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 - all beneficiaries
ICD-10 code Z25.1100%
of Scheme rateTetanus diphtheria booster
info As needed - all beneficiaries
ICD-10 code Z23.5100%
of Scheme ratePneumococcal vaccinations
info As needed - beneficiaries 60 years and older and high-risk beneficiaries
ICD-10 code Z23.8100%
of Scheme rate - Early detection and screening
General physical examination (in GP's rooms)
Tariff codes 190 - 192
Tariff code 4188 - urine dipstick testinfo Adults 21 to 29 years old - one medical examination every five years
Adults 30 to 59 years old - one medical examination every three years
Adults 60 to 69 years old - one medical examination every two years
Adults 70 years and older - one medical examination every year
ICD-10 code Z0.00100%
of Scheme rateCholesterol test (Pathologist)
Tariff codes 4025, 4026 and 4147
info Once a year - all adult beneficiaries
ICD-10 code Z13.6100%
of Scheme ratePap smear consultation (GP/Gynaecologist)
Tariff codes 0190, 0191 and 0192
info Once a year - females 15 years and older
ICD-10 code Z01.4100%
of Scheme ratePap smear test
Tariff code 4566
info Once a year - females 15 years and older
ICD-10 code Z01.4100%
of Scheme rateDEXA bone density scan (Radiologist)
Tariff code 50120
ORwarning Once every three years - beneficiaries 50 years and older
ICD-10 code Z01.6DEXA bone density scan (GP/Gynaecologist)
Tariff code 3604
warning Once every three years - beneficiaries 50 years and older
ICD-10 code Z01.6100%
of Scheme rateImmunological faecal occult blood test (Pathologist)
Tariff code 4352
info Once a year - beneficiaries 40 years and older
100%
of Scheme rateColorectal screening test (Pathologist)
Tariff code 4352
info Once a year - 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 - all adult beneficiaries
between the age of 55 to 74
who are current/former smokers (having quit within the preceding 15 years)
with at least a 30-pack year 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 Male beneficiaries from the age of 40 to 49, once every three years
Male beneficiaries from the age of 50, once a year100%
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
Males beneficiaries aged nine to 18
Female beneficiaries aged nine to 26
A third dose may be considered for high-risk women up to the age of 45, based on motivation from their treating doctor100%
of Scheme rateHealth assessments from a nurse/pharmacy clinic
Blood pressure, fingerprick cholesterol, blood glucose (sugar) tests and height, weight and waist circumference or body mass index (BMI)
Tariff code 88001
NAPPI code 00711326001info Once a year - all 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 Once every two years - adult beneficiaries
100%
of Scheme rateMammogram (Radiologist)
Tariff codes 34100 and 34101
info Once every two years - females 40 years and older
Once a year - females with risk factors where clinically indicated family history exists100%
of Scheme rateMammogram (GP/Gynaecologist)
Tariff code 3605
info Once every two years - females 40 years and older
Once a year - females with risk factors100%
of Scheme rateGlaucoma screening
Tariff code 3014
info One screening every two years - adults 40 years and older
100%
of Scheme rateProstate screening
Tariff code 4519
info One screening every year - males 50 years and older
100%
of Scheme rateHIV test (Pathologist)
Tariff code 3932
info Once a year - beneficiaries 15 years and older
100%
of Scheme rate