Extended Major Medical Benefit

To ensure that members receive adequate care when recovering from a major hospital procedure without being restricted by the availability of day-to-day benefits, TopMed provides an Extended Major Medical Benefit on the Comprehensive, Executive, Family, Savings Option and limited cover on the Active Saver and Essential Option.

This unique benefit gives members access to extended rehabilitation benefits for 5 major events, as outlined below, which are funded from the Major Medical Benefits portion and not from day-to-day benefits.

OPTIONSPOST TOTAL HIP REPLACEMENTPOST TOTAL KNEE REPLACEMENTPOST CRIME TRAUMAHEART ATTACKSTROKE
TopMed ComprehensiveYesYesYesYesYes
TopMed ExecutiveYesYesYesYesYes
TopMed FamilyYesYesYesYesYes
TopMed SavingsYesYesYesYesYes
TopMed Active SaverTrauma onlyTrauma onlyYesYesYes
TopMed EssentialTrauma onlyTrauma onlyYesYesYes
TopMed NetworkNo Benefits
TopMed LimitedNo Benefits
DESCRIPTION & DEFINITIONBENEFITSEVENTS
Post Total Knee Replacement
As with a hip replacement, effective mobilisation after a knee replacement is always difficult and at times painful, yet critical to the success of this expensive operation.
8 physiotherapy sessions within 3 months after being discharged from the hospital.
Once per annum (per knee).
Authorisation required.
N/A
Post Crime Trauma
This benefit is aimed at supporting you when you have been exposed to a traumatic crime-related incident. To access this benefit, you need to report the event at your nearest Police Station and obtain a Police Reference Number (MR Number).
Combined total of 12 consultations for 6 months from the date of the event per dependant, with any of the following specialists:

  • Psychologist
  • Psychiatrist
  • Social worker

Authorisation required.

  • A hijacking or attempted hijacking
  • Attempted murder
  • Assault or attempted assault, including sexual assault
  • Robbery (including armed robbery) or attempted robbery
Heart Attack
(Myocardial Infarction)
A heart attack is caused by a blockage in the arteries supplying your heart muscle.
Subject to Case Management and must be prescribed by the treating cardiologist / physician.
Authorisation required.
N/A
Stroke
(Cerebro-vascular accident)
A stroke occurs when the blood supply to the brain tissue is compromised – either by a blockage of a blood vessel or a brain haemorrhage.
Comprehensive rehabilitation programme including therapy from a multi-disciplinary team for a period of 3 months after the ACUTE event.

  • Physiotherapist
  • Occupational therapist
  • Speech therapist

This benefit is subject to Case Management. Authorisation required.

N/A

Scopes

TopMed covers the following scopes on all options except TopMed Network:

  • Authorisation required.
  • Done in doctors rooms or as a day case at Hospital PRE-AUTHORISATION – Tel: 0860 00 21 58.
  • Requires Benefit Authorisation and pays at 100% of the TopMed Tariff.
  • Conscious sedation ONLY unless clinically appropriate for general anaesthetic.
DESCRIPTIONTARIFF CODE
Colonoscope1653
Endoscope1587
Gastroscope1656

International Business & Leisure Travel Insurance

Medical expenses are covered subject to the terms and conditions of the TIC (EuropAssistance) policy schedule and completion of a DECLARATION OF TRAVEL DAYS document which can be obtained from TopMed on 0860 002158. Maximum of 90 days cover. Applicable on all options except TopMed Network.