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 gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy. 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 350.
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

65+

Specialised Radiology

Detection of osteopaenia or osteoporosis (fragile bones)

Colonoscopy

F/M

50+

Endoscopy**

Early detection of colorectal or colon cancer

HIV test

F/M

All

Pathology

Early detection of HIV/AIDS

Immunisation
Human Papillomavirus (HPV):
Cervarix / Gardasil
(1 lifetime vaccine for female beneficiaries from age 9 to 26, unless motivated by your doctor)

F

9-26

Vaccines

Prevention of cervical cancer caused by HPV

Flu Vaccine
(1 vaccine and 1 consultation per beneficiary per year)

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)

Pneumococcal Vaccine
(1 vaccine and 1 consultation per year per beneficiary over the age of 55)

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
Consultation

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

  • Cholesterol
  • Glucose
  • Thyroid

F/M

All

Pathology

Early detection of chronic illness

Prostate check (blood test)

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

  • Cholesterol
  • Blood glucose (Sugar)
  • BMI
  • Blood pressure

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

Benefit Category

Purpose

Eyesight check
Including Glaucoma screening

F/M

40+

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

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

Immunisation children
As recommended by the Department of Health, GP or paediatrician

F/M

As per schedule

Member savings

Prevention and reduction of complications of childhood diseases

Baby and child
Paediatric assessment

F/M

Baby/Child

Member savings

Early detection of developmental problems

Senior members
Home nursing assessment on
Doctor or Scheme request

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

*recommended age unless you have specific risk factors
**co-payments may apply in hospital

Refer to the relevant benefit category for more detail

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