2017 - compendium insurance group · 5 days average claim turnaround 8 seconds average call waiting...

2017

Rates & Benefits Guide

2017

index

Rates & Benefits Guide

Our Philosophy - A family affair 02

Strength in numbers 03

Four ways to stay in touch 03

Corporates are in good company 03

Home Sweet Home - 360 Care 04

Foundation benefit 04

The Foundation benefit unpacked 05

360 Care keeps it in our family 06

Our Comprehensive Options at a glance 07

- Quick Comparison 08

- Foundation Benefit 09

- Major Medical Benefit 10-13

- Chronic Disease Benefit 13-14

- Day-to-Day Benefit 14-15

- Maxima StandardElect Network Hospitals 15

Our Saver Options at a glance 17


- Foundation Benefit 19-20


- Chronic Disease Benefit 23

- Day-to-Day Benefit 23-24

- Maxima Saver GRID Options 25

- Maxima Saver Options Network Hospitals 27-28

- Maxima Saver Options Network Day Clinics 29-30

Our Hospital Options at a glance 31





- Day-to-Day Benefit 37

- Maxima Hospital GRID Option 38

- Maxima Hospital Options Network Hospitals 39-40

- Maxima Hospital Options Network Day Clinics 41-42

Blue Door Plus at a glance 43




- Day-to-Day Benefit 45

- Blue Door Plus Network Hospitals 47-48

- Blue Door Plus Network Day Clinics 49

Contribution Tables 51-52

01

Please note: All Fedhealth benefits are subject to registered Scheme Rules, and as such, this document only aims to provide a summary of such benefits.

For the full Scheme Rules, please visit fedhealth.co.za or contact the Fedhealth Customer Contact Centre on 0860 002 153 to obtain a copy.

A FAMILY affair

The Fedhealth story started in 1936. Eighty years later, we continue to deliver quality, value for money medical aid that treats every member like a part of the family. Although advances in medicine, treatment and technology mean that we run our Scheme a little differently these days, our essence is still the same. At Fedhealth, family takes care of family. Since we’re in the business of health, we take great pride in our healthy bottom line. We’ve maintained our AA- Global Credit Rating for 10 consecutive years and have reserves well over the required 25%. With options designed to suit every pocket, lifestyle and life stage, and unique benefits that pay more from Risk, you belong in the Fedhealth family!

02

STRENGTH in numbers

Administered by Medscheme:

LEVEL 2BBBEE COMPANY

SA’s LARGESTMANAGED CARE

SERVICES PROVIDER

SA’s 3rd LARGESTMEDICAL SCHEME ADMINISTRATOR

5 DAYSAVERAGE CLAIM TURNAROUND

8 SECONDSAVERAGE CALL WAITING TIME

90%ONE CALL QUERY

RESOLUTION

5

FOUR ways to stay in touch with us

FE

DCHAT MOBILE APP

FR

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LTH MEMBER MOBILE

AP

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FE

DHEALTH WEBSITE

Visit fe

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.co.za for Scheme info, member t

ools,

life

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Corporates are in good COMPANY

GROUP IMPLEMENTATION

AND TRAINING

DEDICATED ACCOUNT

EXECUTIVE (AE)

> 25 staff members

DEDICATED CREDIT

CONTROLLER

TAILOR-MADE OPTION

MAPPING

To make life easier for our corporate clients, we offer:

03

Corporate wellness offering It’s been proven time and again that healthy employees are productive employees. Not only does absenteeism in the workplace impact negatively on employees’ productivity, but it also ultimately affects the employer’s bottom line. Chronic conditions, stress, unhealthy working conditions, and poor managerial support may also cause or exacerbate existing conditions. Sustained, healthy behaviour change is key in addressing these issues, and Fedhealth has a comprehensive corporate wellness offering to help employees do just that. We provide targeted interventions to ensure effective healthcare, which improves employee quality of life and thus enhances their professional output. Our corporate wellness offering includes:

· Conservative Back and Neck Rehabilitation Programme· Mental Health Programme· Oncology Disease Management

· Aid for AIDS (HIV Disease Management)· Fedhealth Baby/High Risk Maternity/ Contraceptive benefit· Health Risk Assessments· Screening benefits· Trauma/Casualty benefit· Children’s Health· Sisters on Site· MyHealth Portal· Chronic Medicine Management· Hospital Benefit Management· Chronic Disease Self-management Programme· Corporate Wellness Days· Free Trauma Counselling

Ask your dedicated Account Executive for more information on these programmes, designed to look after the health of your business (and bottom line).

The money in your Savings

Account is your money

and gives you a certain level of

control over your spending. Money not

used during the year is carried over to the next

year, and is called carry-over Savings. Unused Savings will be paid out to you if you

leave the Scheme.

