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 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
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 beneficiary over the age of 55 per year)
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: Cancer Screening Early detection of cervical cancer
Prostate check (blood test) M 50+ Pathology Early detection of prostate cancer
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 Out Of Hospital Family Limit, other relevant benefit limit 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+ Eye Care benefit Early detection of eye disease or deterioration
Dental check-up F/M All Basic Dental benefit Early detection of dental disease and preservation of dentine
Gynaecological check-up F All Out of hospital services 

Sublimit 2
Early detection of cancer and gynaecological problems
Hearing test F/M ALL Out of hospital services
Sublimit 1
Early detection of medical conditions and hearing dysfunction
HIV test F/M All Pathology Out of hospital 
(non-PMB)
Early detection of HIV/AIDS
Immunisation children
As recommended by the Department of Health, GP or paediatrician
F/M As per schedule Out of hospital services
Sublimit 2
Prevention and reduction of complications of childhood diseases
Baby and child
Paediatric assessment
F/M Baby/Child Out of hospital services
Sublimit 2
Early detection of developmental problems
Pathology screening •Cholesterol •Glucose •Thyroid F/M All Pathology Out of hospital benefit
(non-PMB)
Early detection of chronic illness
Senior members
Home nursing assessment on
Doctor or Scheme request
F/M 65+ Out of hospital services
Sublimit 1
Detection of complications or mobility problems negatively impacting on wellbeing or illness
Podiatry Care F/M All Out of hospital services
Sublimit 1
Skin health F/M All Out of hospital services benefit
Sublimit 2
Detection of skin cancer
Stool test (cancer and other screening) F/M 50+ Pathology Out of hospital benefit (non-PMB): Detection of cancer and other diseases

*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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