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
At GEMS we believe that every one of our members matter. That is why we have prepared the member newsletter to focus on your specific needs.