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maxima PLUS 2019

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Medical Aid Year: 
2019
Day to day Benefits: 

Unlimited Network GP consultations Unlimited GP visits at Fedhealth Network GPs paid from risk never from savings

Specialised radiology Unlimited specialised radiology paid from the Core Benefit Bundle if pre-authorised

Fedhealth Baby Maternity Programme All pregnant members and dependants

Fedhealth Toddler Programme Access to sound advice for parents with toddlers up to the age of 24 months
Doula benefit R1 300 per delivery

Postnatal midwifery benefit 4 consultations with a midwife in and out-of-hospital per pregnancy

Infant hearing screening benefit 1 test with an audiologist up to Fedhealth Rate

Paed-IQ An online parenting hub for expert advice

Take-home medicine benefit Up to 100% of MPL. Limited to 7 days medication per hospital event

Post-hospitalisation treatment For up to 30 days after discharge form hospital like physiotherapy, x-rays or
pathology i.e. follow-up treatment for a full 30-day period is covered

Trauma treatment at a casualty ward Unlimited at 100% of Fedhealth Rate

Female contraception benefit Oral, patches, contraceptive rings, certain injectables as well as IUDs that include Mirena

In Hospital Benefits
Hospital Rate of Payment: 
No overall annual limit
Specialists: 
Unlimited
Other healthcare professionals eg. Physio, Occupational, Dietician: 
Unlimited subject to medical practitioner referral
Radiology and pathology: 
Unlimited at 100% of Fedhealth Rate
Dialysis: 
Unlimited at Designated Service Provider. 40% co-payment on use of non-DSP.
Organ Transplants: 
Unlimited
Oncology / Cancer: 
Unlimited
Neck and Back Operations: 
No benefit unless utilisation of back & neck rehabilitation programme has been completed
Joint Replacements: 
No co-payment
Prosthesis: 

Internal Various sub-limits apply
Aorta Stent Grafts R58 500
Bone lengthening devices See combined benefit limit for all unlisted internal prosthesis*
Cardiac pacemakers R58 500
Cardiac stents R50 100
Cardiac valves R44 500
Carotid Stents See combined benefit limit for all unlisted internal prosthesis*
Detachable platinum coils R50 700
Elbow replacement R44 500
Embolic Protection Devices See combined benefit limit for all unlisted internal prosthesis*
Hip replacement R44 500
Intraocular lenses (per lens) R3 200
Knee replacement R44 500
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 R44 500
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 *R36 100
External R21 800 at cost

Medical and Surgical Appliances: 
R15 500 per family per year before & after threshold. Subject to Savings, OHEB & threshold. (R4 340 sub-limit per beneficiary for foot orthotics)
Maternity Confinements: 
Unlimited
In Hospital Dentistry: 
Hospitalisation and anaesthetist covered for children up to the age of 7
Take home Medicine: 
Up to 100% of MPL. Limited to 7 days medication per hospital event
Rehabilitation, Hospice and Step-down facilities: 
Unlimited at negotiated tariff
HIV / AIDS: 
Unlimited
Day-to-day benefits
GP consultations: 

Unlimited GP visits at Fedhealth Network GPs

Specialist consultations: 

Unlimited at Fedhealth Rate

Over-the-counter (OTC) Medicine: 

Subject to Savings only. Does not accumulate to or pay from Threshold

Optometry benefits: 
Limit of R3 340 per person per year, up to an overall annual limit of R10 190 per family per year
Basic dentistry: 
Unlimited at 100% of the Fedhealth Rate
Specialised Dentistry: 
Limit of R7 400 per person per year, up to an overall annual limit of R22 100 per family per year
Orthodontics: 

Unlimited at cost

MRI and CT Scans (Out of Hospital): 
Unlimited at 100% of Fedhealth Rate
Radiology and Pathology: 
Unlimited at 100% of Fedhealth Rate
Pregnancy benefits: 
Limited to 2 x 2D antenatal scans per pregnancy before and after Threshold. Subject to Savings, OHEB and Threshold
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

 

Additional conditions on maxima PLUS

Alzheimer’s Disease, Angina, Ankylosing Spondylitis, Anorexia Nervosa,
Attention Deficit Disorder (in children only), Barrett’s Oesophagus, Benign
Prostatic Hyperplasia, Bulimia Nervosa, Conn’s Syndrome, Cushing’s
Syndrome, Cystic Fibrosis, Deep Vein Thrombosis, Depression,
Dermatomyositis, Gastro-Oesophageal Reflux Disease, Generalised Anxiety
Disorder, Gout, Hypoparathyroidism, Menopause, Motor Neuron Disease,
Muscular Dystrophy, Myasthenia Gravis, Narcolepsy, Obsessive Compulsive
Disorder, Osteoporosis, Paget’s Disease of the Bone, Pancreatic Disease,
Panic Disorder, Paraplegia/ Quadriplegia (associated medicine), Pemphigus,
Polyarteritis Nodosa, Post-Traumatic Stress Syndrome, Pulmonary
Interstitial Fibrosis, Scleroderma, Stroke, Thromboangitis Obliterans,
Thrombocytopaenic Purpura, Tourette’s Syndrome, Valvular Heart Disease,
Zollinger-Ellison Syndrome

Preventative Care Benefits
Preventative Benefits: 

Cervical cancer screening (Pap smear) Women; ages 21 to 65 1 every 3 years

Prostate Specific Antigen (PSA) Men; ages 45 to 69 1 every year

Immunisation Programme (as per State EPI) Birth to 12 years Various

Cholesterol screening (full lipogram) All lives; aged 20 and older 1 every 5 years

Pneumococcal vaccination All lives; aged 65 and older 1 per lifetime

Colorectal cancer screening (faecal occult blood test) All lives; ages 50 to 75 1 every year

Bone densitometry Women; aged 65 and older and Men; aged 70 and older. 1 every two years

Breast cancer screening with mam-mography All lives; aged 45 and older 1 every 3 years

Flu vaccination All lives 1 every year

HIV finger prick test by a contracted wellness network provider All lives 1 every year

Wellness screening (BMI, blood pres-sure, 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: 
8354.00
Total Contribution Adult: 
7204.00
Total Contribution Child*: 
2610.00
Maxima PLUS
Annual Medical Savings Account
Annual Medical Savings Main Member: 
14243.00
Annual Medical Savings Adult: 
11047.00
Annual Medical Savings Child*: 
3662.00
Monthly Medical Savings
Savings Child*: 
144.00
Savings Adult: 
396.00
Savings Main Member: 
460.00
Annual Threshold Amounts
Annual Threshold Main Member: 
15818.00
Annual Threshold Adult: 
12166.00
Annual Threshold Child*: 
4219.00
Risk Contributions
Risk Contribution Main Member: 
7894.00
Risk Contribution Adult: 
6808.00
Risk Contribution Child: 
2466.00
Medical Aid Plan Name Term: 
Any