Select a scheme and option
View the benefits, health management programmes and chronic conditions covered by your patient’s medical scheme and option.
| Benefit summaries | |
|---|---|
| Day-to-day benefis |
Optical and dental service are paid for from the respective dental and optical benefis. All other day-to-day services (except for service covered on an authorised PMB treatment plan), are paid for from the day-to-day limit. Members may use any registered healthcare or service provider of their choice, except for optical and dental services, which are managed by the contracted providers. |
| Major medical benefis |
Major medical benefits for treatment of PMB and non-PMB conditions in hospital will be covered in full if the treatment is obtained at a State hospital. The Transmed private hospital network is the secondary DSP. This network is only available for emergency or involuntary admissions for PMB conditions where a State hospital is not accessible. Pre-authorisation, where necessary, can be obtained 24 hours a day and on weekends and public holidays, by calling 0800 225 151. |
| Chronic medication benefits |
The Transmed pharmacy network is the DSP. Comprehensive formulary applies. Reference pricing applies. To register a member on the programme call 0800 122 263 or email the Chronic Medicine Risk Management Programme application to [email protected] |
| Preventative care benefits |
The Transmed pharmacy network is the designated service provider. Preventative Care Benefits:
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| Healthcare programmes Members need to register on health management programmes to gain access to the benefits outlined below. | |
|---|---|
| HIV (YourLife programme) |
The YourLife Programme assists people living with HIV/AIDS to access quality care and make optimal use of the benefits available to them. This programme is available to members on the Select, Prime and Guardian Plans. For registration on the YourLife Programme, please call 0860 109 793 or email [email protected]. |
| Chronic medication management programme |
The Chronic 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. To register a member on the programme call 0800 122 263 or email the Chronic Medicine Risk Management Programme application to [email protected] |
| Oncology programme |
The Oncology Risk Management Programme is specifically designated 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, call 0800 225 151 or, email [email protected] For Link Plan call 0861 686 278 |
| Maternity programme |
The Maternity Programme is specifically designated to actively empower and provide knowledge for a safe and healthy pregnancy and delivery. To access your maternity benefits, pregnant members or dependants must register on the programme as soon as their pregnacy is confirmed. Members can call 0800 225 151 to register on the programme |
| Chronic condition lists | |
|---|---|
| Prescribed minimum benefits (PMB) | |