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FEDHEALTH FLEXIFED1 Elect 2019

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Medical Aid Year: 
2019
Day to day Benefits: 

Savings/
Wallet

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

Unlimited. Network hospitals only or a co-payment of R11 500 will apply

Upfront Payments to hospitals: 

A co-payment applies for non-PMB MRI/ CT scans

Trauma treatment at casualty ward co-payment of R570 per visit for non-PMBs applies

R11 500 co-payment on voluntary use of non-network hospital

Co-payments per event applicable on the hospital/ facility bill only
Adenoidectomy R6 200
All open hernia surgery R6 200
Arthroscopic procedures - other R7 800
Back & neck pain procedures R6 200
Bunion procedures R6 200
Colonoscopy, upper GI endoscopy R6 200
Diagnostic cystoscopy R6 200
Gastritis/ dyspepsia/ heartburn R6 200
Hysterectomy (unless for cancer) R3 600

 

Casualty / Emergency Visits: 
Whether admitted to hospital or not, emergency treatment, like stitches, is covered. Authorisation must be obtained and a co-payment of R570 per visit for non-PMBs applies
Specialists: 
Unlimited at cost with network specialists
Other healthcare professionals eg. Physio, Occupational, Dietician: 
Subject to referral by a medical practitioner, pre-authorisation & treatment protocols
Radiology and pathology: 
Unlimited at Fedhealth Rate
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: 
Unlimited at cost up to PMB level of care at Designated Service Provider. 40% co-payment on use of non-DSP
Organ Transplants: 
Unlimited at cost up to PMB level of care
Oncology / Cancer: 
Unlimited at cost up to PMB level of care
Neck and Back Operations: 
No benefit unless Back & Neck Rehabilitation Programme has been completed. You pay a co-payment of R6 200 on the hospital bill
Joint Replacements: 
Unlimited at cost at PMB level of care
Prosthesis: 

Internal 

Unlimited at cost at PMB level of care

Aorta Stent Grafts, Bone lengthening devices, Cardiac pacemakers, Cardiac stents, Cardiac valves, Carotid stents, Detachable platinum coils, Elbow replacement, Embolic Protection Devices, Hip replacement, Intraocular lenses (per lens), Knee replacement, Other approved spinal implantable devices, Peripheral Arterial Stent Grafts, Shoulder replacement, Spinal plates and screws 

 

 

Medical and Surgical Appliances: 
In & out-of-hospital: Paid from Savings/ Wallet or self-funded
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: 
Support for members with substance-abuse or mental health issues like depression or bipolar mood disorder
HIV / AIDS: 
Unlimited (see HPT)
Day-to-day benefits
GP consultations: 

Unlimited at nominated network GP

Specialist consultations: 

Unlimited at Fedhealth Rate.

Optometry benefits: 
No benefit
Basic dentistry: 
Preventative dental benefit
Pregnancy benefits: 
4 consultations per pregnancy with a midwife in- and out-of-hospital, 1 test from birth up to the age of 8 weeks with an audiologist up to the Fedhealth Rate
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

Total Contributions
Total Contribution Main Member: 
1208.00
Total Contribution Adult: 
905.00
Total Contribution Child*: 
394.00
flexiFED 1stElest
Monthly Medical Savings
Savings Child*: 
6.00
Savings Adult: 
14.00
Savings Main Member: 
19.00
Risk Contributions
Risk Contribution Main Member: 
1189.00
Risk Contribution Adult: 
891.00
Risk Contribution Child: 
388.00
Medical Aid Plan Name Term: 
Any