Provider Portal - Benefit summaries - Fishmed

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View the benefits, health management programmes and chronic conditions covered by your patient’s medical scheme and option.

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Benefit summaries
Out-of-hospital benefits	Annual benefits for day-to-day medical services. Read more
In-hospital benefits	Annual benefits for hospitalisation and other major medical services. Treatment at State facility only; UPFS rates applicable. No private hospital cover. Read more
Preventative care procedures (out of hospital)	Consultations and/or any other costs incurred at the time of the visit will be paid from the member’s benefits, as specified in the rules of the Scheme. Once the preventative benefit limits have been reached, tests will be paid from the applicable benefit limit. Read more

Benefit summaries

Out-of-hospital benefits

Annual benefits for day-to-day medical services.

In-hospital benefits

Annual benefits for hospitalisation and other major medical services. Treatment at State facility only; UPFS rates applicable. No private hospital cover.

Preventative care procedures (out of hospital)

Consultations and/or any other costs incurred at the time of the visit will be paid from the member’s benefits, as specified in the rules of the Scheme. Once the preventative benefit limits have been reached, tests will be paid from the applicable benefit limit.

Healthcare programmes Members need to register on health management programmes to gain access to the benefits outlined below.
Medicine risk management programme	The Medicine Risk Management (MRM) Programme is dedicated to managing chronic medication use in a manner that is beneficial to the health of members and to ensure quality care through integrated healthcare and holistic patient management. Members need to register on the Medicine Risk Management Programme and get approval for chronic medication to be paid from the chronic benefit. To register a member, send the completed application form and all supporting documents by email to [email protected]. Application for chronic medication (Medicine Risk Management). Read more
Maternity programme	The Maternity Programme is specifically designed to give members access to support, education and advice from experts, through all stages of their pregnancy, confinement and even after the baby is born. To access benefits members must be registered on the Maternity Programme. The designated service provider for in-hospital maternity treatment for Primary Option members is the State; UPFS rates apply. Members can register on the Maternity Programme by calling 0861 888 109 or by sending an email to [email protected]. Read more
Palliative care programme	Fishmed has partnered with Momentum Health Solutions, the Scheme’s healthcare administrator, to provide members with access to a Palliative Care Programme. Palliative Care Programme application form. Read more

Healthcare programmes Members need to register on health management programmes to gain access to the benefits outlined below.

Medicine risk management programme

The Medicine Risk Management (MRM) Programme is dedicated to managing chronic medication use in a manner that is beneficial to the health of members and to ensure quality care through integrated healthcare and holistic patient management.

Members need to register on the Medicine Risk Management Programme and get approval for chronic medication to be paid from the chronic benefit.

To register a member, send the completed application form and all supporting documents by email to [email protected].

Application for chronic medication (Medicine Risk Management).

Maternity programme

The Maternity Programme is specifically designed to give members access to support, education and advice from experts, through all stages of their pregnancy, confinement and even after the baby is born.

To access benefits members must be registered on the Maternity Programme.

The designated service provider for in-hospital maternity treatment for Primary Option members is the State; UPFS rates apply.

Members can register on the Maternity Programme by calling 0861 888 109 or by sending an email to [email protected].

Palliative care programme

Fishmed has partnered with Momentum Health Solutions, the Scheme’s healthcare administrator, to provide members with access to a Palliative Care Programme.

Palliative Care Programme application form.

Chronic condition lists
Prescribed minimum benefits (PMB)	Fishing Industry Medical Scheme - Integrated Care Programme

Resources for you and your patient

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Resources for you and your patient

Momentum Carecross GP Guide

Health4Me network GP patient education pad

Health4Me network GP IVR flow diagram