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 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.
|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|
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|
(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)|
(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|
|F||Maternity||Monitoring of your pregnancy and prevention of complications|
|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|
||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.
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
|Early detection of cancer and gynaecological problems|
|Hearing test||F/M||ALL||Out of hospital services
|Early detection of medical conditions and hearing dysfunction|
|HIV test||F/M||All||Pathology Out of hospital
|Early detection of HIV/AIDS|
As recommended by the Department of Health, GP or paediatrician
|F/M||As per schedule||Out of hospital services
|Prevention and reduction of complications of childhood diseases|
|Baby and child
|F/M||Baby/Child||Out of hospital services
|Early detection of developmental problems|
|Pathology screening •Cholesterol •Glucose •Thyroid||F/M||All||Pathology Out of hospital benefit
|Early detection of chronic illness|
Home nursing assessment on
Doctor or Scheme request
|F/M||65+||Out of hospital services
|Detection of complications or mobility problems negatively impacting on wellbeing or illness|
|Podiatry Care||F/M||All||Out of hospital services
|Skin health||F/M||All||Out of hospital services benefit
|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.