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
  • Beneficiary 40 years and older
    or clinically indicated (high risk members).
  • Once every 2 years.
 1 of the following tariff codes will be allowed: 3605;
34100/01		 1 per beneficiary per year
Bone Density scan (DEXA) One per female beneficiary (over 65 years) every two years.
One per male beneficiary (over 70 years)
  • 3604
  • 39173
  • 50120
 1 per beneficiary per year
Colorectal Screening 50 years and older or family history
Faecal Occult blood annually
  • 4351
  • 4352
 1 per beneficiary per year
HIV Finger-prick Screening Test Tariff code
  • 4614
 1 per beneficiary per year
(if this test shows a positive reading, then all subsequent tests will be paid for from the PMB HIV benefit)
HPV Vaccine One regimen of HPV Vaccination per lifetime
Must be administered before onset of sexual activity		 For beneficiaries (Male and Female) 9-26 years of age
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 R380 per beneficiary per year

Subject to Scheme protocols		 Limited to R380 per beneficiary per year
Prostate-specific antigen (PSA) testing The following tariff code will be allowed: 4519 1 per beneficiary per year
Pneumococcal vaccine Subject to the following criteria:
  • Over 65 years
  • Patients diagnosed with:
    • Cancer
    • Asthma
    • Chronic obstructive pulmonary disease (COPD)
    • Cardiac failure
    • HIV
  • Subject to the pneumococcal vaccine formulary
 1 per beneficiary per year
Human papillomavirus (HPV) vaccine Subject to the HPV vaccine formulary 1 per beneficiary per year