advise that we have enhanced our hospital networks for 2021 to ensure that your patients have access to healthcare of the highest standard. Visit www.bonitas.co.za for the list of hospitals on the network.

Independent Clinical Oncology Network (ICON)

A 40% co-payment may apply if a member consults with an oncologist that is not on the ICON network for active oncology treatment. To alleviate out-of-pocket expenses, we urge you to refer BonCap members to a participating ICON oncologist for their oncology treatment.

You can find an ICON oncologist by logging onto www.medscheme.com and clicking on Networks > ICON, or alternatively please call 0861 239 333

Continuation of agreement

You do not need to sign or return the BonCap Network Annexure again. Should you wish to opt out of the Agreement, please send an email to this effect to nc@medscheme.co.za or fax 0860 222 453 by Thursday, 24 December 2020.

Failure to opt out of the agreement as indicated above will be deemed as a legally binding intention to remain on the BonCap network. You are also welcome to view the BonCap Agreement online by visiting www.medscheme.com (log in as a Provider and click on Networks > E-Contracts). Should you have any questions, please call us on 0861 112 666.

Thank you for your assistance during 2020.
We look forward to continuing our partnership in 2021.

Kind regards
Bonitas Medical Fund

The South African Medical Association - Postal Address-The South African Medical Association P O Box 74789,Lynnwood Ridge Pretoria 0040, South Africa Physical address The South African Medical Association, Block F Castle Walk Corporate Park Nossob Street Erasmuskloof Ext3 Pretoria 0181,
South Africa www.samedical.org

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