Wellness Benefits

Wellness Benefits

Why should I go for screening tests?

Getting screening tests is one of the most important things you can do for your health. Screenings are medical tests that check for diseases before there are any symptoms. Screenings can help doctors find diseases early, when the diseases may be easier to treat.

How can the Wellness Benefits help me?

These preventative benefits are available on all Plans and consists of two types of Wellness Benefits: a Pharmacy Wellness Benefit, plus certain tests that can be conducted by a GP or specialist.

This benefit is separate from the Day-to-Day Benefit and is not paid from these limits, but subject to the use of the correct diagnostic and tariff codes as well as the correct Designated Service Provider.

The aim of this benefit is to encourage members to take care of their health and wellbeing by going for a general health consultation once a year and to keep track of their results.

What is available under the Pharmacy Wellness Benefit?

The Pharmacy Wellness Benefit gives you access to Clicks, Dis-Chem and Pick n Pay pharmacy clinics, where a qualified nurse will assess your current state of health and give you advice as well as tools on how to improve your health. Please note that you will be covered for one visit per beneficiary per benefit year and that these benefits are only redeemable from your Wellness Benefits if obtained from one of the listed pharmacy clinics.

At the clinic they can offer the following tests, measurements and services:

  • Blood pressure – Limited to 1 test per beneficiary per benefit year.
  • Blood glucose – Limited to 1 test per beneficiary per benefit year.
  • Cholesterol – Limited to 1 test per beneficiary per benefit year.
  • HIV/ Aids Test – Limited to 1 test per beneficiary per benefit year.
  • Body Mass Index (BMI) – Limited to 1 test per beneficiary per benefit year.
  • Flu vaccine – Limited to 1 vaccination per beneficiary per benefit year. (The cost of a visit to a General Practitioner is subject to the Day-to-Day Benefit.)
  • Pneumococcal vaccine – Limited to 1 vaccination per beneficiary per lifetime. (The cost of a visit to a General Practitioner is subject to the available Day-to-Day Benefit.)
  • Contraceptives – R2 990 per beneficiary per benefit year. R1 880 sub-limit for oral contraceptives. (Products must be prescribed for contraception and not for the treatment of acne or skin conditions, unless otherwise specified as per managed care protocols.) The cost of a visit to a General Practitioner or gynaecologist will not be covered under this benefit.

IMPORTANT: Please ask the General Practitioner, Gynaecologist or Urologist (whichever is applicable) to submit the wellness consultation claim using the following primary ICD-10 code: Z00.0. If this code is not used, the benefit will be paid from your available Day-to-Day Benefits.

 

TIP: Discuss your contraceptive options with your healthcare provider when you have your papsmear.

In addition to having your blood pressure, cholesterol, blood sugar, height, weight and body mass index measured and monitored, you can also ask the clinic staff for advice on how to improve your health through basic exercise and healthy eating plans.

Please contact your nearest Clicks, Dis-Chem or Pick n Pay Pharmacy clinic to make an appointment. Members may request a list of pharmacy clinics by emailing network.accounts@omsmaf.co.za.

If you wish to visit a Clicks pharmacy clinic to make use of this benefit, always present your OMSMAF membership card, which enables the Fund to obtain your results efficiently and pay for your visit.

What is available under the non-pharmacy Wellness Benefit?

Other wellness benefits available outside a pharmacy are the following:

  • Pap smear – limited to 1 test per female beneficiary per benefit year, including consultation with Registered Nurse, General Practitioner or Gynaecologist. This will also be an opportunity to discuss contraceptive options and get a script, if relevant.
  • Mammogram – limited to 1 test per female beneficiary per benefit year, including consultation with a Gynaecologist or GP. (Please note for the above Pap smear and Mammogram, only one Gynaecologist or GP consultation per benefit year will be funded from the Wellness benefit.)
  • Prostate Specific Antigen – limited to 1 test per male beneficiary per benefit year, including consultation with General Practitioner or Urologist.
  • Colorectal screening – limited to 1 test per beneficiary per benefit year.
  • Health Risk assessment – limited to 1 test per beneficiary per benefit year. Only for services rendered by a registered healthcare practitioner (for example, a General Practitioner).
  • Audiology screening – Limited to one test per beneficiary up to the age of 6 weeks.
  • PAED-IQ’s Babyline – A 24/7, paediatric telephone service, whereby parents or caregivers of children from birth to three years of age, who are registered on the Fund, can phone in and get up-to-date child healthcare advice and reassurance.

Any medical expenses not covered under the Wellness Benefit will be paid from your available Day-to-Day Benefits.