Additional non-PMB Chronic limit.

• R8 530 per family. MMAP and out-of-formulary co-payments will still apply to medicine that is pre-approved.

• Pharmacy-based health-screening tests: Blood pressure, blood glucose, cholesterol, HIV/AIDS, BMI. One of each screening test per beneficiary per benefit year.
• Pharmacy-based vaccines: 
• Flu vaccine – Limited to 1 vaccination per beneficiary.
• Pneumococcal vaccine – Limited to 2 vaccinations per beneficiary per lifetime and where clinically appropriate.
• HPV vaccine has been extended to all females up to the age of 26 years.
• Contraceptive benefit: R4 090 per beneficiary. R2 560 sub-limit for oral contraceptives. HPV vaccine has been extended to all females up to the age of 26 years.
• Non-pharmacy based-benefits: One consultation per beneficiary per benefit year with a GP paid at 100% of MSR or a Gynaecologist or a Urologist or a Dermatologist paid at 200% of MSR from the Wellness benefit for any of the following non-pharmacy screenings benefits:
• Pap Smear and HPV PCR tests: limited to 1 pap smear and 1 HPV PCR test every 3 years per female beneficiary.
• Mammogram – limited to 1 test per female beneficiary.
• Syphilis and Chlamydia infection screening – limited to 1 test per female beneficiary.
• Please note for the Pap smear, HPV PCR test, Mammogram and Chlamydia screening, only one Gynaecologist consultation per benefit year will be funded from the Screening Benefit.
• Prostate Specific Antigen – limited to 1 test per male beneficiary, including consultation with General Practitioner or Urologist.
• Colorectal screening – limited to one fecal sample pathology test per beneficiary.
• Health Risk Assessment – limited to 1 test per beneficiary.
• Audiology screening – limited to 1 test per beneficiary up to the age of 6 weeks.
• OMSMAF Nurture – a structured, proactive and personalised mother and baby programme, powered by Baby Yum Yum, providing support during pregnancy and early parenting.
• Nutritional assessment and healthy eating plan – Access to Universal Network of Dieticians – subject to pre-authorisation and registration – for annual assessment, healthy eating plan prescription and regular monitoring.
• Pre-School readiness – Eye and hearing screening for children aged 5 and 6.
• Dental caries (prevention and oral fluoride supplementation) – limited to beneficiaries up to age 6 years, subject to Managed Care Protocols, by oral hygienist consultation.
• Childhood immunisations – Children up to the age of 12 years, as per recommendation by the Department of Health.
• Dermatologist Consultation – limited to 1 consultation for cancer screening per beneficiary every year, for beneficiaries 35 years and older.
• Bone Density Scan – limited to 1 bone density scan performed by a Radiology laboratory, similar to a Mammogram, no additional GP or Specialist consultations will be covered other than one GP or Specialist Wellness Consultation per beneficiary, per annum.
• Wellness Maximiser Benefit – 2 virtual GP consultations (incl. the cost of acute medicine) per family and unlimited nurse advice online chats via the Universal.one App. Only available once all adult beneficiaries have completed all their Pharmacy-based Wellness Screening test and available Day-to-Day benefits being depleted.