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maxima EXEC GRID

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Type of Medical Aid Plan: 
Threshold
Medical Aid Year: 
2020
Day to day Benefits: 

Unlimited Network General Practitioner (GP) visits
On maxima PLUS, members can see Fedhealth Network GPs as often as they need to – unlimited
benefit. On maxima EXEC, members can see Fedhealth Network GPs once their savings is depleted –
unlimited be...

In Hospital Benefits
Hospital Rate of Payment: 
100% of Scheme Rate
Hospitals: 

No overall annual limit

Upfront Payments to hospitals: 

Arthroscopic procedures: hip & wrist R2 500. Arthroscopic procedures - other R2 500. Balloon sinuplasty R4 400. Colonoscopy, upper GI endoscopy R2 500. Single hip and knee replacements – voluntary use of non-CP*-R27 400, Involuntary use of non-CP* fo...

Casualty / Emergency Visits: 
Through our partner Europ Assistance, we provide all members with emergency transport. Whether the member is admitted to hospital or not, emergency treatment, like stitches, is always covered. A co-payment of R600 for non-PMB visits applies on maxima...
Specialists: 
Network GPs and Specialists Unlimited cover at cost. Non-network Specialists Up to 200% of Fedhealth Rate.
Other healthcare professionals eg. Physio, Occupational, Dietician: 
Up to 100% of Fedhealth Rate
Radiology and pathology: 
Unlimited specialised radiology paid from Risk if pre-authorised. First R2 300 for non-PMB MRI/ CT scans is for the member’s account
Dialysis: 
R580 900 at 100% of Fedhealth Rate at Designated Service Provider. 40% co-payment on use of non-DSP
Oncology / Cancer: 
R580 900
Joint Replacements: 
Joint replacements Single hip and knee replacements with CP*-No co-payment Single hip and knee replacements – voluntary use of non-CP*-R27 400 Involuntary use of non-CP* for single hip and knee replacements-R4 400 Other joint replacements-R4 400
Medical and Surgical Appliances: 
In and out-of-hospital: Subject to Savings. Does not accumulate to Threshold. Paid from Threshold up to R16 200 per family per year with a sub-limit of R4 530 for foot orthotics
In Hospital Dentistry: 
In-hospital dentistry for children up to the age of 7 Hospital and anaesthetist covered. Dentist will be paid from Day-to-Day Benefits
Take home Medicine: 
Fedhealth members get seven 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: 
This helps members address their back and neck issues to avoid spinal surgery. Over six weeks, members benefit from a multidisciplinary approach including a GP, physio and biokineticist to assess and treat their condition.
Treatment for Mental Health: 
The Mental Health Programme provides members with mental health or substance-abuse issues, as well as their GP, with access to the best quality primary mental healthcare.
HIV / AIDS: 
Through the Aid for Aids managed care programme, we take expert care of members with HIV/Aids. The programme acts as a care-coordinator between Fedhealth, doctors, pathology labs, pharmacies and patients.
Day-to-day benefits
GP consultations: 

Unlimited GP visits at Fedhealth Network GPs
once savings is depleted

Specialist consultations: 

R181 200

Over-the-counter (OTC) Medicine: 

Fedhealth members get seven 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

Optometry benefits: 
Limit of R3 490 per person per year, up to an overall annual limit of R10 640 per family per year
Basic dentistry: 
Limit of R7 700 per person per year, up to an overall annual limit of R23 000 per family per year
MRI and CT Scans (Out of Hospital): 
Unlimited specialised radiology paid from Risk if pre-authorised. First R2 300 for non-PMB MRI/ CT scans is for the member’s account
Radiology and Pathology: 
Unlimited specialised radiology paid from Risk if pre-authorised. First R2 300 for non-PMB MRI/ CT scans is for the member’s account
Chronic Conditions
Chronic Conditions: 

54 conditions including conditions on the
Chronic Disease List (CDL) plus additional
conditions, as well as medicine for allergic
rhinitis for children up to the age of 18 where
the child is registered with Chronic Medicine
Management for asthma, med...

Total Contributions
maxiFED
Monthly Medical Savings
Savings Child*: 
219.00
Savings Adult: 
599.00
Savings Main Member: 
690.00