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 benefits |
Day-to-day medical expenses are everyday medical expenses such as, claims for GP consultations, dentist visits, optical visits, etc. Day-to-day medical expenses on the Comprehensive Option are subject to the member’s Medical Savings Account (MSA), which covers non-PMB, out-of-hospital claims for GPs, dentists, specialists, medication, optometrists, etc. |
| Hospitalisation benefits |
Pre-authorisation must be obtained for any non-emergency hospital admission and related treatment by calling 0800 118 666. Major medical expenses benefit consists out of three categories:
|
| Maternity benefits |
Subject to pre-authorisation and registration within the first 16 weeks of pregnancy. Members must register their pregnancy by calling the pre-authorisation department. This will ensure that maternity claims are paid correctly. For pre-authorisation, Comprehensive Option members must call 0800 118 666. |
| Preventative testing benefits |
Test: Paid from Major Medical Expenses Benefit. |
| Chronic care benefits |
Members on the Saver Option will be required to register on the Chronic Medication Risk Management Programme to ensure that their PMB chronic medication is approved. Please call 0802 228 922 to register on the Chronic Medication Risk Management Programme. |
| HIV (YourLife programme) |
The Wooltru Healthcare Fund 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. To register on the YourLife Programme, call 0860 109 793 or click here for more information. |
| Healthcare programmes Members need to register on health management programmes to gain access to the benefits outlined below. | |
|---|---|
| HomeCare+ |
Wooltru Healthcare Fund provides members with a programme called HomeCare+, which ensures early identification and management of beneficiaries with multiple conditions. |
| Chronic medication risk management |
The programme is dedicated to managing the use of chronic medication in a way that is beneficial to the health of members ensuring quality care through integrated healthcare and holistic patient management. |
| HIV (YourLife programme) |
The Wooltru Healthcare Fund 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. To register on the HIV YourLife Programme, call 0860 109 793 or click here for more information. |
| Oncology risk management programme |
The Wooltru Healthcare Fund has contracted with Momentum Health Solutions to provide an Oncology Risk Management Programme for the benefit of members who have been diagnosed with cancer. |
| Chronic condition lists | |
|---|---|
| Prescribed minimum benefits (PMB) |
Wooltru Healthcare Fund - Prescribed Minimum Benefitsopen_in_new |