Preventative health screening is one of the most important healthcare strategies to facilitate early diagnosis and treatment of disease as well as to improve quality of life and prevent premature death. GEMS offers comprehensive screening and preventative care benefits to its members. These benefits are available on all options and payable from the risk benefit for eligible members and beneficiaries as per criteria.
A separate limit of R863 per beneficiary per year applies for vaccinations not listed in the table below.
Funding is allowed for Practice types 14, 15, 60, 61, 63, 110 and Specialists. Tariff codes 0017 should be used for pharmacy administration and 0022 for GP administration.
The tables below indicate the preventative care and screening services at pharmacies and selected providers.
SCREENING SERVICES | ||
---|---|---|
Procedure |
Frequency |
Eligible beneficiaries |
Blood Pressure Monitoring |
Once per benefit year |
Beneficiaries 18 years and older |
Cholesterol Screening |
Once per benefit year |
Beneficiaries 20 years and older |
Osteoporosis Screening (Bone Densitometry Scan) |
Once per benefit year |
Female beneficiaries 65 years and older |
Cytology Screening (Pap smears) |
Once per benefit year |
Female beneficiaries12 - 65 years |
HIV / AIDS pre-test counselling with no test |
Once per benefit year |
All beneficiaries |
HIV / AIDS (Screening test, post-test counselling, confirmatory test and condoms) |
Once per benefit year |
All beneficiaries |
Mammography Screening |
Once per benefit year |
Female beneficiaries 40 years and older |
Peak Flow Measurement |
Once per benefit year |
Beneficiaries 4 years and older |
Pregnancy Screening Test |
Once per benefit year |
Female beneficiaries 12 years and older |
Prostate Screening (PSA) |
Once per benefit year |
Male beneficiaries 45 - 69 years |
Faecal Occult blood test |
Once per benefit year |
Beneficiaries 50 - 75 years |
Glucose Screening |
Once per benefit year |
Beneficiaries 20 years and older |
Glaucoma Screening |
Once per benefit year |
Beneficiaries 40 years and older |
Neonatal Hypothyroidism |
Once per beneficiary |
Neonatal beneficiaries up to 28 days old |
Childhood Hearing Screening |
Once per beneficiary |
Beneficiaries from 1 year up to and including 7 years |
Childhood Hearing Screening for infants |
Once per beneficiary |
Beneficiaries from 3 months to 7 years |
Childhood Optometry Screening |
Once per beneficiary |
Beneficiaries from 3 months to 7 years |
Syphilis Screening |
Once per benefit year |
All beneficiaries |
Chlamydia / Gonorrhoea Screening |
Once per benefit year |
All beneficiaries |
TB Screening |
Once per benefit year |
All beneficiaries |
Urine Analysis |
Once per benefit year |
All beneficiaries |
VACCINATION SERVICES |
||
Vaccine |
Frequency |
Eligible beneficiaries |
Influenza vaccination |
Once per benefit year |
All beneficiaries from 6 months and older |
Pneumococcal vaccination |
Once every 5 years |
|
HPV vaccination (1 course = 3 doses) |
One course per beneficiary per lifetime |
Female beneficiaries:
|
If you have any further queries regarding this, kindly contact us on 0860 00 4367, fax us on 0861 00 4367 or send an email to enquiries@gems.gov.za