** SAVINGS ACCOUNT

The Scheme pools together members’ contributions to fund a set of benefits, including the Major Medical benefit, Chronic Disease benefit, Out-of-Hospital Expenses benefit and Threshold benefit. Certain rules and limits apply for when each of the benefits can pay out for particular conditions, treatments and medicines.

All families need a place to call home, a safe space in which to play and grow. The Fedhealth benefit structure is that home, looking after our members’ health needs with excellent Risk and Day-to-Day benefits.

THRESHOLD BENEFIT

CHRONIC DISEASE BENEFIT

MAJOR MEDICAL BENEFIT

FOUNDATION BENEFIT

Most costs for hospitalisation are covered from this benefit and must be pre-authorised.

Medication for approved chronic diseases is covered from this benefit.

Comprehensive options only: This benefit pays for certain day-to-day expenses once Savings and the

OHEB have run out and claims have accumulated to the required level.

Day-to-day expenses are covered from Savings and the Out-of-Hospital Expenses

Benefit (OHEB).

DAY-TO-DAY BENEFIT OHEB*

SAVINGS**

THRESHOLD BENEFIT*

CHRONIC DISEASE BENEFIT*

MAJOR MEDICAL BENEFIT*

FOUNDATION BENEFIT*

Every house calls for a solid foundation and ours is no different. As such, we’re excited about the Foundation benefit for all Fedhealth members – a rich benefit package that truly enhances your Fedhealth membership.

FOUNDATION benefit

BIRTH & BABYBENEFIT

SCREENING BENEFIT

EXTENDED CARE

04

* RISK BENEFITS

Screening benefitAt Fedhealth we firmly believe that prevention is better than

cure. That’s why we pay for women’s-, children’s-, cardiac-,

over 50s-, and general health risk assessments and screenings

from Risk. Depending on option

Birth & Baby benefitFedhealth Baby programme – Free baby goodies, support and

advice for all parents-to-be. Pregnant members or dependants

receive a beautiful Fedhealth baby bag filled with baby product

samples, discount vouchers and a baby handbook. You’ll also

have access to professional advice any time you need it. Call

0860 116 016 or email [email protected] to register.

Post-natal midwifery benefit – We will pay for four

consultations in and out-of-hospital per pregnancy at 100% of

the Fedhealth Rate.

Doula for labour support during natural childbirth –

We allow R1 200 for a doula per delivery.

Extended Care BenefitUnlimited Network FP visits – See your FP as often as you

need on most options, by either visiting any network family

practitioner or a nominated network family practitioner

depending on the option.

24-hour Fedhealth Nurse Line – Our professional nurses

are always on hand to provide advice on issues like medical

emergencies, symptoms, medication side-effects, stress

management and teenage support.

Trauma counselling – We offer all our members free trauma

management assistance, support and care when they need

it most. Members can speak to a registered psychologist or

trauma counselor 24/7.

Emergency transport / response – Through our partner Europ

Assistance, we provide all members with emergency transport.

Child rates for financially dependent children up to the age of 27 – Student dependants pay rates applicable to children,

provided they’re unmarried and not earning more than the

maximum social pension.

Upgrades within 30 days of a life-changing event, such

as pregnancy or the diagnosis of a dread disease. New contributions will apply.

Comprehensive managed care programmes – We offer the

following programmes for our members with specific healthcare

needs:

- Aid for AIDS (AfA) for those living with HIV/AIDS,

- Oncology Disease Management supports cancer sufferers

with comprehensive care including cover for chemotherapy,

radiotherapy, approved medication, related consultations,

pathology and general radiology,

- Mental Health Programme provides members with mental

health or substance-abuse issues, as well as their FP, with

access to the best quality primary mental healthcare,

- Conservative Back & Neck Rehabilitation Programme

helps members address their back and neck issues

to avoid spinal surgery. Over six weeks, members

benefit from a multidisciplinary approach including an

FP, physio and biokineticist to assess and treat their

condition.

Unique benefits paid from Risk:• Post-hospitalisation treatment for up to 30 days

after discharge from hospital (physiotherapy, x-rays,

pathology, etc) – i.e. follow-up treatment for a full 30-

day period paid directly from Risk, to preserve your

day-to-day benefit. Pre-authorisation must be obtained• 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 like MRI/ CT scans, pays from

risk whether they are performed in or out of hospital. A

co-payment may apply on scans, depending on option.

This benefit does not apply to Blue Door Plus• Trauma treatment at a casualty ward – whether

admitted to hospital or not, emergency treatment,

like stitches, is always paid from Risk and never from

Savings. Co-payment applies depending on option.

Authorisation must be obtained• Cover for female contraception – including oral,

patches, contraceptive rings, certain injectables as well

as IUDs that include Mirena®, on all comprehensive and

saver options. On Maxima Core, Maxima EntryZone,

and Blue Door Plus, we cover oral contraception only

subject to an approved list. *Must be prescribed by an FP or gynaecologist and not applicable to pills prescribed for acne

• In-hospital dentistry for children under 7 – We cover

the hospital and anaesthetist costs from the major

medical benefit while the dentist account comes from

day-to-day benefits. This benefit does not apply to Maxima EntrySaver, Maxima EntryZone and

Blue Door Plus

FOUNDATION BENEFIT

The FOUNDATION benefit unpacked

05

We’ve introduced the option-dependent Foundation benefit across all our options, featuring rich benefits like important health screenings and maternity benefits.

