What are tests and scans?
Tests and scans involve any investigative procedures that are undertaken to identify and diagnose medical conditions that would not normally be detected with the naked eye.
MultiChoice Medical Aid Scheme provides cover for in- and out-of-hospital tests and scans, including investigations, radiology, blood tests, MRI and CT scans.
Investigations
| Benefit | Rate of reimbursement | Annual benefit limit |
|---|---|---|
| Radiology | 100% of Scheme Rate | Subject to available funds in the Medical Savings Account and Above Threshold Benefit. |
| Pathology Point-of-care device testing |
100% of Scheme Rate | Subject to available funds in the Medical Savings Account and Above Threshold Benefit. If the Discovery Health pathology form is used, the pathology codes are paid by the Scheme when the funds in the Medical Savings Account and Above Threshold Benefit have been depleted. Point-of-care device testing covered from Chronic Illness Benefit for members registered on the programme, when your doctor uses the defined integration solution to submit claims for tests using these devices. |
| Endoscopic procedures Out-of-hospital subject to authorisation |
100% of Scheme Rate | Subject to Major Medical Expenses Benefit. |
| MRI and CT scans* | 100% of Scheme Rate | Subject to overall annual limit. R30 140 per family per year. |
| Intrauterine devices (In- and out-of-hospital) | 100% of Scheme Rate | Subject to available funds in the Medical Savings Account and Above Threshold Benefit at all times. Device is paid on an out-of-hospital basis even if the procedure is performed in hospital. |
* Limits are applicable to both in- and out-of-hospital claims
** Specialist network applies; if a network specialist is used claims are paid in full. If a network specialist is not used, claims paid up to 200% of Scheme Rate and the claims will be paid to you.
Prevention and Care
This benefit covers a range of vaccines that are aimed at keeping you and your family healthy.
Childhood immunisation benefit
- Childhood vaccines
- Children up to and including the age of 12 years
- Includes BCG, oral polio, rotavirus, diptheria, tetanus, acellular pertussis, inactivated polio and haemophilus influenza type B, hepatitis B, measles and pneumococcal vaccine
- Administered in line with the Department of Health immunization schedule
- Vaccine is paid from Major Medical Expenses Benefit
Seasonal flu vaccine
- One seasonal flu vaccine per beneficiary per year
- Covered from the Major Medical Expenses Benefit
- Further flu vaccines are funded from the available day-to-day benefits (Medical Savings Account and/or limited Above Threshold Benefit)
Pneumococcal vaccination
- Certain high risk individuals
- Individuals aged 65 and older
- Individuals with certain respiratory conditions
- Children who are repeatedly admitted to hospital with pneumonia
- Aimed at preventing repeat admissions to hospital for pneumonia
- Vaccine is paid from the Major Medical Expenses Benefit
Human papillomavirus>br>vaccination (HPV)
- Consists of three doses of vaccines
- Administered to male and female beneficiaries
- From age nine years to age 40 years
- Prevents cervical and other cancers caused by the human papillomavirus
- Vaccine is paid from the Major Medical Expenses Benefit
The Screening Benefit covers a range of screening healthcare services to keep you healthy. This benefit covers certain tests at a Discovery Wellness Network provider or at the annual MultiChoice Medical Aid Scheme corporate wellness day. We help make your Medical Savings Account last longer by paying for your Screening Benefit from the Major Medical Expenses Benefit (limited to one approved test per beneficiary per year).
Screening test consisting of
- Blood glucose
- Blood pressure
- Cholesterol
- Body Mass Index
Pap smear
- One Pap smear per female beneficiary every second year
- This benefit covers the Pap smear code (pathology code)
- The Pap smear is paid from the Major Medical Expenses Benefit
- Further Pap smears are funded from the available Medical Savings Account and/or limited Above Threshold Benefit
Bowel screening
- One faecal occult test per male and female beneficiary every two years
- Must be between 45 and 75 years old
- Includes the cost of a GP consultation
Prostate-specific antigen test benefit
- One prostate-specific antigen test per male beneficiary every second year
- This benefit covers the prostate-specific antigen test code (pathology code)
- The prostate-specific antigen test is paid from the Major Medical Expenses Benefit
- Further prostate-specific antigen tests are funded from the available Medical Savings Account and/or limited Above Threshold Benefit
Mammogram
- One mammogram per female beneficiary every two years
- Must be 18 years or older
- Further mammograms are funded from the available Medical Savings Account and/or Above Threshold Benefit
- High risk members have access to one mammogram every year
What is MyBreastCancerRisk Calculator about?
As a woman especially, you want to do all you can to prevent breast cancer. You can start by understanding your risks and what you need to do to reduce your risk factors for breast cancer, where possible. Preventive screening is crucial in managing your risks and ensuring early detection, which provides a good chance of recovery, or even cancer prevention.
Use the interactive MyBreastCancerRisk Calculator
To help you with this, you can use MyBreastCancerRiskCalculator, which is an interactive calculator. MyBreastCancerRisk Calculator is a tool that allows members who are 35 years and older to calculate an estimated risk of developing breast cancer based on a set of specific questions you answer about your personal health and family history.
MyBreastCancerRisk Calculator cannot predict whether or not you will get breast cancer.
Please note that MyBreastCancerRisk Calculator does not calculate your risk based on your family history entirely.
The assessment uses research from the USA's National Cancer Institute
MyBreastCancerRisk Calculator uses the Breast Cancer Risk Assessment algorithms from the National Cancer Institute.
Discovery Health (Pty) Ltd developed this assessment based on the results of scientific research the National Cancer Institute in the USA conducted.
The assessment will show your risk for breast cancer, if you are 35 years and older
The Breast Cancer Risk Assessment from the National Cancer Institute estimates a woman's risk of developing invasive breast cancer. It estimates the risk during the next five-year period and up to age 90 (lifetime risk) based on age and the information provided. The assessment compares this with the five-year and lifetime risk for a woman of the same age who is at average risk.
Lifetime risk estimates are higher than five-year age interval estimates. This is because the risk of breast cancer increases with the years at risk.
A plan for further screening if you need it
Please note that this calculator is only available for members 35 years and older.
Once you complete the assessment and have calculated your risk, your medical scheme may provide further screening benefits through the Screening and Prevention Benefit, where clinically appropriate. This will enable you and your doctor to put together an appropriate screening plan.