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 facility on the network, 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 or on this list.
If you are admitted to hospital specifically for an endoscopy, you will have to pay a co-payment of R3 615.
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 beneficiaries from age 9 to 26, unless motivated by your doctor) |
F/M | 9-26 | Vaccines | Prevention of cervical cancer caused by HPV |
| Covid-19 vaccine | F/M | As per Department of Health Schedule | Vaccines | Prevention of severe disease and death caused by Covid-19 |
| 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 test | F | 21-65 | Pathology: Cancer Screening, Pap smear | Early detection of cervical cancer |
| Prostate check (blood test) | M | 50+ | Pathology | Early detection of prostate cancer |
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 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
|
F/M | All | Pathology Out of hospital benefit (non-PMB) |
Early detection of chronic illness |
| Prostate check-up (examination) | M | 50+ | Out of hospital services Sublimit 2 |
Early detection of prostate cancer |
| 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 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.