360 CARE keeps it in our family

To recap 360 Care:Our 360 Care philosophy is not a new concept, but it’s one in which we wholeheartedly believe. It encourages you, our member, to see the same family practitioner every time, who then becomes the coordinator of your care. In this way, your doctor builds a valuable relationship with you and gets to know your health history. So when you need a specialist, your FP can refer you to the appropriate specialist type, avoiding fragmented care, costly duplications of tests and treatments, and even the prescription of conflicting medications.

Co-ordinated care protects our members and gives them better quality care, and it also helps ensure the financial sustainability of the Scheme.

From 2017, members on certain options will have to nominate a Fedhealth Network family practitioner per beneficiary to enjoy UNLIMITED FP visits paid from Risk (once their Savings or OHEB have run out, where applicable). We think you’ll agree that being able to see your doctor as often as needed is a very valuable benefit!

FP nomination and referral management through the nominated FP help your Fedhealth family to ensure that all members get quality care and better value for money!

Using Fedhealth Network providers means:• Price certainty and peace of mind that the Scheme covers medical costs in full in hospital• Better quality healthcare• Fully covered treatment for PMB conditions.

Empowering members to manage their own healthA growing number of South Africans are suffering from lifestyle diseases, such as Type-2 Diabetes, heart disease and hypertension (high blood pressure). In addition, our country ranks amongst the most obese nations in the world, with 60% of people not doing any form of exercise. As part of our commitment to our family members’ wellbeing, Fedhealth is taking concrete action to help curb this unhealthy phe-nomenon. One of the new ways in which we hope to guide members towards better health is through Personal Health Records (PHR). PHR will enable you to self-manage your health, wellness and fitness, by hosting all your health data on an easily accessible online platform. You will be able to view, edit and record your medical history, complete certain health risk assessments and link personal monitoring devices like activity trackers to help you reach your fitness goals. You will also be able to view your medicine utilisation and health metrics on the health dashboard – all by simply logging on to the Fedhealth Member Zone and clicking on the PHR icon. We believe that this initiative will help you stay informed about your health and motivated to make healthy changes. PHR puts your health in your hands.

NOMINATE A NETWORK FP

• Beneficiaries can each have their own FP

• May nominate a new FP every 6 months

ENJOY UNLIMITED NETWORK FP VISITS

WHERE NECESSARY, FP REFERS MEMBER TO SPECIALIST TYPE• Member has to locate a

Network specialist

Number of Fedhealth Network Family Practitioners across

South Africa:

> 4 600

Number of Fedhealth Network specialists across

South Africa:

> 3 600Number of Fedhealth Network

pharmacies across South Africa:

> 1 700

Number of Fedhealth Network hospitals across South Africa:

27 – 110 option-specific

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Our comprehensive options at a glance:

Complete reassurance for every stage of life

If you are looking for complete peace of mind for yourself and/or your family, choosing a comprehensive medical aid option is the way to go.

With unlimited private hospitalisation (at either any private or Fedhealth network private hospitals) and varying levels of cover for day-to-day medical expenses like doctor’s visits and prescribed medication, our comprehensive options leave nothing to chance. In most instances, this cover is funded from a medical Savings Account, as well as the Out-of-Hospital Expenses Benefit (OHEB) and the Threshold Benefit. Members with chronic conditions also benefit from the extended cover provided for their conditions.

Fedhealth offers four comprehensive options: Maxima Plus, Maxima Exec, Maxima Standard and Maxima StandardElect. These options provide varying degrees of cover and benefits, with the OHEB not available on Maxima Standard options.

Please refer to the next page for a summary of all the benefits offered by our comprehensive options.

OHEB

SAVINGS

THRESHOLD BENEFIT



FOUNDATION BENEFIT

08

Comprehensive Options

Other healthcareprofessionals

Non-network Specialists

Non-network FPs

Network FPs and Specialists

MajorMedicalBenefit

Hospitalisation

Oncology

Organ transplant

Renal dialysis

Specialisedmedication

Chronic Disease Benefit

FROM R6 740pm

FROM R4 302pm

Maxima Plus Maxima Exec

FROM R3 032pm

Up to 300% of Fedhealth Rate


Unlimited cover at cost with Fedhealth Network FPs and Specialists

No overall annual limit


Maxima Standard

No overall annual limit. Network hospitals only

Unlimited R500 000 R400 000



R313 000 R156 000 No benefit

51 conditionsR13 600 per beneficiary

R25 400 per family


R10 200 per family

Quick Comparison

Up to 200% of Fedhealth Rate Up to 100% of Fedhealth Rate


R11 900 per family

Annual threshold levelPrincipal memberAdultChild (Up to a maximum of 3 children)

Available for day-to-day expensesPrincipal memberAdultChild

Additional medical services

Antenatal scans

Advanced dentistry

Optometry

Prescribed medication

Appliances, external accessories and orthotics

R5 004R4 260R1 500

Unlimited FP visits at Fedhealth Network FPs

Limits may apply when calculating certain claims for accumulation to Threshold. These limits will also apply for refunds from OHEB and Threshold

Two 2D antenatal scans per person per year

Limit of R6 740 per person per year, up to an overall limit of R20 000 per family per year


Limit of R8 980 per person per year, up to an overall limit of

R17 800 per family per year

Unlimited specialised radiology paid from the Major Medical Benefit if pre-authorised

Limit of R14 000 per family per year. Sub-limit of R3 910 for foot orthotics

In & out-of-hospital. Limit of R10 500 per family per year. Sub-limit of R3 910 for foot orthotics. Doesn’t accumulate to

but does pay from Threshold

Limit of R15 700 per family per year for the total of all additional medical

services including psychiatrists

In and out-of-hospital: limit of R10 500 per family per year for the total of all additional medical services including psychiatrists. Doesn’t

accumulate to but does pay from Threshold

R13 038R10 028R3 477

R12 302R9 450R3 072

R11 200R8 600R2 880

R9 158R7 416R1 828

R11 200R8 600R2 880

R6 552R5 580R1 956


In and out-of-hospital: unlimited specialised radiology paid from the Major Medical Benefit if pre-authorised. First R1 900 for non-PMB MRI / CT scans is for the member’s account

Foundation BenefitThe option-dependent Foundation benefit offers members a host of valuable benefits,

from important health screenings to maternity benefits

Day-to-day Benefit

Maxima StandardElect

FROM R2 316pm

FP consultations

Limits

Specialised radiology

In and out-of-hospital: limit of R15 700 per family per year for the total of all additional medical services including

psychiatrists. Doesn’t accumulate to but does pay from Threshold

In & out-of-hospital. Limit of R14 000 per family per year. Sub-limit of R3 910 for foot orthotics. Doesn’t accumulate

to but does pay from Threshold

Limit of R6 430 per person per year, up to an overall limit of

R11 900 per family per year

09

Foundation BenefitThe option-dependent Foundation benefit offers members a host of valuable benefits, from important health screenings to maternity benefits

Maxima Plus Maxima Exec Maxima Standard Maxima StandardElect

BENEFIT CRITERIA ALL LIMITS ARE PER BENEFICIARY

Women’s HealthBreast cancer screening with mammography

Cervical cancer screening (Liquid based cytology will be reimbursed up to the rate of a standard Pap smear)

Women; ages 50 to 74

1 every 3 years


1 every 3 years

Children’s HealthImmunisation Programme (as per State EPI)

Various 3 3 3

Cardiac HealthCholesterol screening (full lipogram)

All lives; aged 20 and older

1 every 5 years

Over 50sPneumococcal vaccination

Bone densitometry

Colorectal cancer screening (faecal occult blood test)

All lives; older than 65

1 per lifetime N/A

Women; older than 65

1 per lifetime N/A

All lives; 50 to 75

1 every 2 years N/A

GeneralFlu vaccination

HIV test (by contracted wellness network provider)

All lives 1 every year


Health risk assessmentsWellness screening (BMI, blood pressure, finger prick cholesterol & glucose tests)

Preventative screening by contracted wellness network provider (waist-to-hip ratio, body fat %, flexibility, posture & fitness)



Fedhealth Baby maternity programme

All pregnant members and dependants

3 3 3

Doula benefitR1 200 per delivery


3 3 3

Postnatal midwifery benefit 4 consultations with a midwife in and out-of-hospital per pregnancy


3 3 3

Unlimited FP visits All livesUnlimited network FP consultations paid

from Risk and never from Savings as long as you use an FP who is on the Fedhealth FP Network

Fedhealth Nurse Line All lives 3 3 3

Trauma counselling All lives 3 3 3

Emergency transport/response All lives 3 3 3

Comprehensive managed care programmesPharmacy benefit management, Hospital benefit management, Aid for AIDS (AfA), Oncology disease management programme

All lives 3 3 3

Active disease risk managementConservative back & neck rehabilitation programme, Mental health programme, Cardiac rehabilitation programme

All lives 3 3 3

Post-hospitalisation treatment All lives 3 3 3

Take-home medicine All lives 3 3 3

Specialised radiologyIn and out-of-hospital All lives

Unlimited at the Fedhealth Rate

Unlimited at the Fedhealth Rate.First R1 900 for non-PMB MRI / CT scans is for the member’s account

Trauma treatment at a casualty ward

All lives 3 R500 co-payment per visit for non PMBs

Female contraception All lives 3 3 3

In-hospital dentistryChildren up to the age

of seven3 3 3

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Major Medical Benefit This table explains how hospitalisation costs are covered


BENEFIT ALL LIMITS ARE PER FAMILY PER YEAR UNLESS OTHERWISE SPECIFIED

Overall annual limit (OAL) Unlimited at negotiated tariff

Unlimited at network hospitals

only. R10 000 co-payment on

voluntary use of non-network

hospital

Healthcare Professional Tariff in

hospital (HPT)

Fedhealth Network FPs and

Specialists

Non-Fedhealth Network FPs

Non-Fedhealth Network

Specialists

Other Healthcare Professionals

Covered at cost

Covered at 100% of

Fedhealth Rate

Covered at 200% of

Fedhealth Rate

Covered at 300% of

Fedhealth Rate

Covered at cost

Covered at 100% of

Fedhealth Rate

Covered at 200% of

Fedhealth Rate

Covered at 100% of

Fedhealth Rate

Covered at cost

Covered at 100% of Fedhealth Rate



Prescribed Minimum Benefits

(PMB): Treatment for PMB

conditions can be funded in two

ways:

To have the treatment for PMB conditions covered in full, you will have to use

Fedhealth Network FPs & specialists

To have the treatment for PMB

conditions covered in full, you will

have to use Fedhealth Network

FPs, hospitals & specialists

Should you choose not to make use of network providers, the

Scheme will only refund treatment at 100% of the Fedhealth Rate for

non-network FPs and 200% of the Fedhealth Rate for non-network

specialists. You will have a co-payment should the healthcare

professional charge more

Should you choose not to make use of network providers, the

Scheme will only refund treatment at 100% of the Fedhealth Rate

and you will have a co-payment should the healthcare professional

charge more

Hospitalisation costs:

Accommodation in a general

ward, high care ward and

intensive care unit, theatre fees,

medicine, material and hospital

apparatus

Unlimited at negotiated tariff

Unlimited at negotiated tariff at

network hospitals only. R10 000

co-payment on voluntary use of

non-network hospitals

Co-payments (per event)

applicable on the hospital/

facility bill only

All open hernia repairs

Arthroscopic procedures - other

Back & neck pain procedures

Balloon sinuplasty

Bunion procedures

Cataract surgery

Colonoscopy, Upper GI endoscopy

Cystoscopy

Dental admissions

Elective Caesarean sections

Gastritis/ dyspepsia/ heartburn

Arthroscopic procedures: hip & wrist

Hysterectomy

Joint replacements*

Laparoscopic hernia repairs (bilateral inguinal, repeated inguinal hernias & nissen/ toupey hernia repairs only)

Laparoscopic procedures

Nasal procedures

Rhizotomies and facet pain blocks (limited to 1 of either pro-cedure per beneficiary per year)

Skin biopsy/ excision

Spinal surgery**

Surgical extraction of impacted wisdom teeth

Tonsil/ adenoid procedures

Varicose vein procedures

No co-payment

No co-payment

No co-payment

No co-payment

No co-payment

No co-payment

No co-payment

No co-payment

No co-payment

No co-payment

No co-payment

No co-payment

No co-payment

No co-payment

No co-payment

No co-payment

No co-payment

No co-payment

No co-payment

No co-payment

No co-payment

No co-payment

No co-payment

No co-payment

R2 100

No co-payment

R3 700

No co-payment

No co-payment

R2 100

No co-payment

No co-payment

No co-payment

No co-payment

R2 100

No co-payment

R3 700

R3 700

R3 700

No co-payment

R3 700

No co-payment

R3 700

R3 700

No co-payment

No co-payment

No co-payment

R2 100

No co-payment

R3 700

No co-payment

No co-payment

R2 100

No co-payment

No co-payment

No co-payment

No co-payment

R2 100

No co-payment

R3 700

R3 700

R3 700

No co-payment

R3 700

No co-payment

R3 700

R3 700

No co-payment

No co-payment

* Must use ICPS for non-PMB hip and knee joint replacements. Non-use of ICPS will result in no benefit

** No benefit unless Conservative Back and Neck Rehabilitation Programme has been completed

11




(dietetics, occupational therapy

and speech therapy)

Unlimited subject to medical

practitioner referral

In and out-of-hospital: Subject to Savings & OHEB. Does not accumulate to Threshold. Paid from Threshold up to R15 700 per family per year

In and out-of-hospital: Subject to Savings. Does not accumulate to Threshold. Paid from Threshold up to R10 500 per family per year

Alternatives to hospitalisation:

Nursing services, private nurse

practitioners & nursing agencies

Sub-acute facilities, physical

rehabilitation facilities



Covered up to PMB level of care

Ambulance Services Unlimited with Europ Assistance

Appliances, external accessories

and orthoticsUnlimited

In and out-of-hospital: subject

to Savings and OHEB. Does not

accumulate to Threshold. Paid

from Threshold up to R14 000

per family per year. Sub-limit of

R3 910pp for foot orthotics

In and out-of-hospital: subject to Savings. Does not accumulate to

Threshold. Paid from Threshold up to R10 500 per family per year. Sub-limit of R3 910pp for foot orthotics

Blood, blood equivalents and

blood productsUnlimited

Immune deficiency related to

HIV infectionUnlimited (see HPT)

Maternity

Healthcare Professional Tariff in

hospital (HPT)

Fedhealth Network FPs and

Specialists (eg. gynaecologists &

paediatricians)



Specialists


Postnatal midwifery benefit

Unlimited

Covered at cost


Covered at 200% of Fedhealth Rate Covered at 100% of Fedhealth Rate

Covered at 300% of

Fedhealth RateCovered at 100% of Fedhealth Rate

4 consultations with a midwife after discharge from hospital

Maxillo-facial surgery

- Surgical extraction of impacted

wisdom teeth

Unlimited, subject to approval

(see HPT)

Unlimited, subject to approval (see HPT)

You pay a co-payment of R3 700 on the hospital bill

Emergency treatment in a

casualty ward

Unlimited at 100% of

Fedhealth RateUnlimited at 100% of Fedhealth Rate. You pay a co-payment of R500 per visit for non PMBs

Female Health Benefit:

contraceptivesUnlimited at MPL

Oncology: oncologist consulta-

tions, visits, treatment and

materials for chemotherapy and

radiotherapy, approved medica-

tion, radiology and pathology

Reimbursement rate if you don’t

use ICON and if ICON is:

A Preferred Provider

A DSP

Specialised Medication

Unlimited at preferred provider*

and subject to level 3 treatment

protocols

R500 000 at preferred provider*

and subject to level 2 treatment

protocols. DSP* above limit

R400 000 at preferred provider* and subject to level 1 treatment

protocols. DSP* above limit

Up to 100% of FR Up to 100% of Fedhealth Rate

40% co-payment

R313 000 at cost R156 000 at cost No benefit

Organ transplant including

immunosuppression medication

Corneal graft

Unlimited (see HPT) R500 000 (See HPT) R400 000 (See HPT)

R18 700 per beneficiary

Pathology, radiology (general) Unlimited at 100% of Fedhealth Rate

Physical therapy (physiotherapy

and biokinetics)Unlimited Subject to referral by a medical practitioner, pre-authorisation and treatment protocols

Post-hospitalisation Up to 30 days after discharge at 100% of Fedhealth Rate and subject to protocols

Prostheses

Internal - Various sub-limits apply This benefit does not include osseo-integrated implants for the purpose of replacing a missing tooth or teeth. Hip and knee bilateral

replacements will be allowed for up to double the amount for a single hip and knee replacement.

Detachable platinum coils R45 670 R45 670 R45 670

Cardiac stents R45 078 R45 078 R25 083

Cardiac valves R40 109 R40 109 R25 083

Cardiac pacemakers R52 651 R43 895 R25 083

Carotid StentsSee combined benefit limit for all

unlisted internal prosthesis†See combined benefit limit for all

unlisted internal prosthesis† See combined benefit limit for all unlisted internal prosthesis†

Aorta Stent Grafts R52 651 R52 651 R52 651

Peripheral Arterial Stent GraftsSee combined benefit limit for all



* Preferred provider and DSP (Designated Service Provider) is ICON (Independent Clinical Oncology Network)

12

Protecting what you hold dearest of all

13

Chronic Disease Benefit Your medication for approved chronic diseases is covered from this benefit


LimitR13 600 per beneficiary, subject to an overall limit of R25 400 per

family per year

R6 430 per beneficiary, subject to an overall limit of R11 900 per

family per year

R5 120 per beneficiary, subject to an overall limit of R10 200 per family per year

IN-BENEFIT

Conditions covered51 conditions

See lists 1, 2 & 3 opposite51 conditions

See lists 1, 2 & 3 opposite39 conditions

See lists 1 & 2 opposite

Formulary Comprehensive formulary Restrictive formulary Restrictive formulary

Designated Service Provider Service provider of choiceMedi-Rite, Dis-Chem &

Pharmacy DirectMedi-Rite, Dis-Chem & Pharmacy Direct

OUT-OF-BENEFIT (List 1 only)

Formulary Comprehensive formulary Restrictive formulary Restrictive formulary

Designated Service Provider Service provider of choiceMedi-Rite, Dis-Chem &

Pharmacy DirectMedi-Rite, Dis-Chem & Pharmacy Direct

HIV/AIDS medicine benefit including treatment for mother-to-child-transmission, rape & post-exposure prophylaxis

