BENEFITS
BCIMA Basic Option
BCIMA Basic Option Benefits 2025
Benefits
LifeSense HIV Programme
Unlimited, Subject to be Registerd on the
program/with Life Sense
COVID Admissions and Related Treatment
Unlimited PMB, subject to Pre-authorisation
Preventative Care Benefit
Unlimited, subject to Pre-authorisation
Hospital Limit
R 1 030 000 per family, per year
Annual Limit: Day-to-day expenses
R 22 900 per family, per year
Chronic Medicine Limit Benefit paid according to Reference Pricing (RP)
R 16 700 per family, per year
Preventative Care Benefits
Conservative Dentistry
For beneficiaries under 6 years of age.
100% of BCIMA Tariff
Mental Health Benefit
1 Clinical Psychologist Consultation per
beneficiary, per year.
Health-on-Line Assistance
Call 082 911 – 24h-hour Emergency/Non-Emergency Telephonic Medical Advice and Information
Hospital Benefits
Hospitalisation
R 1 030 000 per family
Pre-authorisation required
R 1 000 levy if not pre-authorised
In-Hospital and Day Clinics
The Following Services Are Covered, Including All Relevant Accounts
- Ward fees – General, ICU, High Care
- Theatre fees
- Medication (while in hospital)
- Surgical procedures
- GP and specialist visits
- Surgical prostheses
- Oncology
- MRI and CT scans
- Electronic/nuclear appliances and/or prostheses, subject to prior approval by the Board of Trustees and hospital limit
- Alcohol and Drug Abuse/Addiction – 21 days per beneficiary per year
- Dentistry (in-hospital procedures, subject to pre-authorisation)
- Clinical technologists
- Radiology
- Pathology
- Confinements: Normal births
- Confinements: Caesarean sections
- Home confinements: Subject to pre-authorisation
- Blood transfusions
- Renal dialyses
- Psychiatric treatments – 21 days per family, per year
Private Nursing
Private nursing excluding Frail Care, mother and child postpartum
Subject to pre-authorisasion. Limited to 60 days per condition, 100% of the Agreed Tariff
Ambulance Services – Emergency Transport
Ambulance Services – Emergency Transport. Contracted to Netcare 911
100% of the Agreed Tariff
Chronic Medicine
Subject to registration on the Chronic conditions/ medications program for this Benefit
Benefit paid according to Reference
Pricing (RP)
R 16 700 per family, per year
Annual Limit
Day-to-day Benefits
R 22 900 per family, per year
Medicine
Acute (prescribed medication)
Benefit paid according to Reference Pricing (RP) Subject to Annual Limit
80% of cost
Single Member R 7 730
M+ 1 R 8 650
M+ 2 R 9 680
M+ 3 R 10 700
M+ 4 R 11 700
M+ 5+ R 13 000
Pharmacy-advised therapy (PAT) or
Over-the-counter medication (OTC)
Subject to R 250 per script, per beneficiary, per day. Subject to Annual Limit
Single member R 2 160 or Family R 3 500
Homeopathic remedies
80% of cost
General Practitioners/
Specialists (out-of-hospital)
Visits and Consultations. 100% of BCIMA Tariff
Subject to Annual Limit
100% of the BCIMA Tariff
Single Member R 5 050
M+1 R 6 280
M+2 R 7 520
M+3 R 8 760
M+4 R 9 990
M+5+ R 11 300
Non-surgical procedures
100% of BCIMA Tariff. Subject to Annual DTD limit
Dentistry
Conservative:
fillings, scaling & polishing, extractions, etc. Subject to Annual Limit
R 4 800 per family, per year
Specialised:
crowns, bridgework, orthodontics, periodontics, prosthodontics, plastic dentures, maxillo-facial, oral surgery, etc. Subject to Annual Limit
R 6 900 per family, per year
Optical
Eye tests
100% of the Agreed BT
Spectacles or contact lenses
R 4 740 per family, per year
Frames
R 800 maximum (included in optical limit)
Refractive eye surgery
Subject to Annual Limit
Subject to pre-authorisation
Surgical and Medical Appliances
Hearing aids, wheelchairs, crutches, glucometers, etc. Subject to Annual Limit
100% of Agreed tariff – R 5 150 per family, per year
Other Services –
Subject to Annual Limit
(Day-to-Day)
Psychiatric treatments
R 5 050 per family, per year
Traditional Healers
R 1 750 per family, per year
Auxiliary Service –
Subject to Annual Limit
(Day-to-Day)
100% of the BCIMA tariff
Single member R 1 500
M+ 1 R 1 875
M+ 2 R 2 250
M+ 3 R 2 625
M+ 4 R 3 000
M+ 5+ R 3 375
Acupuncturist
Biokinetics
Chiropractors
Clinical services
Clinical technology
Dieticians
Hearing Aid Acoustician
Homeopaths
Medical Technology
Occupational Therapy
Orthotists & Prosthetists
Physiotherapists
Podiatry
Psychologists
Registered Counsellors
Registered nurses
Social workers
Speech therapy and Audiology
BCIMA Basic Option Contributions 1 January 2025
Contribution Schedule for Weekly and Monthly Paid Employees
Contributions payable per family, applicable as from January 2025
Weekly Contribution Schedule Site Employees
Contributions structured according to the employee’s hourly rate of pay.
Contribution Code
A
B
C
D
E
F
G
H
Hourly Wage Band
R 1.00 – R 29.99
R 30.00 – R 33.99
R 34.00 – R 37.99
R 38.00 – R 57.99
R 58.00 – R 74.99
R 75.00 – R 94.99
R 95.00 – R 113.99
R 114.00+
50% of Contribution
R 252.40
R 298.30
R 321.55
R 345.90
R 4 36.65
R 497.45
R 554.60
R 632.70
Per Family Contribution
R 504.80
R 596.60
R 643.10
R 691.80
R 873.30
R 897.10
R 1 109.20
R 1 265.40
Monthly Contribution Schedule Employer, Administrative Staff and Site Employees
Contributions structured according to the employee’s monthly salary.
Contribution Code
A
B
C
D
E
F
G
H
Monthly Income Band
R 1.00 – R 5 199.99
R 5 200.00 – R 5 892.99
R 5 893.00 – R 6 586.99
R 6 587.00 – R 10 052.99
R 10 053.00 – R 12 999.99
R 13 000.00 – R 16 466.99
R 16 467.00 – R 19 759.99
R 19 760.00+
50% of Contribution
R 1 009.60
R 1 193.20
R 1 286.20
R 1 383.60
R 1 746.60
R 1 989.80
R 2 218.40
R 2 530.80
Per Family Contribution
R 2 019.20
R 2 386.40
R 2 572.40
R 2 767.20
R 3 493.20
R 3 979.60
R 4 436.80
R 5 061.60
Contribution Schedule for Continuation Members
Applicable as from January 2025 – Payable monthly and in advance
Contribution Code
L
M
N
P
Q
R
S
T
Monthly Income Band
R 1.00 – R 3 633.99
R 3 634.00 – R 5 281.99
R 5 252.00 – R 7 911.99
R 7 912.00 – R 9 886.99
R 9 887.00 – R 13 194.99
R 13 195.00 – R 16 594.99
R 16 595.00 – R 19 796.99
R 19 797.00+
Per Family Contribution
R 1 744.00
R 2 492.00
R 3 264.00
R 4 521.00
R 5 673.00
R 6 503.00
R 7 309.00
R 8 354.00
