General Practitioners (GPs) and Specialists – out of hospital (annual limits are calculated as a family benefit and can be used by any beneficiary).

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Pre-authorisation must be obtained from the Scheme at least 48 hours prior to the admission date to hospital or, within 48 hours of an emergency admittance for the following events:

• checkHospitalisation.
• checkAdmission for mental health and drug or alcohol dependency.
• checkConfinements (birth of baby).
• checkCT, MRI and radio-isotope scans.
• checkOrgan transplants.
• checkCancer medication and related treatment.
• checkAny other major medical event.

Failure to obtain hospital pre-authorisation will result in a R500 co-payment.

To obtain pre-authorisation please call 0860 467 374.

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Test covered under the Wellness and Preventative Benefit:

• check Health assessment:
     
• • Body mass index (BMI)
  • Finger-prick glucose test
  • Finger-prick cholesterol test
  • Blood pressure test
• checkVaccines.
• checkPap Smear.
• checkMammograms.
• checkProstate-specific Antigen Test (PSA).
• checkDexa Scan (Bone density).
• checkGlaucoma Screening.
• checkColorectal Cancer Screening (Faecal Occult Blood Test Only).

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Prescribed for PMB conditions only. Subject to the chronic medicine formulary only. A 10% Co-payment applies when using a non-formulary medicine. To access benefits, members must be registered on the Chronic Medication Management Programme.

Please call 0860 467 374 or email [email protected] to register a member on the programme. Click here to view the chronic reference price formulary.

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The YourLife Programme assists people living with HIV/AIDS to access quality care and to make optimal use of the benefits available to them.

For registration on the YourLife Programme, please call 0860 109 793 or email [email protected].

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The Oncology Risk Management Programme is specifically designed to effectively manage cancer patients. The primary function of the Programme is to pre-authorise oncology treatment and to interact with oncologists regarding treatment plans for cancer patients. The Programme includes member education, the promotion of wellness and pre-authorisation which grants access to medicine and hospital benefits.

For registration on the Oncology Risk Management Programme, please call 0860 467 374 or email [email protected].

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The Programme is specifically designed to actively empower and provide knowledge about a safe and healthy pregnancy and delivery, providing essential tools to ensure the best possible care.

To access benefits, members must register on the Maternity Programme by calling 0860 467 374 or email [email protected].

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The Chronic Medication Management Programme is dedicated to managing chronic medication use in a way that is beneficial to the health of members.

Please call 0860 467 374 or email [email protected] to register on the programme.

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