Limit Unlimited



Embolic Protection DevicesSee combined benefit limit for all



Shoulder replacement R40 109 R31 354 R25 083

Elbow replacement R40 109 R31 354 R25 083

Hip replacement R40 109 R31 354 R25 083

Knee replacement R40 109 R31 354 R25 083

Total ankle replacementSee combined benefit limit for all



Bone lengthening devicesSee combined benefit limit for all



Spinal plates and screwsSee combined benefit limit for all



Other approved spinal

implantable devices

See combined benefit limit for all



Intraocular lenses (per lens) R2 958 R2 958 R2 958

†Combined benefit limit for all

unlisted internal prosthesis†R32 537 †R26 266 †R22 480

Prostheses

ExternalR19 700 at cost R15 600 at cost R10 500 at cost

Psychiatric Services:

Accommodation in a general

ward, procedures, ECT, materials

and hospital equipment,

consultations and visits,

medicines and injection material

R36 300 (See HPT) R28 900 (See HPT) R22 600 (See HPT)

Renal dialysis (chronic):

Consultations, visits, all services,

materials and medicines

associated with the cost of renal

dialysis

Unlimited at 100% of

Fedhealth Rate

R500 000 at 100% of

Fedhealth RateR400 000 at 100% of Fedhealth Rate

Specialised Medication (eg.

biologicals) Benefit (oncology &

non-oncology)

R313 000 at cost R156 000 at cost No benefit

Specialised radiology Unlimited at Fedhealth Rate Unlimited at the Fedhealth Rate. First R1 900 for non-PMB MRI & CT scans for the member’s account

Spinal surgery

No benefit unless Conservative

Back and Neck Rehabilitation

programme has been completed

No benefit unless Conservative Back and Neck Rehabilitation programme has been completed.


Take-out medicines 7 days medication per hospital event at MPL

Terminal care benefit R27 900 at Fedhealth Rate

HPT - Healthcare Professional Tariff | FR - Fedhealth Rate | *ICON - Independent Clinical Oncology Network | DSP - Designated Service Provider | MPL - Medicine Price List

Non-compliance with DSP and/ or formulary requirements will attract a co-payment of 40%. All medicine claims are subject to the Medicine Price List (MPL), a generic reference price list, and the maximum negotiated dispensing fee. Where the dispensing fee has not been negotiated, a maximum dispensing fee of 26%/ R26 will apply.


BENEFIT LIMIT PER FAMILY PER YEAR

Tariff Up to 100% of FR

Co-payments in Threshold No co-payment 10% co-payment 20% co-payment

Appliances, external accessories and orthotics: Hearing aids, wheelchairs etc

R14 000 per family per year before & after Threshold. Subject to Sav-ings, OHEB & Threshold. (R3 910 sub-limit for foot orthotics)

In and out-of-hospital: subject to Savings & OHEB. Does not ac-cumulate to Threshold. Paid from Threshold up to R14 000 per family per year. (R3 910 sub-limit for foot orthotics)

In and out-of-hospital: subject to Savings. Does not accumulate to Threshold. Paid from Threshold up to R10 500 per family per year. (R3 910 sub-limit for foot orthotics)

Alternative healthcare: Acupuncture, homeopathy, naturopathy, osteopathy and phytotherapy (including prescribed medication)

Subject to Savings and OHEB. Does not accumulate to or pay from Threshold

Subject to Savings and OHEB. Does not accumulate to or pay from Threshold

Subject to Savings. Does not accumulate to or pay from Threshold

Additional Medical Services: Audiology, dietetics, genetic counselling, hearing aid acous-tics, occupational therapy, orthoptics, podiatry, private nursing*, psychologists, social workers, speech therapy

R15 700 per family per year before & after Threshold. Subject to Savings, OHEB & Threshold

In and out-of-hospital: subject to Savings & OHEB. Does not accumulate to Threshold. Paid from Threshold up to R15 700 per family per year

In and out-of-hospital: subject to Savings. Does not accumulate to Threshold. Paid from Threshold up to R10 500 per family per year

Dentistry Advanced: inlays, crowns, bridges, mounted study models, metal base partial dentures, osseo-integrated im-plants, orthognathic surgery, oral surgery, orthodontic treatment, periodontists, prosthodontists and dental technicians

R6 740 per beneficiary per year, R20 000 per family per year before and after Threshold. Subject to Savings, OHEB and Threshold


R6 740 per beneficiary per year, R20 000 per family per year before and after Threshold. Subject to Savings and Threshold

Dentistry (Basic) Subject to Savings, OHEB and Threshold. Unlimited once Threshold is reached

Subject to Savings, OHEB and Threshold. Unlimited once Threshold is reached

Subject to Savings and Threshold. Unlimited once Threshold is reached

Family PractitionersFedhealth Network FPs


Subject to OHEB then unlimited from Risk

Subject to OHEB then unlimited from Risk

Unlimited FP consultations paid from Risk never from Savings

Subject to Savings, OHEB and Threshold. Unlimited accumulation to and refund from Threshold at FR

