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FEDHEALTH FLEXIFED1 2019

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Medical Aid Year: 
2019
Day to day Benefits: 

Unlimited network GP visits See Benefit Maximiser
Maternity No benefit
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 the age of 8 weeks up to the Fedhealth Rate
Paed-IQ Free membership
Paediatrician consultations No benefit
Optometry No benefit
Post-hospitalisation treatment benefit For up to 30 days after discharge from hospital like physiotherapy, x-rays
or pathology i.e follow-up treatment for a full 30-day period is covered
Take-home medicine benefit 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

Specialised radiology benefit Unlimited at Fedhealth Rate. First R3 000 for each non-PMB MRI/ CT scan for

member’s own account

Trauma treatment at a casualty ward Unlimited at 100% of Fedhealth Rate. You pay a co-payment of R570 per visit

for non-PMBs

Female contraception benefit Oral and injectable contraceptives subject to the acute formulary

In Hospital Benefits
Hospital Rate of Payment: 
Unlimited. Network hospitals only or a co-payment of R6 400 will apply
Hospitals: 

Unlimited at negotiated tariff at network hospitals only. R6 400 co-payment

on voluntary use of non-network hospitals

Upfront Payments to hospitals: 

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
Balloon sinuplasty No benefit
Bunion procedures R6 200
Colonoscopy, upper GI endoscopy R6 200
Diagnostic cystoscopy R6 200
Dental admissions No benefit
Gastritis/ dyspepsia/ heartburn R6 200
Arthroscopic procedures: hip No benefit
Arthroscopic procedures: wrist Unlimited at cost at PMB level of care
Hysterectomy (unless for cancer) R3 600

Casualty / Emergency Visits: 
Unlimited at 100% of Fedhealth Rate. You pay a co-payment of R570 per visit for non-PMBs
Specialists: 
Unlimited at Fedhealth Rate. First R3 000 for non-PMB MRI/ CT scans for the member’s account
Other healthcare professionals eg. Physio, Occupational, Dietician: 
Subject to savings, wallet or self-funded
Radiology and pathology: 
Unlimited at Fedhealth Rate. First R3 000 for non-PMB MRI/ CT scans for the member’s account
MRI and CT scans: 
Unlimited at Fedhealth Rate. First R3 000 for non-PMB MRI/ CT scans for the member’s account
Dialysis: 
Unlimited at cost at PMB level of care at Designated Service Provider. 40% co-payment on use of non-DSP.
Organ Transplants: 
Unlimited at cost at PMB level of care
Oncology / Cancer: 
Unlimited at cost at PMB level of care at Designated Service Provider* and subject to level 1 treatment protocols. 40% co-payment for non-use of DSP
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

 

Total ankle replacement No benefit
*Combined benefit limit for all unlisted internal prosthesis Unlimited at cost at PMB level of care

 

External Unlimited at cost at PMB level of care

 

Medical and Surgical Appliances: 
Subject to 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: 
Unlimited at negotiated tariff Unlimited at cost up to PMB level of care
HIV / AIDS: 
Unlimited
Day-to-day benefits
GP consultations: 

Unlimited network GP visits

Specialist consultations: 

Unlimited at Fedhealth Rate. First R3 000 for each non-PMB MRI/ CT scan for

member’s own account

Basic dentistry: 
Preventative dental benefit
MRI and CT Scans (Out of Hospital): 
Unlimited at Fedhealth Rate. First R3 000 for non-PMB MRI/ CT scans for the member’s account
Radiology and Pathology: 
Unlimited at Fedhealth Rate
Pregnancy benefits: 
Fedhealth Network GPs and Specialists (e.g. Gynaecologists & paediatricians) Covered at cost Non-Fedhealth Network GPs Covered at 100% of Fedhealth Rate Non-Fedhealth Network Specialists Covered at 100% of Fedhealth Rate Other Healthcare Professionals Cov
Chronic Conditions
Provider: 
Unlimited cover for conditions on the Chronic Disease List (CDL) at provider of choice. Subject to basic formulary and MPL
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

Preventative Care Benefits
Preventative Benefits: 

Women’s Health
Cervical cancer screening
(Pap smear)

Women; ages
21 to 65 1 every 3 years

Men’s Health
Prostate Specific Antigen (PSA) Men; ages 45 to 69 1 every year
Children’s Health
Immunisation Programme
(as per State EPI)

Birth to 12 years Various

Cardiac Health
Cholesterol screening (full lipogram) All lives; aged 20 and older 1 every 5 years
General
Breast cancer screening with
mammography

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
Pneumococcal vaccination All lives; aged 65 older 1 per lieftime
Colorectal cancer screening (faecal
occult blood test)

All lives; ages 50 to 75 1 every year

Health risk assessments
Wellness screening (BMI, blood
pressure, 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: 
1611.00
Total Contribution Adult: 
1207.00
Total Contribution Child*: 
525.00
flexiFED
Monthly Medical Savings
Savings Child*: 
8.00
Savings Adult: 
19.00
Savings Main Member: 
25.00
Risk Contributions
Risk Contribution Main Member: 
1586.00
Risk Contribution Adult: 
1188.00
Risk Contribution Child: 
517.00
Medical Aid Plan Name Term: 
Any