Wellness Benefit
Topmed offers Wellness Benefits on all options except on the Network option and is limited to Screening Benefits (Health Assessment) only on the Essential option. Our Wellness Benefit allows you access to certain preventative screening tests which are payable from Topmed’s Major Medical Benefit, thus extending your day-to-day benefits.
Category | Sub Category | Age Band | Tariff Code | Frequency | Max rate payable at Topmed Tariff |
Immunisation program | Influenza Vaccination | All | 1 every year | 100% | |
Baby Immunisation | Covered for the first 6 years of life | According to the Dept of Health protocols | 100% | ||
Tetanus | All | 1 every year | 100% | ||
Pneumococcal | Beneficiaries aged 60 years and older, high risk individuals | 1 every year | 100% | ||
Screening benefit (Health Assessment) | BMI | All adult beneficiaries | 1 every year | 100% | |
Blood sugar test (finger prick) | All adult beneficiaries | 1 every year | 100% | ||
Blood pressure test | All adult beneficiaries | 1 every year | 100% | ||
Cholesterol test (finger prick) | All adult beneficiaries | 1 every year | 100% | ||
Early detection tests | General physical examination (at a GP) | Adults 30-59 years | 0190/0191/0192 | 1 medical examination every 3 years | 100% |
Adults 60-69 years | 0190/0191/0192 | 1 medical examination every 2 years | 100% | ||
Adults 70 years & older | 0190/0191/0192 | 1 medical examination every year | 100% | ||
Pap smear | |||||
– Consultation | Females 15 years & older | 0190/0191/0192 | 1 every year | 100% | |
– Pathology Test | Females 15 years & older | 4566/4559 | 1 every year | 100% | |
Prostate Specific Antigen (PSA) Test (Pathologist) | Males 40-49 years | 4519 | 1 every 5 years | 100% | |
Males 50-59 years | 4519 | 1 every 3 years | 100% | ||
Males 60-69 years | 4519 | 1 every 2 years | 100% | ||
Males 70 years & older | 4519 | 1 every year | 100% | ||
Free Prostate Specific Antigen (Free PSA) Only if PSA is raised (Pathologist) | Males 40-49 years | 4524 | 1 every 5 years | 100% | |
Males 50-59 years | 4524 | 1 every 3 years | 100% | ||
Males 60-69 years | 4524 | 1 every 2 years | 100% | ||
Males 70 years & older | 4524 | 1 every year | 100% | ||
Only if finger prick is raised above 6mmol/L | |||||
– LDL | All adult beneficiaries | 4026 | 1 every year | 100% | |
– Basic total | All adult beneficiaries | 4027 | 1 every year | 100% | |
– HDL | All adult beneficiaries | 4028 | 1 every year | 100% | |
– Triglyceride | All adult beneficiaries | 4147 | 1 every year | 100% | |
– Lipogram | All adult beneficiaries | 4025 | 1 every year | 100% | |
Only if finger prick is raised above 11mmol/L | |||||
– Blood sugar – Quantitative | All adult beneficiaries | 4057 | 1 every year | 100% | |
HIV Elisa Test | Beneficiaries 15 years and older | 3932 | 1 every year | 100% | |
Mammogram (Includes Sonar) | Females 40 years and older | 34100/34101 | 1 every 2 years | 100% | |
Bone Densitometry | Beneficiaries 50 years and older | 3604/50120/58531 | 1 every 3 years | 100% | |
Glaucoma test | Beneficiaries 40-49 years | 3002 /11202/ 11212 /3014 | 1 every 2 years | 100% | |
Beneficiaries 50+ years | 1 every year | 100% |
Please note: Except in the case of PMBs, any consultations and costs not specifically stated above but related to the above tests will be paid from your day-to-day benefits.