Preventative Care Benefits
To support you in managing your health proactively, we encourage you to take preventative measures. Detecting health risks or a disease early could prevent a disease, or at least improve the success rate of the treatment.
Endoscopies
Endoscopies include gastroscopies, colonoscopies, sigmoidoscopies and proctoscopies. To obtain authorisation call 0860 222 633. No co-payment is due, if the endoscopy is performed in a day clinic, or in the case of emergency. For a list of accredited facilities call the Call Centre on 0860 222 633 or log in as a member and find day clinics in the Provider search tool.
If you are admitted to hospital specifically for an endoscopy you will have to pay a co-payment of R3 800.
The below preventative care benefits are paid by the Scheme (not from your normal benefits) at the Scheme Reimbursement Rate. Refer to the relevant benefit category for more detail.
|
Description |
Sex |
Age |
Benefit Category |
Purpose |
|
Bone density scan |
F/M |
65+ |
Specialised Radiology |
Detection of osteopaenia or osteoporosis (fragile bones) |
|
Colonoscopy |
F/M |
50+ |
Endoscopy** |
Early detection of colorectal or colon cancer |
| Childhood vaccines As per Department of Health schedule | F/M | 0-12 | Vaccines | Early detection and reduction of childhood diseases |
|
HIV |
F/M |
All |
HIV Care Management Programme |
Early detection of HIV/AIDS |
|
Immunisation |
F/M |
As per Department of Health schedule |
Vaccines |
Prevention of severe illness and death |
|
Flu Vaccine |
F/M |
All |
Vaccines |
Influenza prevention; particularly important for people who are at risk of serious complications from influenza (chronic conditions, pregnant, HIV patients or ageing members) |
| Human Papillomavirus (HPV): Cervarix/Gardasil | F/M | 9-26 | Vaccines | Prevention of cervical cancer caused by HPV |
|
Pneumococcal Vaccine |
F/M |
55+ |
Vaccines |
Prevention of serious lung infections; particularly important for people who are at high risk for serious complications (chronic conditions, HIV patients or ageing members) |
|
Mammogram |
F |
40+ |
Specialised Radiology |
Early detection of breast cancer |
|
Maternity |
F |
|
Maternity |
Monitoring of your pregnancy and prevention of complications |
|
Ultrasound |
F |
|
Maternity |
|
|
Pap smear |
F |
21-65 |
Pathology |
Early detection of cervical cancer |
|
Pathology screening
|
F/M |
All |
Pathology: Pap smear |
Early detection of chronic illness or cancer |
|
Prostate check |
M |
50+ |
Pathology |
Early detection of prostate cancer |
|
Stool test (cancer and other screening) |
F/M |
50+ |
Pathology |
Detection of cancer and other diseases |
|
Vitality check
|
F/M |
All |
Vitality check |
Early detection of chronic illness |
The following preventative care measures are recommended and will be paid from your relevant benefit limit or Medical Savings Account at the Scheme Reimbursement Rate or negotiated rate or cost if PMB. Please discuss your individual need with your doctor.
|
Description |
Sex |
Age |
Paid from |
Purpose |
|
Eyesight check |
F/M |
40+ |
Eye Care Benefit or Member Savings |
Early detection of eye disease or deterioration |
|
Dental check-up |
F/M |
All |
Dental benefit or Member savings (after depletion of your dental benefit) |
Early detection of dental disease and preservation of dentine |
| Glaucoma screening | F/M | All | Member Savings | Early detection of glaucoma |
|
Gynaecological check-up |
F |
All |
Member savings |
Early detection of cancer and gynaecological problems |
|
Hearing test |
F/M |
All |
Member savings |
Early detection of medical conditions and hearing dysfunctions |
|
Baby and child |
F/M |
Baby/Child |
Member savings |
Early detection of developmental problems |
|
Senior members |
F/M |
65+ |
Member savings |
Detection of complications or mobility problems negatively impacting on wellbeing or illness |
|
Podiatry Care |
F/M |
All |
Member savings |
|
|
Skin health |
F/M |
All |
Member savings |
Detection of skin cancer |
Refer to the relevant benefit category for more detail