Preventative Care Benefits
All AMS members have access to Preventative Care Benefits, which cover a range of preventive tests and health assessments.
These tests are important because they enable the early detection of potential medical conditions, giving you a better chance of maintaining good health and overall well-being.
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.
You have cover for a wellness check including:
Blood glucose
Cholesterol
Blood pressure
Body Mass Index (BMI)
Other screening tests included in the Preventive care benefit, subject to the applicable benefits of your plan, may include:
Mammogram
Breast Cancer screening (Females)
Value Care Plan: One mammogram, age 40 +
Authorisation required
Standard Care and Managed Care Plans: Scheme to pay at 100% of the SRR.
Authorisation not required
Pap smear (Females)
Benefit description: Histology test only
Value Care Plan: One test per beneficiary. Subject to approved tests and protocol at a Prime Cure facility.
Standard Care and Managed Care Plans: Scheme to pay at 100% of the SRR. One test per beneficiary -per year unless motivated by a doctor.
Prostate Specific Antigen (PSA) (Males 50 years and older)
Benefit description: Pathology test
Value Care Plan: Subject to approved tests and protocol at a Prime Cure facility.
Standard Care and Managed Care Plans: Scheme to pay one PSA screening test per year at 100% of SRR.
Colorectal cancer screening
Benefit description: Faecal occult blood test (FOBT)
Value Care Plan: To be provided at Prime Cure Network facilities contracted for endoscopic procedures. Subject to the Family Hospital Limit.
Standard Care and Managed Care Plans: Scheme to pay one FOBT at 100% of the SRR every two years, for members aged 50 to 75. Additional screening in the form of colonoscopy will be made available for high-risk members or those with a positive faecal occult blood test.
Brittle bone screening
Benefit description: Bone Densitometry
Value Care Plan: Subject to approved tests and protocol at a Prime Cure facility, subject to Specialised Radiology Limit of R23 620 per family and the Family Hospital Limit.
Authorisation required
Standard Care and Managed Care Plans: Scheme to pay at 100% of the SRR.
Authorisation and referral required.
Additional scans must meet clinical criteria for it to be authorised.
Preventative care benefits per plan
Please click on your plan below to view the full list of 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. The following table describes the preventative care measures and explains from which benefit category they will be funded.
|
Description |
Sex |
Age* |
Benefit Category |
Purpose |
|
Contraceptives |
F |
All |
Contraceptive medicine |
Prevention of unintended pregnancies and promotion of reproductive health |
|
Dental check and preventative treatment |
F/M |
All |
Dental benefits |
Early detection of dental disease and preservation of dentine |
|
Endoscopies |
F/M |
All |
Endoscopies |
Detection and treatment of early signs of gastrointestinal diseases, including cancers |
|
Eyesight check |
F/M |
All |
Eye care benefits |
Early detection of eye disease or deterioration |
|
Gynaecological check |
F |
All |
GP consultations or specialist consultations |
Early detection and management of reproductive health issues, including cancers and infections |
|
Hearing test |
F/M |
All |
Allied / auxiliary health services out of hospital |
Early detection of signs of hearing loss and related conditions |
|
HIV screening/test |
F/M |
All |
HIV screening/test |
Early detection of HIV, timely treatment and reduction of the spread of the virus |
|
Mammogram |
F |
40+ |
Radiology: Mammogram |
Early detection of breast cancer |
|
Prostate check |
M |
All |
Pathology: Cancer Screening |
Early detection of prostate cancer |
|
Pap Smear |
F |
All |
Pathology: Cancer Screening |
Early detection of cervical cancer |
|
Skin test |
F/M |
All |
Specialist consultations out of hospital |
Detection of skin cancer |
|
Maternity care Consultations Ultrasounds Vitamins |
F |
All |
Maternity |
Monitoring of your pregnancy and prevention of complications
|
|
Immunisation - Influenza (Flu) |
F/M |
All |
Flu Vaccine |
Influenza prevention; particularly important for people who are at risk of serious complications from influenza (chronic conditions, pregnant, HIV patients or ageing members) |
|
Immunisation - COVID-19 |
F/M |
All |
COVID-19 Vaccine |
Prevention of severe illness and death |
|
F/M |
All |
Wellness screening at Dis-Chem or Clicks pharmacies |
Early detection of chronic illness |
|
Nurse practitioner consultation |
F/M |
All |
Nurse practitioner consultation |
Consultation for early detection of disease. Performed at Pime Cure contracted network pharmacy wellness clinic |
|
GP consultations |
F/M |
All |
GP Consultations network and non-network |
Consultation for early detection of disease |
|
Virtual consultations |
F/M |
All |
Virtual consultations |
Consultation for early detection of disease at Prime Cure Virtual clinics |
*recommended age unless you have specific risk factors.
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.
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 |
|
1 faecal occult blood test every 2 years) |
F/M |
50+ |
Pathology |
Early detection of colorectal cancer |
|
Childhood vaccines |
F/M |
0-12 |
Vaccines |
Early detection and reduction of childhood diseases |
|
HIV screening/test |
F/M |
All |
HIV Care Management Programme |
Early detection of HIV |
|
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): |
F/M |
9-26 |
Vaccines |
Prevention of cervical cancer caused by HPV |
|
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 |
|
|
Newborn screening for metabolic disorders |
F/M |
2 - 3 days |
Pathology |
Early detection of metabolic disorders that can interfere with your baby's development |
|
Pap smear |
F |
All |
Pathology: 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 |
**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.
If you are admitted to hospital specifically for an endoscopy, you will have to pay a co-payment of R3 960.
The following preventative care measures are recommended and will be paid from your Out of Hospital Family Limit or 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 |
F/M |
40+ |
Eye Care benefit |
Early detection of eye disease or deterioration |
|
Dental check-up at a DSP |
F/M |
All |
Basic Dental benefit |
Early detection of dental disease and preservation of dentine |
|
Glaucoma screening |
F/M |
All |
Out of Hospital Services Sublimit 2 |
Early detection of glaucoma |
|
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 |
|
Baby and child |
F/M |
Baby/Child |
Out of hospital services |
Early detection of developmental problems |
|
Pathology screening
|
F/M |
All |
Pathology Out of hospital benefit |
Early detection of chronic illness |
|
Prostate check-up (examination) |
M |
50+ |
Out of hospital services |
Early detection of prostate cancer |
|
Senior members |
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 |
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.
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.
The below preventative care benefits are paid by the Scheme (not from your normal benefits) at the Scheme Reimbursement Rate.
|
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 |
|
1 faecal occult blood test every 2 years |
F/M |
50+ |
Pathology |
Early detection of colorectal 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 DoH# 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 |
|
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 |
|
|
Newborn screening for metabolic disorders |
F/M |
2 - 3 days |
Pathology |
Early detection of metabolic disorders that can interfere with your baby's development. |
|
Pap smear |
F |
All |
Pathology |
Early detection of cervical cancer |
|
Pathology screening
|
F/M |
All |
Pathology |
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 |
**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 950.
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 |
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 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
Mental Health Care
Your mental wellbeing matters. AMS offers a Mental Health Care Programme for members diagnosed with Major Depression. Access to the programme requires enrolment by your Premier Plus GP or a psychologist within the Scheme's mental health network.
This programme gives you and your healthcare provider access to tools and benefits to monitor and manage your condition and ensure you get high quality coordinated healthcare and the best outcomes.