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

Unlimited at contracted nominated GP
subject to protocols & utilisation monitoring
after 10 visits per beneficiary. Use of
non-nominated GP limited to two visits per
beneficiary per year at a contracted GP
(referred to as out-of-area). Can nominate
u...

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

Unlimited at Fedhealth myFED network
hospitals only. R12 000 co-payment on voluntary
use of non-network hospitals will apply

Casualty / Emergency Visits: 
Unlimited at 100% of Fedhealth Rate. You pay a co-payment of R600 per visit for non-PMBs
Specialists: 
Fedhealth Network Specialists 2 specialist consultations up to R1 800 per family per year. Must be referred by contracted GP. If a referral is not obtained, a 40% co-payment will apply. Non-Network Specialists No benefit
Other healthcare professionals eg. Physio, Occupational, Dietician: 
Up to 100% of Fedhealth Rate
Radiology and pathology: 
up to R28 300 per family in hospital only
Dialysis: 
Covered up to PMB level of care at designated service provider. 40% co-payment for non-use of DSP
Oncology / Cancer: 
Covered up to PMB level of care at designated service provider* and subject to level 1 treatment protocols. 40% co-payment for non-use of DSP
Prosthesis: 

Internal and external Unlimited at cost at PMB level of care

Medical and Surgical Appliances: 
Unlimited at cost at PMB level of care
Rehabilitation, Hospice and Step-down facilities: 
Unlimited at cost at PMB level of care
Treatment for Mental Health: 
See GP benefit. Limited to 2 mental health consultations per beneficiary
HIV / AIDS: 
Unlimited
Day-to-day benefits
GP consultations: 

Unlimited at contracted nominated GP
subject to protocols & utilisation monitoring
after 10 visits per beneficiary. Use of
non-nominated GP limited to two visits per
beneficiary per year at a contracted GP
(referred to as out-of-area). Can nominate
u...

Specialist consultations: 

2 specialist consultations up to R1 800
per family per year. Must be referred by
contracted GP. If a referral is not
obtained, a 40% co-payment will apply.

Acute medicine: 

1. This is once-off medication for the treatment of a minor condition, which the myFED contracted GP can give to
you if they are licensed to dispense medicine.
2. If the myFED contracted GP is licensed to dispense medicine, then they must give you yo...

Over-the-counter (OTC) Medicine: 

No benefit

Optometry benefits: 
Subject to ISO Leso Network Optometrists*. Frame to the value of R210 or R210 off any other frame. 1 pair of single vision clear CR39 lenses or 1 pair of bifocal clear CR39 lenses. 1 comprehensive consultation per beneficiary. This benefit is availab...
Basic dentistry: 
Subject to a contracted list of dentists and limited to a list of approved procedures, dental tariff codes and protocols. Plastic dentures limited to one set per beneficiary every two years
Radiology and Pathology: 
up to R28 300 per family in hospital only
Chronic Conditions
Provider: 
Covered up to PMB level of care at designated service provider. 40% co-payment for non-use of DSP
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, Dysr...

Total Contributions
myFED
Risk Contributions
Risk Contribution Child: 
634.00
Medical Aid Plan Name Term: 
Any