Acute Medicine

Prescribed medicine is normally taken when your condition is acute and will clear up within a short space of time, such as when you have influenza. On TFG Health Plus, we fund acute medication at 80% of Scheme Medication Rate up to an annual sub-limit.

On TFG Health, acute medicines are covered subject to the acute medicine list (formulary). Only acute medicine prescribed or dispensed by the member's chosen GP will be covered

Over-the-counter medicine (OTC)

Schedule 0 - 2 medicine, whether prescribed or not, are also known as over-the-counter medicine. On TFG Health Plus we will only pay for medicine bought over-the-counter up to 80% of the Scheme Medication Rate and up to the sub-limit per item, subject to the prescribed medication limit.

We will only pay for acute or over-the-counter medicine if:

  • It is prescribed by a registered healthcare provider with a valid practice number, in the case of acute medicine.
  • You get the medicine from a registered healthcare provider with a valid practice number;
  • The claim displays a valid ICD-10 and medicine dispensing code.

N.B. On TFG Health over-the-counter medication is not covered, even if prescribed.