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FEDHEALTH FLEXIFED4 GRID 2019

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Medical Aid Year: 
2019
In Hospital Benefits
Hospital Rate of Payment: 
Unlimited. Network hospitals only or a co-payment of R11 500 will apply
Specialists: 
Unlimited cover at cost
Other healthcare professionals eg. Physio, Occupational, Dietician: 
Up to 100% of Fedhealth Rate
Radiology and pathology: 
MRI/ CT scans are paid whether they are performed in- or out-of-hospital. A co-payment applies for non-PMB MRI/ CT scans
MRI and CT scans: 
MRI/ CT scans are paid whether they are performed in- or out-of-hospital. A co-payment applies for non-PMB MRI/ CT scans
Dialysis: 
R444 700 at Designated Service Provider. 40% co-payment on use of non-DSP
Organ Transplants: 
R444 700
Oncology / Cancer: 
R444 700
Prosthesis: 

Prostheses
Internal Various sub-limits apply
Aorta Stent Grafts R58 500
Bone lengthening devices See combined benefit limit for all unlisted internal prosthesis*
Cardiac pacemakers R27 800
Cardiac stents R27 800
Cardiac valves R27 800
Carotid stents See combined benefit limit for all unlisted internal prosthesis*
Detachable platinum coils R50 700
Elbow replacement R27 800
Embolic Protection Devices See combined benefit limit for all unlisted internal prosthesis*
Hip replacement R27 800
Intraocular lenses (per lens) R3 200
Knee replacement R27 800
Other approved spinal implantable devices See combined benefit limit for all unlisted internal prosthesis*
Peripheral Arterial Stent Grafts See combined benefit limit for all unlisted internal prosthesis*
Shoulder replacement R27 800
Spinal plates and screws See combined benefit limit for all unlisted internal prosthesis*
Total ankle replacement See combined benefit limit for all unlisted internal prosthesis*
*Combined benefit limit for all unlisted internal prosthesis *R25 000

Medical and Surgical Appliances: 
Subject to savings, wallet or self-funded. Does not accumulate to threshold. Paid from threshold up to R11 600 per family per year. (R4 340 sub-limit per beneficiary for foot orthotics)
In Hospital Dentistry: 
for children under 7 We cover the hospital and anaesthetist costs from the in-hospital benefit. The dentist account will be paid for by the member
Take home Medicine: 
7-days of paid for take home medication after discharge from hospital - provided the medication is dispensed by the hospital and reflects on the original hospital account.
Rehabilitation, Hospice and Step-down facilities: 
Unlimited at negotiated tariff Unlimited at cost up to PMB level of care
Treatment for Mental Health: 
Psychiatric services: accommodation in a general ward, procedures, ECT, materials and hospital equipment, consultations and visits, medicines and injection material R25 100
HIV / AIDS: 
unlimited
Day-to-day benefits
GP consultations: 

Unlimited network GP visits

Specialist consultations: 

Unlimited network speciaalist visits

Over-the-counter (OTC) Medicine: 

Limit of R5 680 per person per year, up to an overall limit of

R11 400 per family per year

Optometry benefits: 
Limit of R3 340 per person per year, up to an overall limit of R10 190 per family per year
Basic dentistry: 
Limit of R7 400 per person per year, up to an overall limit of R22 100 per family per year
Specialised Dentistry: 
Limit of R7 400 per person per year, up to an overall limit of R22 100 per family per year
MRI and CT Scans (Out of Hospital): 
MRI/ CT scans are paid whether they are performed in- or out-of-hospital. A co-payment applies for non-PMB MRI/ CT scans
Radiology and Pathology: 
MRI/ CT scans are paid whether they are performed in- or out-of-hospital. A co-payment applies for non-PMB MRI/ CT scans
Chronic Conditions
Chronic Conditions: 

Addison’s Disease, Asthma, Bipolar Mood Disorder, Bronchiectasis, Cardiac
Failure, Cardiomyopathy, COPD/Emphysema/Chronic Bronchitis, Chronic
Renal Disease, Coronary Artery Disease, Crohn’s Disease, Diabetes Insipidus,
Diabetes Mellitus type 1 & 2, Dysrhythmias, Epilepsy, Glaucoma, Haemophilia,
HIV, Hyperlipidaemia, Hypertension, Hypothyroidism, Multiple Sclerosis,
Parkinson’s Disease, Rheumatoid Arthritis, Schizophrenia, Systemic Lupus

Erythematosus, Ulcerative Colitis

Preventative Care Benefits
Preventative Benefits: 

Women’s health Cervical cancer screening (Pap smear) Women; ages 21 to 65. 1 every three years
Children’s health Immunisation Programme (as per state EPI) Birth to 12 years
Cardiac health Cholesterol screening (full lipogram) All lives; aged 20 and older. 1 every five years
General Flu vaccination All lives; 1 every year
HIV finger prick test All lives; 1 every year
Breast cancer screening with mammography All lives; aged 45 and older. 1 every three years
Pneumococcal vaccination All lives; aged 65 and older. 1 per lifetime
Colorectal cancer screening
(faecal occult blood test)

All lives; aged 50 to 75. 1 every year
Men’s health Prostate Specific Antigen (PSA) Men; ages 45 to 69. 1 every year
Health risk
assessments

Wellness screening (BMI, blood pressure, finger
prick cholesterol & glucose tests)

All lives; 1 every year

Preventative screening by contracted
wellness network provider (waist-to-hip ratio, body
fat %, flexibility, posture & fitness)

All lives; 1 every year

Total Contributions
Total Contribution Main Member: 
2698.00
Total Contribution Adult: 
2389.00
Total Contribution Child*: 
825.00
flexiFED 4GRID
Monthly Medical Savings
Savings Child*: 
7.00
Savings Adult: 
20.00
Savings Main Member: 
22.00
Risk Contributions
Risk Contribution Main Member: 
2676.00
Risk Contribution Adult: 
2369.00
Risk Contribution Child: 
818.00
Medical Aid Plan Name Term: 
Any