Fedhealth

Fedhealth provides cover for approximately 143 000 lives and offers a choice of 25 plans. Members have the option of using a hospital of choice or a plan that uses a network of hospitals (the Elect or GRID options). The Elect hospital network is very restrictive whilst the GRID network has a more comprehensive list of hospitals. On the Elect options, a standard co-payment will apply to all hospital admissions except for emergency admissions. Balloon sinuplasty is an exclusion on all options.

On the flexiFED plans, hospitalization benefits are offered with very limited savings available for day to day claims. Additional funds are allocated for day to day benefits through MediVault (Wallet) which can be accessed only when needed and paid back over a rolling 12 month period, interest free. These are known as the "Flexible" options. Alternatively, members can select upfront savings at the beginning of the year. This savings portion is then added to the monthly contribution and these options are the "Fixed" options.

Premiums for a single member range from R1 128 to R10 772 and the flexiFED 4 is the most popular option. All options offer some preventative care benefits. Annual contribution increases will be effective from 1st April 2022.


MaxiFED Maxima Plus

This option is suited for individuals and families requiring extensive medical cover. It offers unlimited hospital cover at a hospital of choice, with in-hospital specialist bills paid at 200%. If the scheme's Conservative Back and Neck Rehabilitation Programme is not completed, no cover is available for spinal surgery. Co-payments are applied for certain surgical procedures (e.g. hip replacement) if the contracted service provider is not used. Day to day claims are paid from savings, then from a risk benefit. Thereafter, a self payment gap applies and then claims are paid from the above threshold benefit.

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MaxiFED Maxima Exec

MaxiFED Maxima Exec is suited for individuals and families requiring extensive medical cover. It offers unlimited hospital cover at a hospital of choice, with in-hospital specialist bills paid at 200%. Co-payments are applied to a comprehensive list of in-hospital procedures. If the scheme's Conservative Back and Neck Rehabilitation Programme is not completed, no cover is available for spinal surgery. Day to day claims are paid from savings, then from a risk benefit. Thereafter, a self payment gap applies and then claims are paid from the above threshold benefit.

flexiFED 4 & Elect & GRID (Flexible & Fixed)

flexiFED 4 is suited for individuals and families requiring comprehensive medical cover. It offers unlimited hospital cover at a hospital of choice, or if selecting the GRID or Elect options, through a hospital network, with in-hospital specialist bills paid at 100%. Co-payments are applied to a comprehensive list of in-hospital procedures. If the scheme's Conservative Back and Neck Rehabilitation Programme is not completed, no cover is available for spinal surgery.

Day to day benefits are available through MediVault (Wallet) on the Flexible options or through Savings on the Fixed options. Once the MediVault or Savings has been exhausted an above threshold benefit applies. Unlimited cover for network GPs, network Specialists, Basic Dentistry, Pathology, Basic Radiology once threshold reached - 20% co-pay applies.

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flexiFED 3 & Elect & GRID (Flexible & Fixed)

flexiFED 2 & Elect & GRID (Flexible & Fixed)

flexiFED 2 is suited for individuals requiring general medical cover. It offers unlimited hospital cover at a hospital of choice, or if selecting the GRID or Elect options, through a hospital network, with in-hospital specialist bills paid at 100%. Co-payments are applied to a comprehensive list of in-hospital procedures. A short list of in-hospital exclusions applies.

Day to day benefits are available through MediVault (Wallet) on the Flexible options or through Savings on the Fixed options. Once the MediVault or Savings has been exhausted, additional cover (certain dentistry and GP consultations only) is available once the Threshold has been reached. All day to day expenses accumulate to the Threshold limit. Specialised radiology, optometry and preventative care benefits are also offered.

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flexiFED 1 & Elect (Flexible & Fixed)

myFED

myFED is an entry level capitated network plan which is affordable and ideal for low earning individuals. A co-payment will apply for Elective Caesarean Sections and an extensive list of in-hospital exclusions applies. ALL treatments are subject to network providers and network protocols.

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Unique Benefits

Upgrades within 30 days of a life-changing event; 24-hour Fedhealth Nurse Line; emotional wellbeing programme; emergency transport/response; MediTaxi; SOS Call Me

Lifestyle Programme

Sanlam Reality is a lifestyle and rewards programme available to members of Fedhealth Medical Aid. Sanlam Reality members get special offers on selected Sanlam products, save money on wellness, travel and entertainment, and are rewarded for financially responsible behaviour by earning tier points.

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