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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.

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

  • All beneficiaries 65 years and older
  •  High risk beneficiaries between the ages of 2 and 64 with the relevant chronic or hospital admission

 

  HPV vaccination (1 course = 3 doses)

One course per beneficiary per lifetime

 

Female beneficiaries: 

  • Ages between 9 – 14 years of age: 1 course = 2 doses (Initial single dose, then follow-up dose to be given at 6 or 12 months) 
  • Ages between 15 – 45 years of age: 1 course = 3 doses (Initial single dose, then follow-up doses given at 2 and 6 months, respectively)  

 

 

 

 

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