Which preventative screenings are covered by medical schemes?

Preventative screening can enable the early detection of any medical conditions you may have - and it may even save your life.

The National Cancer Registry estimates that one in four South Africans is affected by cancer. Breast cancer causes the highest percentage of deaths, at 16%. With early detection however, notes the American Cancer Society, this disease has a 99% recovery rate.

This article investigates potentially life-saving screenings that are covered by medical schemes, and what they entail.

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Manage your health proactively

It's a well-known fact that as we age, we become more susceptible to chronic conditions and dread diseases.

Medical schemes offer free preventative screenings for conditions categorised as Prescribed Minimum Benefits (PMBs), while screenings for conditions that are not on the PMB list may be paid out of your medical scheme savings or your day-to-day benefits.

Medical schemes encourage medical aid members to manage their health proactively, by making use of available screenings.

“Members who have regular screenings have a better chance of successful treatment and recovery,” says Jarrod Higgs, adviser sales team leader at Bestmed Medical Scheme. “This may help to avoid the future trauma of members having to put their lives on hold while receiving treatment for conditions.”

Health outcomes aside, medical scheme members who use these benefits will ultimately save on healthcare expenses. The early detection of conditions can also reduce medical claims, notes Higgs; saving the scheme money, and ultimately benefitting its members.

Which screenings are covered?

On its website, IFC lists ten potentially life-saving screenings. The specific tests covered, and the level of cover given, differs from scheme to scheme.

Source: Independent Financial Consultants.

The list is not exhaustive, as schemes may also cover pap smear, body mass index, and HIV screenings for adults. Free screenings for children may include growth assessment tests, including height, weight, head circumference, and health and milestone tracking, while age-appropriate screenings for senior citizens may include hearing and visual screening.

Where screenings are required, consult your medical scheme. It’s wise to work out what’s covered beforehand, so you don’t have to pay out of your pocket.

How often can you go for screenings?

Akila Jaufrally, senior specialist: clinical risk at Fedhealth, says preventative screenings differ according to medical scheme and age. “Some schemes offer a mammogram benefit to members of a certain age,” she explains. “However, if you are at high risk - for example, there’s breast cancer in your family – exceptions can be made.”

Higgs says Bestmed provides screenings in two-year cycles, depending on the beneficiary’s age. For example, pap smears are offered to females aged over 19 years once every 24 months, and mammograms are offered to women aged over 40 on the same basis. Similarly, men over 50 can go for a prostate test once every 24 months.

This tends to be standard for medical aid schemes, although there may be slight differences among service providers.

Jaufrally says some health risk assessments can be done at pharmacies, providing a useful snapshot of your health. These include blood pressure, blood glucose and cholesterol monitoring, and HIV testing.

“If your cholesterol is a bit elevated, the pharmacy nurse will recommend lifestyle modifications; if it’s very high, you may be directed to your GP,” she says.

“Prevention is key, so go for screenings offered by your medical scheme, even if you feel completely healthy,” she recommends. “Discuss screenings with your GP as to the necessity of screenings in general or pertinent to your specific situation.”

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