Plus Option

Plus Option Benefits Preventative Procedures

Preventative Procedures

  • 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:

    • the consultation fee for a dental check-up/oral hygienist
    • the actual injection for the flu vaccine
    • the actual testing of cholesterol and pap smears
    • the mammogram itself.

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

Benefits Description
Flu vaccine injection
1 per beneficiary per year
Cholesterol testing 1 of the following tariff codes will be allowed: 4025/6/7/8; 4170 1 per beneficiary per year
Baby and childhood vaccinations Subject to the baby and childhood vaccine formulary 100% of formulary
Pap smear The following tariff codes will be allowed: 4566 and 4599 1 per beneficiary per year
Mammogram 1 of the following tariff codes will be allowed: 3605;
34100/01/10/20/30/50; 34300		 1 per beneficiary per year
Preventative health screenings:
  • Blood pressure screening
  • Blood glucose finger-prick test
  • Cholesterol finger-prick test
  • Body mass index (BMI)
 These screening tests may be done at any clinic or pharmacy on the Scheme's pharmacy network limited to R362 per beneficiary per year

Subject to Scheme protocols		 Limited to R362 per beneficiary per year
Prostate-specific antigen (PSA) testing The following tariff code will be allowed: 4519 1 per beneficiary per year
Pneumococcal vaccine

(Pneumovax only)		 Subject to the following criteria:
  • Over 65 years
  • Patients diagnosed with:
    • ‐ Cancer
    • ‐ Asthma
    • ‐ Chronic obstructive pulmonary disease (COPD)
    • ‐ Cardiac failure
    • ‐ HIV
 1 per beneficiary per year