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Preventative care benefits

BENEFIT 

QUANTITY AND FREQUENCY

BENEFIT CRITERIA  BEAT PACE PULSE 
Flu vaccines  1 per beneficiary per year  Applicable to all active members and beneficiaries      
Pneumonia vaccines  Children: As per schedule of Department of Health Adults: Twice in a lifetime with booster above 65 years of age
The Scheme will identify high-risk individuals for immunisation    
Travel vaccines  Quantity and frequency dependent on Mandatory travel vaccines for typhoid, yellow fever, tetanus, meningitis, hepatitis and cholera from Scheme risk benefits 
*Available on Beat2, Beat3 and Beat4      
Paediatric immunisation  According to the Bestmed vaccine schedule    *Available on Beat2, Beat3 and Beat4     
Female contraceptives  Quantity and frequency dependent on product and subject to maximum amount
Mirena - 1 device every 60 months 
Limited to R2 315 per beneficiary per year       
Back and neck preventative programme  Subject to pre-authorisation  Preferred providers (DBC/ Workability Clinics)   √   √   √ 
Mammogram  Females 40 years and older. Once every 24 months  Scheme tariff applies *Available on Beat2, Beat3 and Beat4  

(tariff code 34100) 
HPV vaccinations 3 vaccinations per beneficiary. Females 9 - 26 years Vaccinations funded at MRP      
PSA screening  Males 50 years and older. Once every 24 months Can be done at a urologist or GP. Consultation paid from the available savings/consultation benefit *Available on Beat2, Beat3 and Beat4    X
Bone densitometry Beneficiaries 45 years and older. Once every 24 months    X  *Available on Pace2, Pace3 and Pace4  X
Pap smear 18 years and older. Once every 24 months At any gynaecologist or GP. Consultation is paid from available savings or consultation benefit       X
Preventative dentistry Dependent on the type of procedure required Subject to pre-authorisation, clinical protocols and funding guidelines *Available on Beat2, Beat3 and Beat4     X
Note:

The Pulse range offers preventative services under the basic and specialised dentistry benefit. Benefits mentioned above may be subject to pre-authorisation, clinical protocols, formularies, funding guidelines and the Mediscor Reference Price (MRP).

Preventative dentistry benefits
DESCRIPTION OF SERVICE AGE FREQUENCY BEAT PACE PULSE
General full-mouth examination by a general dentist (incl. gloves and use of sterile equipment for the visit)  12 years and above

Under 12 years

Once a year

Twice a year


*Available on Beat2, Beat3 and Beat4



 

X

X


Full-mouth intra-oral radiographs  All ages  Once every 36 months 

*Available on Beat2, Beat3 and Beat4
Intra-oral radiographs  All ages  2 photos per year 

*Available on Beat2, Beat3 and Beat4
√  X
Scaling and/or polishing  All ages  Twice a year 

*Available on Beat2, Beat3 and Beat4
  X
Fluoride treatment  All ages  Twice a year 

*Available on Beat2, Beat3 and Beat4
√   X
Fissure sealing  Up to and including 21 years  In accordance with accepted protocols 

*Available on Beat2, Beat3 and Beat4
X
Space maintainers  During primary and mixed denture stage  Once per space 

*Available on Beat2, Beat3 and Beat4
  X

*Subject to pre-authorisation, clinical protocols and funding guidelines.

Note:

The Pulse range offers preventive services under the basic and specialised dentistry benefit.