Wellness and Preventative - Health Plan
- 1Screening tests
a Health Assessment
Body mass index (BMI)
Finger-prick glucose test
Finger-prick cholesterol test
Blood pressure testinfo One visit per beneficiary per annum
Major Medical Expenses100%
of Medical Scheme Rate
b HIV test
Finger-prick test
info One visit per beneficiary per annum
Major Medical Expenses100%
of Medical Scheme Rate - 2Vaccines
a Childhood vaccines
info Subject to the Scheme's baby and childhood vaccine formulary from birth to 12 years of age
Paid from Major Medical Expenses
Vaccines outside the formulary will be paid from the Acute Medicine limit100%
of Medical Scheme Rate
REQUIRED AGE VACCINE Birth Bacillus Calmette Guerin (TB) Vaccine
Oral Polio Vaccine6 Weeks Oral Polio Vaccine
Rotavirus Vaccine
Diphtheria, Tetanus, Pertussis, Polio, Haemophilus Influenzae Type B
Hepatitis B
Pneumococcal Conjugated Vaccine10 Weeks Diphtheria, Tetanus, Pertussis, Polio, Haemophilus Influenzae Type B
Hepatitis B14 Weeks Rotavirus Vaccine
Diphtheria, Tetanus, Pertussis, Polio, Haemophilus Influenzae Type B
Hepatitis B
Pneumococcal Conjugated Vaccine6 Months Measles 9 Months Pneumococcal Conjugated Vaccine 12 Months Measles 18 Months Diphtheria, Tetanus, Pertussis, Polio, Haemophilus Influenzae Type B 6 Years Tetanus Vaccine 12 Years Tetanus Vaccine
b Flu and pneumococcal vaccines
For patients diagnosed with the following conditions:
. oncology;
. asthma;
. COPD;
. cardiac failure;
. HIV; and
. patients over 65 yearsinfo One of each injection per enrolee per annum
Major Medical Expenses100%
of Medical Scheme Rate
cChildhood vaccine consultations
Day-to-Day GP/ Specialist benefit Limit
85%
of Medical Scheme Rate - 3Human papillomavirus (HPV) vaccine
1 Treatment in a lifetime
Paid from Major Medical Expenses
Two-dose for females between 9 and 26 years once in a life time
Two-dose for males between 9 and 18 years once in a life time100%
of Medical Scheme Rate - 4Pap Smear
1 Per female beneficiary per annum
Paid from Major Medical Expenses100%
Scheme Rate
paid from Major Medical Expenses(MME) - 5Mammograms
1 Every 2 years for females 38 years and older
Paid from Major Medical Expenses100%
of Medical Scheme Rate - 6Prostate-specific Antigen (PSA) Test
1 Every 3 years for males between 30 - 59 years
1 Every 2 years for males between 60 - 69 years
1 Every year for males 70 years and older
Paid from Major Medical Expenses100%
of Medical Scheme Rate - 7Dexa Scan (Bone density)
Limited to R1800 per scan, and subject to 1 scan every 3 years for beneficiaries 50 years and older
Paid from Major Medical Expenses100%
of Medical Scheme Rate - 8Glaucoma Screening
1 Every 2 years for beneficiaries between 40 and 49 years
1 Every year for beneficiaries 50 years and older
Paid from Major Medical Expenses100%
of Medical Scheme Rate - 9Colorectal Cancer Screening (Faecal Occult Blood Test Only)
1 Every year for beneficiaries 40 and older
Paid from Major Medical Expenses100%
of Medical Scheme Rate