Members and their dependants are entitled to Day-to-day benefits, subject to the provisions of the rules of the Scheme, and in particular the provisions of the statutory Prescribed Minimum Benefits (PMBs).

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Benefits for admission to a private hospital are subject to the utilisation of DSP hospitals appointed by the Scheme.
Admissions are subject to pre-authorisation with the Scheme’s managed care provider two working days prior to admission and within 48 hours of the incident in the case of emergencies.

Please call 0860 767 633 or email [email protected] to obtain pre-authorisation for admission to hospital.

Members can request pre-authorisation on the Pick n Pay Medical Scheme mobile app.

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Members and their dependants are entitled to Day-to-day benefits, subject to the provisions of the rules of the Scheme, and in particular the provisions of the statutory Prescribed Minimum Benefits (PMBs).

Members must be registered on the Maternity Programme to access benefits for antenatal care.

Please call 0860 767 633 or email [email protected] to register a member on the Maternity Programme.

Members can register on the Maternity Programme on the Pick n Pay Medical Scheme mobile app.

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List of preventative procedures covered from insured benefit.

Please be advised that these preventative procedures do not include all the costs incurred at the time of the procedure, but only to those specified, i.e.:

• checkFlu vaccine.
• checkCholesterol testing.
• checkBaby and childhood vaccinations.
• checkPap smear.
• checkMammogram.

Preventative health screenings:

• checkBlood pressure screening.
• checkBlood glucose finger-prick test.
• checkCholesterol finger-prick test.
• checkBody mass index (BMI).
• checkProstate-specific antigen (PSA) testing.
• checkPneumococcal vaccine (Pneumovax only).

Any other costs incurred at the time of the visit will be paid from the members Medical Spending Account (MSA) balance or as otherwise specified in the rules.

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Chronic care benefits are subject to the provisions of the rules of the Scheme, and in particular the provisions of the statutory Prescribed Minimum Benefits (PMBs).

Members' treating doctors or pharmacists must call 0860 767 633 for approval of medicines.

All chronic conditions covered, subject to registration on the Scheme's Medicine Risk Management Programme and approval of treatment protocols, except in respect of diabetes types 1 and 2.

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Members and their dependants are entitled to the following benefits, subject to the provisions of the rules of the Scheme, and in particular the provisions of the statutory Prescribed Minimum Benefits (PMBs).

To register on the YourLife Programme, call 0860 767 633.

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The Integrated Care Programme identifies beneficiaries who have respiratory, cardiovascular system, diabetic, renal (kidney) and mental health conditions.

Upon identifying the beneficiary, they are automatically enrolled on the programme to assist with management of their condition(s). Once enrolled, they will receive an individual treatment plan to manage your condition(s).

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

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The Oncology Programme is specifically designed to actively empower our cancer patients. Participants on this programme generally have a more positive attitude and approach to treating their condition and improving their general wellbeing. This positive attitude often translates into improved treatment compliance and a healthier lifestyle, which can make a real difference in the way patients respond to treatment and their general quality of life.

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

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The Medicine Risk Management (MRM) Programme was established to provide a service to patients who require treatment for their chronic medical conditions. The MRM Programme is dedicated to managing chronic medication usage and ensuring quality care through integrated healthcare and holistic patient management.

For authorisation please call 0860 767 633.

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The Scheme has contracted with Momentum Health Solutions to provide the YourLife Programme for the benefit of members who are at risk of being HIV positive or have been diagnosed as a person living with HIV/AIDS. The YourLife Programme ensures absolute confidentiality and motivates participating members to manage their condition appropriately.

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