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Preventative screening

 

Preventative care and screening benefit

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 contained herein. This means that day to day benefits will not be affected.

From 1 January 2021 an additional benefit for vaccinations has been made available on all GEMS Options. A limit of R750 per beneficiary per year applies and funding is allowed for Practice types 14, 15, 60, 61, 63, 110 and Specialists. Tariffs codes 0017 should be used for pharmacy administration and 0022 for GP administration.

The tables below list the benefits available from General Practitioners and Pharmacies.

 

 

 



 SCREENING SERVICES 

Procedure

Frequency

Eligible beneficiaries

Blood Pressure Monitoring

Once per annum

All beneficiaries 18 years and older

Cholesterol Screening

Once per annum

20 years and older

Osteoporosis Screening (Bone Densitometry Scan)

 

Once per annum

Females 65 years and older

Cytology Screening (Pap smears)

Once per annum

Females 12-65 years

HIV / AIDS pre-test counselling with no test

  Once per annum

All beneficiaries

HIV / AIDS (Screening test, post-test counselling, confirmatory test and condoms)

 

  Once per annum

 

All beneficiaries

 

  Mammography Screening

 

  Once per annum

Females 40 years and older (earlier?)

  Peak Flow Measurement

  Once per annum

Beneficiaries 4 years and older

  Pregnancy Screening Test

  Once per annum

FEMALES only

  Prostate Screening (PSA)

  Once per annum

Males 45-69 years

  Faecal Occult blood test

  Once per annum

50-75 years

  Glucose Screening

  Once per annum

20 years and older

  Glaucoma Screening

 Once per annum

40 years and older

  Neonatal Hypothyroidism

  Single Screening

Up to 28 days old

  Childhood Hearing Screening   

  Once per beneficiary

≥1 –7 years

 

  Childhood Hearing Screening for infants

 

  Once per beneficiary

 Birth - from 3 months to 1 year

 

  Childhood Optometry Screening

 

  Once per beneficiary

 Birth - from 3 months to 7 years

 

  Syphilis Screening

Once per beneficiary per annum

 

All beneficiaries

 

  Chlamydia / Gonorrhoea Screening

Once per beneficiary per annum

 

All beneficiaries

 

  TB Screening

Once per beneficiary per annum

 

All beneficiaries

 

  Urine Analysis

Once per beneficiary

per annum

All beneficiaries

                                                                                                      VACCINATION SERVICES

  Vaccine

  Frequency

  Eligible beneficiaries

 

  Influenza vaccination 

 

  Once per annum

All beneficiaries ≥6 months of age#

 

 

  Pneumococcal vaccination

 

 

  Once every 5 years

  High risk beneficiaries:

  ≥65 years

2-64 years with a chronic registration / relevant hospital admission*

 

  HPV vaccination (1 course = 3 doses)

One course per beneficiary per lifetime

 

  Females 9-14 years

 

 

 

 

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