Wellness Benefits

  • Immunisation programmes
    Baby immunisation programme

    Covered for the first six years of a child's life

    As required by the Department of Health

    100%

    of Scheme rate

    Flu vaccinations

    Once a year - all beneficiaries
    ICD-10 code Z25.1

    100%

    of Scheme rate

    Tetanus diphtheria booster

    As needed - all beneficiaries
    ICD-10 code Z23.8

    100%

    of Scheme rate

    Pneumococcal vaccinations

    As needed - beneficiaries 60 years and older and high-risk beneficiaries
    ICD-10 code Z23.8

    100%

    of Scheme rate

  • Early detection programmes
    General physical examination (in GP's rooms)

    Tariff codes 190 - 192
    Tariff code 4188 - urine dipstick test

    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 Z0.00

    100%

    of Scheme rate

    Cholesterol test (Pathologist)

    Tariff codes 4025, 4026 and 4147

    Once a year - all beneficiaries
    ICD-10 code Z13.6

    100%

    of Scheme rate

    Pap smear consultation (GP/Gynaecologist)

    Tariff codes 190 - 192

    Once a year - females 15 years and older
    ICD-10 code Z01.4

    100%

    of Scheme rate

    Pap smear

    Tariff code 4566

    Covered by the Administrator
    ICD-10 code Z01.4

    100%

    of Scheme rate

    DEXA bone density scan (Radiologist)

    Tariff code 50120

    Once every three years - beneficiaries 50 years and older
    ICD-10 code Z01.6

    OR
    DEXA bone density scan (GP/Gynaecologist)

    Tariff code 3604

    Once every three years - beneficiaries 50 years and older
    ICD-10 code Z01.6

    100%

    of Scheme rate

    Immunological faecal occult blood test (Pathologist)

    Tariff code 4352

    Once a year - beneficiaries 40 years and older

    100%

    of Scheme rate

    Colorectal screening test (Pathologist)

    Tariff code 4352

    Once a year - beneficiaries 40 years and older

    100%

    of Scheme rate

  • Additional tests covered at no cost to you
    Cholesterol screening (Pathologist)

    Tariff code 4027

    Once every two years - adult beneficiaries

    100%

    of Scheme rate

    Mammogram (Radiologist)

    Tariff codes 34100 and 34101

    Once every two years - females 40 years and older
    Once a year - females with risk factors where clinically indicated family history exists

    100%

    of Scheme rate

    Mammogram (GP/Gynaecologist)

    Tariff code 3605

    Once every two years - females 40 years and older
    Once a year - females with risk factors

    100%

    of Scheme rate

    Glaucoma screening

    Tariff code 3014

    One screening every two years - adults 40 years and older

    100%

    of Scheme rate

    Prostate screening

    Tariff code 4519

    One screening every year - males 50 years and older

    100%

    of Scheme rate

    HIV test (Pathologist)

    Tariff code 3932

    Once a year - beneficiaries 15 years and older

    100%

    of Scheme rate