My Health Programs

PSMAS health management programs are designed to improve quality of life for our members with chronic conditions. The programs involves coordinated healthcare interventions  and communications for defined members with specific conditions, designed to improve the health of members and reduce associated costs from avoidable complications by identifying and treating them more quickly and more effectively. Program empowers members with information to better manage their conditions and prevent complications.

The diabetes mellitus care program is designed to promote preventive initiatives, early detection and ensuring diabetic members have access to quality and appropriate healthcare. Members will have access to health support by dedicated healthcare coach as individuals and support groups

What are the benefits for joining the Diabetes Program?

    • Access to diabetic care and support for improved quality of life by health coach.
    • Gain knowledge on the disease, prevention and management.
    • Access to self-care devices such as glucometers and access to diabetes medication.

Further details on the programme are included in the program guide attached for download,



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Pregnancy is an extraordinary experience. If one must highlight life experiences, most women will say that pregnancy and childbirth are the experiences that they will never forget.
Pregnant members and dependants of PSMAS have access to the Maternity Benefit Programme. The PSMAS Maternity Benefit Programme is a comprehensive programme designed with the needs of expectant parents, and their support network in mind.

PSMAS’s comprehensive Maternity Programme aims to provide members with the support and affordable quality care needed during their pregnancy. The focused quality care includes pre and post-natal visits, scans, pathology and delivery.

Benefits of joining the programme

  1. You will receive support during the pregnancy journey through health education and access to care.
  2. You will access quality care with good outcomes.
  3. You will experience enjoy access to all services offered by the programme.

Further details on the programme are included in the program guide attached for download,


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What is Chronic Medicine?

It is a medicine that is used on a continuous basis to treat disabling chronic illnesses that has a negative effect on your health. Chronic medicine is usually prescribed for more than three months and helps to control a disease and its progression. In this way is prevents complications which can lead to hospitalisation.

Chronic and Chemotherapy medicines must be pre-authorised by PSMAS to ensure uninterrupted access. Once initiated on Chronic/Chemotherapy medicines should fill out form below and submit together with their prescription for pre authorization. Pre – authorisation ensures appropriateness and cost effectiveness of the required medicines. Medicines are awarded by PSMAS according to the Medicines Formulary which determines the type of medicines a member can have access to, based on their medical aid scheme.

How do I register and get access to Chronic/Chemotherapy Medicines?

  • Download the Chronic Care/Chemotherapy registration form attached
  • A separate form must be completed for each member or dependant who needs chronic/chemotherapy medicine.
  • You do not need to send a new application if your doctor changes your chronic/chemotherapy medicine, you will only need to submit a new prescription.
  • Email the completed form and repeatable doctor’s prescription to; submit in person at the nearest PSMAS offices.
  • For Chemotherapy Medicines at the beginning of each year resubmit your prescription for updating as indicated above

Check on the Your Provider Network tab for a Pharmacy closest to you to access your medicines.

Care coordination is premised on organizing more effectively the care of the members to achieve safer and more effective care.  PSMAS aims to improve the health outcomes, patient experience and lower overall costs for both member and the health fund by using care coordination.

Part of the process involves members having and nominating a designated General Practitioner (GP) or Family Doctor. To nominate your preferred designated GP, download the GP nomination form below:


Most of the dental diseases are behavioral in origin, meaning that they are affected by individual’s lifestyle. Oral health promotion is therefore at the heart of preventing and controlling dental ill health.

PSMAS has a dental program tailor made for its members to make sure they have access to quality and affordable dental healthcare as a way of minimizing dental illness and complications. Members select their preferred dental practitioner from the Premier Express Network. By using dentists from the network, members will incur minimal shortfalls. Benefits members can enjoy on joining program include:

  • Healthcare advice and support to help members towards good oral care.
  • Guidance on how to comply with regular check-ups to minimize dental complications.
  • Members have access to dental health information that will make it possible for them to make informed decisions regarding their oral health.
  • Access to all services offered by the programme.

Dental Pre-authorizations

Certain treatments that fall under Specialized Dentistry require pre-authorization and the list is as follows:

  • Orthodontics
  • Crowns and Bridges
  • Dentures
  • Maxilla-facial surgery
  • Oral Pathology
  • Periodontics

Members should ask their dental practitioners to fill in a form for submission at the Society for pre-authorization.

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PSMAS’s Hospital Benefit Management (HBM) focuses on mitigating financial risks associated with the intensity (what happens in one day) and severity (what happens over a period) risks. Pre-authorisation of hospital admissions and out-of-hospital care is a key component in managing access to affordable, appropriate, safe, and quality health care. PSMAS’s pre-authorisation requests are adjudicated against clinical and funding guidelines as well as set criteria in recognizing healthcare providers who can perform certain procedures.

We therefore:

  • Review and pre-authorise appropriate requests for benefits to registered facilities,
  • Ensure that members are treated by registered and appropriate providers, and
  • Ensure that members receive acceptable forms of treatment at appropriate levels of care for a reasonable length of stay.

Our clinical audit and re-pricing of claims process ensure that legitimate claims are paid against the contracted hospital rates and the authorized admission. And our member-centric process provides a single-entry point for members to contact PSMAS for administrative support and hospital pre-authorisation (pre-certification).

PSMAS also focuses on member care co-ordination by improving the quality of care for members through the efficient and effective use of available resources. The power of this sits in the sharing of information about a member’s condition, well-being, and health within different managed health care departments as well as with the member’s doctor. Co-ordinating the member’s care is done through the following interventions – from pre-admission to eight weeks after they are discharged – to ensure best health care; reduce re-admissions and encourage members to take responsibility for their own health:

  • Targeted telephonic contact with a member before they are admitted.
  • Distribution of a pre-admission hospital checklist to prepare the member for hospitalization and post discharge recovery.
  • Post-discharge follow-up telephonic contact by clinical agents and assessment of important health parameters.
  • Referral to various managed care services and appropriate healthcare providers as and when needed.

Certain high cost procedures and services require pre-authorisation by PSMAS before being approved. PSMAS’s pre-authorisation requests are adjudicated against clinical and funding guidelines as well as set criteria in recognizing healthcare providers who can perform certain procedures. Pre-authorisation is a key component in managing access to affordable, appropriate, safe, and quality health care.

Benefits of Pre-authorization

  1. Pre-authorization ensures that the requested service is the most cost effective option available.
  2. Helps expedite treatment process and ensures that members can have access to the healthcare they truly need.
  3. Protects the health and safety of members by ensuring they receive necessary prescriptions and treatments that have been clinically proven.
  4. Pre-authorization helps healthcare funders to plan and allocate resources more efficiently.

The process of obtaining pre-authorization involves submission of administrative and clinical information by the treating service provider.

Pre-authorization is done at the commencement of haemodialysis treatment or at the beginning of each year for all members already receiving dialysis treatment. Service providers are required to submit referral letter from treating physician and treatment plan for pre-authorization. Members can access dialysis services for as long as the benefit is still available.  

Pre-authorization is done at the commencement of radiotherapy treatment.  A treatment plan is requirement for all new cases. Service providers required to submit the documents to the Society for pre-authorization. 


Service providers submit forms with clinical information for pre-authorization. The form is available for download: