Keep an eye on your health

You have Screening and Prevention Benefits On Both TFG Health and TFG Health Plus

Preventative screening is important to ensure that medical conditions are detected early. As a TFG Medical Aid Scheme member, you have access to screening and prevention benefits at any one of our wellness providers. The preventive tests, screening and flu vaccinations must be referred and done by an appropriately registered healthcare professional, and network provider where applicable.

The Screening and Prevention Benefit does not cover the cost of any related consultations. Consultations are covered from the available funds in your day-to-day benefits, unless it relates to a Prescribed Minimum Benefit diagnosis.

On TFG Health Plus members have access to Child and Adult Vaccinations as part of the Screening and Prevention Benefit, which is not available to members on TFG Health. These Vaccinations are covered as follows:

Up to 100% of the Scheme Medicine Rate for the cost of vaccination and injection material administered by a registered nurse, general practitioner or specialists:

Adult vaccinations per beneficiary as clinically appropriate include:

  • Tetanus/Diphtheria
  • Hepatitis A
  • Hepatitis B
  • Measles
  • Mumps
  • Rubella
  • Chickenpox
  • Shingles
  • Meningococcal

Child vaccinations per beneficiary as clinically appropriate include:

  • Polio
  • TB
  • Hepatitis B
  • Rotavirus
  • Diphtheria
  • Tetanus
  • Acellular
  • pertussis
  • Haemophilus
  • Influenza Type B
  • Chickenpox
  • Measles
  • Mumps
  • Rubella

TFG Health and TFG Health Plus members have access to the following screening benefits:

Screening for adults

The Screening and Prevention Benefit covers certain tests such as blood glucose, blood pressure, cholesterol, body mass index and HIV screening at one of our wellness providers. We also cover a mammogram at least every two years, a Pap smear at least once every three years and a PSA test (prostate screening) each year.

Screening for kids

This benefit covers growth assessment tests, including height, weight, head circumference and health and milestone tracking at any one of our wellness providers for your kids.

Chronic Illness Benefits

Both TFG Health and TFG Health Plus provide essential cover for chronic medicine of all PMB Chronic Disease Listed conditions. Although this benefit is offered on both Benefit Plans, there are significant differences between these offerings. Please note the following key differences:

If you are registered on TFG Health and you will only receive cover for the PMB list of chronic conditions. Approved medicine is paid in full if it is on our medicine list (formulary). Not all medication is covered. A deductible will be applicable if you choose to use medicine not on the medicine list. You need to obtain your approved chronic medicine from one of our network pharmacies or from your chosen KeyCare Network GP (if he or she is a dispensing GP). If you obtain your medicine from any other pharmacy, a 20% deductible will be applicable.

Members registered on TFG Health Plus will receive the following cover for chronic medicine:

The Chronic Illness Benefit (CIB) covers approved medicine for the 26 Prescribed Minimum Benefit (PBM) Chronic Disease List (CDL) conditions. Your approved medicine is paid in full if it is on our medicine list (formulary). If your approved medicine is not on our medicine list, we will pay your chronic medicine up to a set monthly amount, called the Chronic Drug Amount (CDA), for each medicine class. If you use more than one medicine in the same medicine class, where both medicines are not on the medicine list, or where one medicine is on the medicine list, and the other is not, we will pay for both medicines up to the one monthly CDA for that medicine class. You have further cover for medicine for Additional Disease List (ADL) conditions. There is no medicine list (formulary) for these ADL conditions. Approved medicine for these conditions will be funded up to the monthly CDA for that medicine class, up to an annual limit. You can obtain your approved chronic medicine from any pharmacy or dispensing GP.

Both the TFG Health and TFG Health Plus Benefit Plans provided cover for four (4) GP consultations related to your approved PMB CDL conditions(s) per year. The number of tests and consultations are calculated based on the number of months left in the year at the time your condition is approved. If you have cover for the same procedures or tests for more than one condition, funding will be limited to the basket that gives you the most procedures or tests.  A difference occurs between the Benefit Plans, where for TFG Health Plus, if your PMB CDL condition is approved, the Chronic Illness Benefit will automatically open access to cover for a limited number of selected tests, procedures and/ or specialist consultations for the diagnosis and ongoing management of your condition.