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.

Immunisation program


Sub Category Age Band Tariff Code Frequency Max rate  payable at Topmed Tariff
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.