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FEDHEALTH FLEXIFED2 Elect 2019

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Medical Aid Year: 
2019
Day to day Benefits: 

Unlimited network GP visits See Benefit Maximiser
Maternity 2 x 2D scans; antenatal classes up to R1 050; 8 antenatal and/or
postnatal consults with a midwife, Network GP or network
gynaecologist, amniocentesis
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 Up to R1 300 per delivery
Postnatal midwifery benefit 4 consultations per pregnancy with a midwife in- and out-of-hospital
Infant hearing screening benefit 1 test from birth up to the age of 8 weeks with an audiologist

up to the Fedhealth Rate
Paed-IQ Free membership
Paediatrician consultations 1 consultation per beneficiary with a network paediatrician

up to 12 months of age
Optometry No benefit
Post-hospitalisation treatment 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 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 MRI/ CT scans are paid whether they are performed in- or out-of-hospital.
A co-payment applies for non-PMB MRI/ CT scans
Trauma treatment at casualty ward 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
Female contraception Includes oral, patches, contraceptive rings, certain
injectables as well as IUDs (includes Mirena device)
Additional benefits Upgrades within 30 days of a life-changing event; 24-hour Fedhealth Nurse
Line; emotional wellbeing programme; emergency transport/response;
MediTaxi; SOS Call Me; managed care programmes

In Hospital Benefits
Hospital Rate of Payment: 
Unlimited.
Hospitals: 

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

Upfront Payments to hospitals: 

Adenoidectomy R6 200
All open hernia surgery R4 200
Arthroscopic procedures - other R7 800
Back & neck pain procedures R6 200
Balloon sinuplasty No benefit
Bunion procedures R6 200
Colonoscopy, upper GI endoscopy R4 200
Diagnostic cystoscopy R6 200
Dental admissions R6 200
Gastritis/ dyspepsia/ heartburn R6 200
Arthroscopic procedures: hip R7 800
Arthroscopic procedures: wrist R7 800
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: 
Network Specialists Unlimited cover at cost. Non-network Up to 100% of Fedhealth Rate
Other healthcare professionals eg. Physio, Occupational, Dietician: 
Up to 100% of 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: 
R277 900 at Designated Service Provider. 40% co-payment on use of non-DSP
Organ Transplants: 
R277 900
Oncology / Cancer: 
R277 900
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

 

External R11 000 at cost

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: 
R23 700 (see HPT)
HIV / AIDS: 
Unlimited
Day-to-day benefits
GP consultations: 

Fedhealth Network GPs Covered at cost

Non-Fedhealth Network GPs Covered at 100% of Fedhealth Rate

Specialist consultations: 

Fedhealth Network Specialists Covered at cost

Non-Fedhealth Network Specialists Covered at 100% of Fedhealth Rate

Basic dentistry: 
Basic dental benefit
MRI and CT Scans (Out of Hospital): 
Unlimited at Fedhealth Rate. First R2 200 for non-PMB MRI/ CT scans for the member’s account
Radiology and Pathology: 
Unlimited at Fedhealth Rate
Pregnancy benefits: 
2 x 2D scans; antenatal classes up to R1 050; 8 antenatal and/or postnatal consults with a midwife, Network GP or network gynaecologist, amniocentesis
Chronic Conditions
Provider: 
Unlimited cover for conditions on the Chronic Disease List (CDL) at provider of choice. Subject to intermediate 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 three years
Children’s health Immunisation Programme (as per state EPI) Birth to 12 years
Cardiac health Cholesterol screening (full lipogram) All lives; aged 20 and older. 1 every five years
General Flu vaccination All lives; 1 every year
HIV finger prick test All lives; 1 every year
Breast cancer screening with mammography All lives; aged 45 and older. 1 every three years
Pneumococcal vaccination All lives; aged 65 and older. 1 per lifetime
Colorectal cancer screening
(faecal occult blood test)

All lives; aged 50 to 75. 1 every year
Men’s health Prostate Specific Antigen (PSA) Men; ages 45 to 69. 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: 
1565.00
Total Contribution Adult: 
1327.00
Total Contribution Child*: 
462.00
flexiFED 2Elect
Monthly Medical Savings
Savings Child*: 
6.00
Savings Adult: 
16.00
Savings Main Member: 
19.00
Risk Contributions
Risk Contribution Main Member: 
1546.00
Risk Contribution Adult: 
1311.00
Risk Contribution Child: 
456.00
Medical Aid Plan Name Term: 
Any