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FEDHEALTH MYFED R12 022 - 13 739 2019

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Medical Aid Year: 
2019
In Hospital Benefits
Hospital Rate of Payment: 
100% of Scheme Rate
Hospitals: 

No overall annual limit. Network hospitals only

Casualty / Emergency Visits: 
Unlimited at 100% of Fedhealth Rate. Co-payment of R570 per visit for non-PMBs
Specialists: 
Unlimited cover at cost with Fedhealth Network GPs and Specialists
Radiology and pathology: 
Unlimited at cost up to PMB level of care
MRI and CT scans: 
Unlimited at cost up to PMB level of care
Dialysis: 
Unlimited at cost at PMB level of care at Designated Service Provider. 40% co-payment for non-use of DSP
Organ Transplants: 
Unlimited at cost up to PMB level of care
Oncology / Cancer: 
Covered up to PMB level of care at Designated Service Provider and subject to level 1 treatment protocols. 40% co-payment for non-use of DSP
Prosthesis: 

Unlimited at cost up to PMB level of care

Medical and Surgical Appliances: 
Unlimited at cost up to PMB level of care
Take home Medicine: 
Unlimited at cost up to PMB level of care
Rehabilitation, Hospice and Step-down facilities: 
Unlimited at cost up to PMB level of care
Treatment for Mental Health: 
Unlimited at cost up to PMB level of care
HIV / AIDS: 
Unlimited at cost up to PMB level of care
Day-to-day benefits
GP consultations: 

Fedhealth Network GPs and Specialists Covered at cost
Non-Fedhealth Network GPs and Specialists Covered at 100% of Fedhealth Rate. Limited to R2 220 per beneficiary per year

Specialist consultations: 

Fedhealth Network GPs and Specialists Covered at cost
Non-Fedhealth Network GPs and Specialists Covered at 100% of Fedhealth Rate. Limited to R2 220 per beneficiary per year

Over-the-counter (OTC) Medicine: 

Up to 100% of MPL. Limited to 7 days medication per hospital event

Optometry benefits: 
Subject to a contracted list of dentists and limited to a list of approved procedures, dental tariff codes and protocols.
Basic dentistry: 
Subject to ISO Leso Network Optometrists*.
Radiology and Pathology: 
Unlimited subject to basic protocols & limited list of tests & procedures. Must be referred by contracted medical practitioner
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
Hyperlipidaemia
Hypertension

Hypothyroidism
Multiple Sclerosis
Parkinson’s Disease
Rheumatoid Arthritis
Schizophrenia
Systemic Lupus Erythematosus
Ulcerative Colitis

Preventative Care Benefits
Preventative Benefits: 

Flu vaccination All lives 1 every year
HIV finger prick test All lives 1 every year
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 (waist-to-hip ratio, body fat %, flexibility, posture & fitness) All lives 1 every year

Total Contributions
Total Contribution Main Member: 
2068.00
Total Contribution Adult: 
1672.00
Total Contribution Child*: 
808.00
myFED R12 022 - 13 739
Risk Contributions
Risk Contribution Main Member: 
2068.00
Risk Contribution Adult: 
1672.00
Risk Contribution Child: 
808.00
Medical Aid Plan Name Term: 
Any