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FEDHEALTH FLEXIFED2 GRID 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: 
100% of Scheme Rate
Hospitals: 

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

Upfront Payments to hospitals: 

Co-payments per event applicable on the hospital/ facility bill only
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: 
Unlimited at cost with network specialists and GPs
Other healthcare professionals eg. Physio, Occupational, Dietician: 
Subject to referral by a medical practitioner, pre-authorisation & treatment protocols
Radiology and pathology: 
MRI/ CT scans are paid whether they are performed in- or out-of-hospital. A co-payment applies for non-PMB MRI/ CT scans
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
Prosthesis: 

Joint replacements
Single Hip and knee with CP* Unlimited at cost at PMB level of care
Single Hip and knee - voluntary
non-use of CP* Unlimited at cost at PMB level of care
Other joint replacements and
involuntary non-use of CP*
for Single hip and knee

Unlimited at cost at PMB level of care

Laparoscopic hernia repairs (bilateral inguinal, repeated inguinal hernias & nis-
sen/ toupey hernia repairs only) R6 200

Laparoscopic procedures R6 200
Laparoscopic varicocelectomy R6 200
Nasal procedures R6 200
Rhizotomies and facet pain blocks (limited to 1 of either procedure
per beneficiary per year) No benefit
Skin biopsy/ excision R6 200
Spinal surgery** R6 200
Surgical extraction of impacted
wisdom teeth

Medical and Surgical Appliances: 
Subject to savings, wallet or self-funded
In Hospital Dentistry: 
for children under 7 We cover the hospital and anaesthetist costs from the in-hospital benefit. The dentist account will be paid for by the member
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
Medical Aid Plan Name Term: 
Any