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.

CategorySub CategoryAge BandTariff CodeFrequency Max rate  payable at Topmed Tariff
Immunisation programInfluenza VaccinationAll1 every year100%
Baby Immunisation  Covered for the first 6 years of lifeAccording to the Dept of Health protocols100%
Tetanus  All1 every year100%
Pneumococcal   Beneficiaries aged 60 years and older, high risk individuals1 every year100%
Screening benefit (Health Assessment)BMIAll adult beneficiaries1 every year100%
Blood sugar test (finger prick)All adult beneficiaries1 every year100%
Blood pressure testAll adult beneficiaries1 every year100%
Cholesterol test (finger prick)All adult beneficiaries1 every year100%
Early detection testsGeneral physical examination (at a GP)Adults 30-59 years0190/0191/01921 medical examination every 3 years100%
Adults 60-69 years0190/0191/01921 medical examination every 2 years100%
Adults 70 years & older0190/0191/01921 medical examination every year100%
Pap smear   
 –  ConsultationFemales 15 years & older0190/0191/01921 every year100%
 – Pathology TestFemales 15 years & older4566/45591 every year100%
Prostate Specific Antigen (PSA) Test (Pathologist)Males 40-49 years45191 every 5 years100%
Males 50-59 years45191 every 3 years100%
Males 60-69 years45191 every 2 years100%
Males 70 years & older45191 every year100%
Free Prostate Specific
Antigen (Free PSA) Only if PSA is raised (Pathologist)		Males 40-49 years45241 every 5 years100%
Males 50-59 years45241 every 3 years100%
Males 60-69 years45241 every 2 years100%
Males 70 years & older45241 every year100%
Only if finger prick is raised above 6mmol/L
 –  LDLAll adult beneficiaries40261 every year100%
 –  Basic totalAll adult beneficiaries40271 every year100%
 –  HDLAll adult beneficiaries40281 every year100%
 –  TriglycerideAll adult beneficiaries41471 every year100%
 –  LipogramAll adult beneficiaries40251 every year100%
Only if finger prick is raised above 11mmol/L    
 –  Blood sugar – QuantitativeAll adult  beneficiaries40571 every year100%
HIV Elisa TestBeneficiaries 15 years and older39321 every year100%
Mammogram (Includes Sonar)Females 40 years and older34100/341011 every 2 years100%
Bone Densitometry Beneficiaries 50 years and older3604/50120/585311 every 3 years100%
Glaucoma testBeneficiaries 40-49 years3002 /11202/ 11212 /30141 every 2 years100%
Beneficiaries 50+ years1 every year100%

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.