Hospital Rate of Payment:
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
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.
