Provider Portal - Benefit summaries - Transmed - Prime plan

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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
Day-to-day benefits	Day-to-day service (except for services covered on an authorised PMB treatment plan), are payable by the member. Read more
Major medical benefis	Prime Plan providers hospital benefis for both PMB only, with the Transmed private hospital network as DSP for hospital services. Transmed Prime Plan private hospital network Read more
Chronic medication benefits	Paid at the Transmed rate according to the PMB medicine formulary. Reference pricing applies. Subject to pre-authorisation and registration on the Chronic Medicine Management Programme. To register a member on the programme call 0800 122 263 or email the Chronic Medicine Risk Management Programme application to [email protected] Network Pharmacies Read more
Preventative care benefits	Preventative care benefits must be obtained from Transmed pharmacy network. Preventative Care Benefits: Contraceptive benefit. Flu vaccinations. Human papillomavirus (HPV) vaccination. Pneumococcal vaccination Childhood immunisation. Circumcision (out of hospital/in doctor's rooms). Any other major medical event. Network Pharmacies Read more
Early detection benefits	Screening tests covered under the Early Detection enefits: Health-check benefit. Cholesterol (finger prick) Glucose (finger prick) - diabetes mellitus Blood pressure Body mass index Total cholesterol (lipogram) - high cholesterol. Glucose (finger prick) - diabetes mellitus. Prostate-specific antigen (PSA) level - prostate cancer. Pap smear - cervical cancer. Mammogram - breast cancer. Quantitative polymerase chain reaction (qPCR) - HIV (newborns). Read more

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]. Read more
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] Network Pharmacies Read more
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 Read more
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 Read more

Chronic condition lists
Prescribed minimum benefits (PMB)	Transmed - Chronic condition list

Resources for you and your patient

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