Preventative Care Benefits
Preventive screening is important as early detection improves long-term clinical outcomes and ensures that you receive the best care. The Preventative Care Benefit covers screening tests, a seasonal flu vaccination and a pneumococcal vaccine. Clinical entry criteria may apply, and some of these tests and treatments have specified frequency and age limits.
The screening tests and vaccinations must be done by an appropriately registered healthcare provider, and network provider where applicable.
Tests covered by the Preventative Care Benefit
We pay certain screening tests from the Preventative Care Benefit. Consultations and related costs are paid from your available benefits, where applicable, unless they relate to a Prescribed Minimum Benefit (PMB) diagnosis.
Once you have reached the frequency limit for the tests set out below, any additional screening and preventive tests and treatments will be paid from your available benefits, where applicable.
We will cover healthcare services when using registered providers (with a valid Board of Health Funders (BHF) registration number), and provided that the service has the following:
- A valid tariff or NAPPI code
- ICD-10 diagnosis code
- Pneumococcal vaccination
- Prostate-specific antigen (PSA).
Tests and vaccinations covered:
- Blood glucose (fasting)
- Bone density scan
- Cholesterol (including a lipogram)
- COVID-19 vaccination
- Fecal-occult blood test (colorectal screening)
- Flu vaccination
- PGP preventative medical examination
- Health risk assessment (body mass index, blood pressure, cholesterol finger-prick test and blood sugar finger-prick test)
- HIV test
- Mammogram
- Midstream urine dipstick test
- Pap smear and liquid-based cytology test
- Pneumococcal vaccination
- Prostate-specific antigen (PSA)