A program available on all options to provide Beneficiaries with certain additional benefits, at no extra cost to Members, for preventative care:
- Only the benefits stated in the Benefit Structure under Health Booster, and applicable to that particular benefit option, will be paid by the Scheme; up to a maximum rand value which is determined according to specific tariff codes.
- Members qualify automatically for Health Booster benefits according to the set criteria.
- However, pre-authorisation is required in order to access the Maternity benefits on Health Booster. Contact the Client Service Centre on 0860 671 050 and obtain pre-authorisation.
(Failing to do this will result in the service costs being deducted from day-to-day benefits.);
- When maternity related claims are submitted by providers, these claims should specify the relevant ICD10 code as contained in the pre-authorisation letter;
- Verify the tariff code or maximum rand value with the Call Centre Consultant;
- Inform the relevant service provider accordingly.
- One of the benefits available on the Health Booster program is the Health Assessment.
- This assessment comprises the following screening tests:
- Body Mass Index (BMI);
- Blood sugar (finger prick test);
- Total Cholesterol (finger prick test);
- Blood pressure (systolic and diastolic);
- Prostate Phlebotomy for PSA;
- Rapid Semi-Quantitive Prostate Specific Antigen (PSA) test (finger prick).
- Principal Members and their Dependants are entitled to one Health Assessment per calendar year and must have the screening tests done at any pharmacy.
- A Health Assessment (HA) form can be downloaded from KeyHealth’s website
- No authorisation is required for these screening tests.
|TYPE OF TEST||WHO & HOW OFTEN|
|Baby immunisation||Child dependants aged ≤6 – as required by the Department of Health.|
|Flu vaccination||All beneficiaries.|
|Tetanus diphtheria injection||All beneficiaries – as and when required.|
|Pneumococcal vaccination (Prevenar not included)||All beneficiaries.|
|Malaria medication||All beneficiaries – R380 once per year.|
|Baby growth assessments||3 baby growth assessments at a pharmacy/baby clinic for beneficiaries aged between 0 – 35 months – per year.|
|EARLY DETECTION TESTS|
|Pap smear (Pathologist)||Female beneficiaries aged ≥15 – once per year.|
|Pap smear (including consultation and pelvic organs ultrasound; GP or Gynaecologist)||Female beneficiaries aged ≥15 – once per year.|
|Mammogram||Female beneficiaries aged ≥40 – once per year.|
|Prostate specific antigen (PSA) (Pathologist)||Male beneficiaries aged ≥40 – once per year.|
|HIV/AIDS test (Pathologist)||Beneficiaries aged ≥15 – once per year.|
|Health Assessment (HA): Body mass index, Blood pressure measurement, Cholesterol test (finger prick), Blood sugar test (finger prick) PSA (finger prick)||All beneficiaries – once per year.|
|Dental consultation||All beneficiaries – once per year.|
|WEIGHT LOSS (Pre-authorisation essential to access benefits)|
|Weight Loss Programme||For all beneficiaries when the Health
Assessment BMI is ≥ 30:
|MATERNITY (Pre-authorisation essential to access benefits)|
|Antenatal visits (GP, Gynaecologist or midwife) & urine test (dipstick)#||Female beneficiaries. Pre-notification of and pre-authorisation by the Scheme compulsory. 12 visits.|
|Ultrasounds (GP or Gynaecologist) – one before the 24th week and one thereafter #||Female beneficiaries. Pre-notification of and pre-authorisation by the Scheme compulsory. 2 pregnancy scans.|
|Short payments/co-payments for services rendered in (#) above and birthing fees||Covered to the value of R1 180 per pregnancy.|
|Paediatrician visits||Baby registered on Scheme.
2 visits in baby’s 1st year.
1 visit in baby’s 2nd year.
|Ante-natal vitamins||Covered to the value of R1 990 per pregnancy.|
|Ante-natal classes||Covered to the value of R1 990 for first pregnancy.|