Vaccines are the best prevention

Vaccines are an incredible tool to prevent disease. Being vaccinated protects you and your family against diseases that can have serious complications like polio, measles and whooping cough (pertussis). Because we believe in protecting our members’ health, TFG Medical Aid Scheme pays for childhood vaccines as well as some adult vaccines, without using your day-to-day benefits.

Please note that we only pay for the vaccine from your Risk Benefit. We pay the consultation costs to have the vaccine administered from your available day-to-day benefits.

Seasonal flu vaccine

We pay for the seasonal flu vaccine at 100% of the Scheme Rate for high-risk members who are 65 years or older and for members registered for the following chronic conditions:

  • Asthma
  • Bronchiectasis
  • Cardiac failure
  • Cardiomyopathy
  • Chronic obstructive pulmonary disease (COPD)
  • Chronic renal disease
  • Coronary artery disease
  • Diabetes (types 1 and 2)
  • HIV.

Pneumococcal vaccine

We pay for the vaccine at 100% of the Scheme Rate for certain high-risk individuals.

Members are considered at risk if they:

  • Are 65 years or older
  • Are children who are repeatedly admitted to hospital for diseases caused by meningococcal bacteria like pneumonia or meningitis
  • Have certain respiratory conditions. 

Human papillomavirus (HPV) vaccine

We pay for the HPV vaccine at 100% of the Scheme Rate for male and female members between 9 and 26 years old. The vaccination involves three doses. It protects against cervical and other cancers caused by HPV.

Child vaccines

We pay up to 100% of the Scheme Rate for each child up to the age of 14 years to have scheduled vaccines for:

  • Accellular pertussis (whooping cough)
  • Chickenpox
  • Haemophilus influenza type b
  • Hepatitis B
  • Measles, mumps and rubella (German measles)
  • Polio
  • Rotavirus
  • Tetanus/diphtheria
  • Tuberculosis (TB).

Adult vaccines

We pay up to 100% of the Scheme Rate for each person to have a clinically appropriate vaccine for:

  • Chickenpox
  • Hepatitis A
  • Hepatitis B
  • Measles, mumps and rubella (German measles)
  • Meningococcal disease
  • Shingles - vaccine for members older than 60 years
  • Tetanus/diphtheria – booster shot every 10 years for each member.

Please note: TFGMAS is contracted with contracted pharmacies and service providers and should you receive your vaccine at a non-contracted provider, the Scheme will fund only up to the contracted dispensing fee. You may in those instances experience a co-payment and will need to pay the service provider, following payment from the Scheme to you. In some instances some vaccines also requires to be requested and prescribed by your treating doctor. Please consult with your treating doctor or contact us at 0860 123 077 for further information or assistance.

Catch possible problems early

Preventive screenings are important because they make sure you detect possible medical conditions early so we can make sure you get the best care.

The Screening and Preventive Benefit covers specific tests that will not affect your day-to-day benefits. We pay the tests from the Screening and Preventive Benefit but we pay the consultation cost (if any) from your day-to-day benefits. If you use a provider in our network, we cover the cost in full. You have to pay the difference if your healthcare provider charges more than the Scheme Rate.

Tests

You have cover for these tests:

  • One mammogram a year for female members
  • One Pap smear a year for female members
  • One prostate-specific antigen (PSA) test a year for male members
  • 12 HIV tests a year, unless the test is a Prescribed Minimum Benefit.

Measurements

You have cover for one Vitality Health Check a year. This check measures your:

  • Blood glucose (to check for diabetes)
  • Blood pressure
  • Cholesterol
  • Body mass index or BMI (to check your weight).

Please note: We only cover the full amount if you have the Vitality Health Check done at the same day at a designated service provider. Otherwise we pay up to R285 for the checks. To find a list of designated service providers, you can go to www.tfgmedicalaidscheme.co.za