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FEDHEALTH FLEXIFED3 2019

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Medical Aid Year: 
2019
In Hospital Benefits
Hospital Rate of Payment: 
Unlimited at hospital of choice
Specialists: 
Unlimited cover at cost
Other healthcare professionals eg. Physio, Occupational, Dietician: 
Up to 100% of Fedhealth Rate
Radiology and pathology: 
Up to 100% of Fedhealth Rate
MRI and CT scans: 
Up to 100% of Fedhealth Rate
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 com- pleted. You pay a co-payment of R6 200 on the hospital bill
Prosthesis: 

Prostheses
Internal Various sub-limits apply
Aorta Stent Grafts R58 500
Bone lengthening devices See combined benefit limit for all unlisted internal prosthesis*
Cardiac pacemakers PMBs only
Cardiac stents PMBs only
Cardiac valves PMBs only
Carotid stents See combined benefit limit for all unlisted internal prosthesis*
Detachable platinum coils R50 700
Elbow replacement See combined benefit limit for all unlisted internal prosthesis*
Embolic Protection Devices See combined benefit limit for all unlisted internal prosthesis*
Hip replacement See combined benefit limit for all unlisted internal prosthesis*
Intraocular lenses (per lens) R3 200
Knee replacement See combined benefit limit for all unlisted internal prosthesis*
Other approved spinal implantable devices See combined benefit limit for all unlisted internal prosthesis*
Peripheral Arterial Stent Grafts See combined benefit limit for all unlisted internal prosthesis*
Shoulder replacement See combined benefit limit for all unlisted internal prosthesis*
Spinal plates and screws See combined benefit limit for all unlisted internal prosthesis*
Total ankle replacement No benefit
*Combined benefit limit for all unlisted internal prosthesis *R25 000
External R11 600 at cost
Psychiatric services: accommodation in a general ward, procedures, ECT,
materials and hospital equipment, consultations and visits, medicines and
injection material

R25 100

Medical and Surgical Appliances: 
In & out-of-hospital: Paid from Savings/ Wallet or self-funded
Maternity Confinements: 
Private ward cover for delivery. Unlimited at cost with network specialists and GPs
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
Treatment for Mental Health: 
Mental Health Programme 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: 

Fedhealth Network GPs
and Specialists

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 Covered at 100% of Fedhealth Rate

Specialist consultations: 

Fedhealth Network GPs
and Specialists

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 Covered at 100% of Fedhealth Rate

Over-the-counter (OTC) Medicine: 

Paid from Savings/ Wallet or self-funded

Optometry benefits: 
1 comprehensive consultation, 1 pair single vision or bifocal lenses, frame up to R200
Basic dentistry: 
1 comprehensive consultation, 1 pair single vision or bifocal lenses, frame up to R200
Specialised Dentistry: 
1 comprehensive consultation, 1 pair single vision or bifocal lenses, frame up to R200
MRI and CT Scans (Out of Hospital): 
MRI/ CT scans are paid whether they are performed in- or out-of-hospital. A co-payment applies for non-PMB MRI/ CT scans
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
Pregnancy benefits: 
consultations per pregnancy with a midwife in- and out-of-hospital
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

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: 
2294.00
Total Contribution Adult: 
2018.00
Total Contribution Child*: 
818.00
fl exiFED 3
Monthly Medical Savings
Savings Child*: 
9.00
Savings Adult: 
22.00
Savings Main Member: 
25.00
Risk Contributions
Risk Contribution Main Member: 
2269.00
Risk Contribution Adult: 
1996.00
Risk Contribution Child: 
809.00
Medical Aid Plan Name Term: 
Any