Wellness Benefits
- Vaccinations
Baby immunisation programme
Covered for the first six years of a child's life
Subject to the Baby and child vaccine formularyinfo As required by the Department of Health
100%
of Scheme rateFlu vaccinations
info Once a year for all beneficiaries
ICD-10 code Z25.1100%
of Scheme rateTetanus diphtheria booster
info All beneficiaries, as needed
ICD-10 code Z23.5100%
of Scheme ratePneumococcal vaccinations
info As needed for beneficiaries 60 years and older, and high-risk beneficiaries
ICD-10 code Z23.8Subject to the pneumococcal vaccine formulary
100%
of Scheme rate - Early detection and screening
General physical examination (in GP's rooms)
Tariff codes 190 - 192
Tariff code 4188 - urine dipstick testinfo One medical examination every five years for adult beneficiaries 21 to 29 years old
One medical examination every three years for adult beneficiaries 30 to 59 years old
One medical examination every two years for adult beneficiaries 60 to 69 years old
One medical examination every year for adult beneficiaries 70 years and older
ICD-10 code Z0.00100%
of Scheme rateCholesterol test (Pathologist)
Tariff codes 4025, 4026 and 4147
info Once a year for adult beneficiaries
ICD-10 code Z13.6100%
of Scheme ratePap smear consultation (GP/Gynaecologist)
Tariff codes 0190, 0191 and 0192
info Once a year for female beneficiaries 15 years and older
ICD-10 code Z01.4100%
of Scheme ratePap smear test
Tariff code 4566
info Once a year for female beneficiaries 15 years and older
ICD-10 code Z01.4100%
of Scheme rateDEXA bone density scan (Radiologist)
Tariff code 50120
ORwarning Once every three years for beneficiaries 50 years and older
ICD-10 code Z01.6DEXA bone density scan (GP/Gynaecologist)
Tariff code 3604
warning Once every three years for beneficiaries 50 years and older
ICD-10 code Z01.6100%
of Scheme rateColorectal screening test (Pathologist)
Tariff code 4352
info Once a year for beneficiaries 40 years and older
100%
of Scheme rateFull blood count (FBC)
Tariff code 3755
info All adult beneficiaries, as needed
100%
of Scheme rateErythrocyte sedimentation rate (ESR)
Tariff code 3743
info All adult beneficiaries, as needed
100%
of Scheme rateUrea, creatine and electrolytes
Tariff code 4032 and 4171
info All adult beneficiaries, as needed
100%
of Scheme rateUric acid
Tariff code 4155
info All adult beneficiaries, as needed
100%
of Scheme rateGamma-glutamyl transferase (GGT)
Tariff code 4134
info All adult beneficiaries, as needed
100%
of Scheme rateFasting glucose
Tariff code 4057
info All adult beneficiaries, as needed
100%
of Scheme rateChest X-ray: Lung cancer detection
Tariff codes 30100 and 30110
info Once a year for all adult beneficiaries
- 55 to 74 years old
- who are current/former smokers (i.e. who quit smoking within the past 15 years)
- with at least a 30 pack-day smoking history and with no history of lung cancer
ICD-10 code Z01.6100%
of Scheme rateProstate-specific antigen (PSA) test
Tariff codes 4519 and 4524
info Once every three years for male beneficiaries 40 to 49 years old
Once a year for male beneficiaries 50 years and older100%
of Scheme rateHuman papillomavirus (HPV) vaccine
NAPPI codes 00710020001, 00710249001, 00710249002 and 03006049001
info One treatment (two doses) in a lifetime for male and female beneficiaries
Male beneficiaries 9 to 18 years old
Female beneficiaries 9 to 26 years old
A third dose may be considered for high-risk women up to 45 years old, based on motivation from their treating doctor
Subject to the human papillomavirus (HPV) vaccine formulary100%
of Scheme rateHealth assessments from a nurse or pharmacy clinic
Blood pressure measurement, finger-prick cholesterol test, finger-prick blood glucose (sugar) test, and body mass index (BMI) calculation through height, weight and waist circumference measurement
Tariff code 88001
NAPPI code 00711326001info Once a year for adult beneficiaries
ICD-10 code Z00.0100%
of Scheme rate - Additional tests covered at no cost to you
Cholesterol screening (Pathologist)
Tariff code 4027
info One every two years for adult beneficiaries
100%
of Scheme rateMammogram (Radiologist)
Tariff codes 34100 and 34101
info One every two years for female beneficiaries 40 years and older
Once a year for female beneficiaries with risk factors for breast cancer and where clinically indicated family history exists100%
of Scheme rateMammogram (GP/Gynaecologist)
Tariff code 3605
info One every two years for female beneficiaries 40 years and older
Once a year for female beneficiaries with risk factors for breast cancer and where clinically indicated family history exists100%
of Scheme rateGlaucoma screening
Tariff code 3014
info One screening every two years for adult beneficiaries 40 years and older
100%
of Scheme rateHIV test (Pathologist)
Tariff code 3932
info Once a year for beneficiaries 15 years and older
100%
of Scheme rate