Subject to Savings, OHEB and Threshold. Unlimited accumulation to and refund from Threshold at FR

Subject to Savings and Threshold. Unlimited accumulation to and refund from Threshold at FR

Maternity benefit

Limited to 2 x 2D antenatal scans per pregnancy before and after Threshold. Subject to Savings, OHEB and Threshold

Limited to 2 x 2D antenatal scans per pregnancy before and after Threshold. Subject to Savings, OHEB and Threshold

Limited to 2 x 2D antenatal scans per pregnancy before and after Threshold. Subject to Savings and Threshold

Optometry: frames, single vision, bifocal, multifocal or special lenses, lens add-ons, contact lenses, Readers and optometric examinations




Over-the-counter medication: Subject to Savings only. Does not accumulate to or pay from Threshold

Subject to Savings only. Does not accumulate to or pay from Threshold

Subject to Savings. Does not accumulate to or pay from Threshold

PathologySubject to Savings, OHEB and Threshold. Unlimited once Threshold is reached



Physical therapy: biokinetics, chiropractics and physiotherapy


Subject to Savings and OHEB. Does not accumulate to Threshold. Paid from Threshold up to the Additional Medical Services limit of R15 700 per family per year

Subject to Savings. Does not accumulate to Threshold. Paid from Threshold up to the Additional Medical Services limit of R10 500 per family per year

Day-to-Day Benefit Day-to-day expenses are covered from available funds in your Savings Account and Out-of-Hospital Expenses Benefit (OHEB).

Limits may apply when calculating certain claims for accumulation to Threshold. These limits will also apply for refunds from OHEB and Threshold

14

LIST 1: PMB conditions (all options) LIST 2: (Maxima Plus, Exec, and Standard) LIST 3: (Maxima Plus and Exec)

Addison’s DiseaseAsthmaBipolar Mood DisorderBronchiectasisCardiac FailureCardiomyopathyCOPD/ Emphysema/ Chronic BronchitisChronic Renal DiseaseCoronary Artery DiseaseCrohn’s DiseaseDiabetes InsipidusDiabetes Mellitus type 1 & 2DysrhythmiasEpilepsyGlaucomaHaemophiliaHyperlipidaemiaHypertensionHypothyroidismMultiple SclerosisParkinson’s DiseaseRheumatoid ArthritisSchizophreniaSystemic Lupus ErythematosusUlcerative Colitis

Ankylosing SpondylitisAnorexia NervosaAttention Deficit Disorder (in children only)Bulimia NervosaDepressionDermatomyositisGeneralised Anxiety DisorderNarcolepsyObsessive Compulsive DisorderPanic DisorderParaplegia/ Quadriplegia (associated medicine)Post-Traumatic Stress SyndromeSclerodermaTourette’s Syndrome

AnginaBarrett’s OesophagusConn’s SyndromeCushing’s SyndromeDeep Vein ThrombosisGastro-Oesophageal Reflux DiseasePolyarteritis NodosaPulmonary Interstitial FibrosisThromboangitis ObliteransThrombocytopaenic PurpuraValvular Heart DiseaseZollinger-Ellison Syndrome

* Private nursing that falls outside the Alternatives to Hospitalisation Benefit

15

Hospital Name Province Town

Life St Mary’s Private Hospital Eastern Cape Umtata

Life Queenstown Private Hospital Eastern Cape Queenstown

Riemland Clinic Free State Frankfort

St Helena Hospital Free State Welkom

Botshilu Private Hospital Gauteng Soshanguve

Clinix Botshelong-Empilweni Private Hospital Gauteng Vosloorus

Clinix Naledi-Nkanyezi Private Hospital Gauteng Sebokeng

Clinix Lesedi Private Hospital Gauteng Southdale

Clinix Tshepo-Themba Private Hospital Gauteng Soweto

Zamokhule Private Hospital Gauteng Tembisa

Folateng Pretoria West Hospital Gauteng Pretoria West

Folateng Helen Joseph Hospital Gauteng Auckland Park

Folateng Sebokeng Hospital Gauteng Sebokeng

Louis Pasteur Hospital Gauteng Pretoria

La Verna Private Hospital KwaZulu-Natal Ladysmith

Shifa Private Hospital KwaZulu-Natal Durban

Pongola Hospital KwaZulu-Natal Pongola

Zoutpansberg Private Hospital Limpopo Polokwane

Mediclinic Tzaneen Limpopo Tzaneen

Clinix Phalaborwa Private Hospital Mpumalanga Phalaborwa

Life Piet Retief Hospital Mpumalanga Piet Retief

Clinix Itokolle - Victoria Private Hospital North West Mafikeng

Vryburg Private Hospital Northern Cape Vryburg

Lenmed Health Kathu Private Hospital Northern Cape Kathu

Ceres Private Hospital Western Cape Ceres

Bellville Medical Centre Western Cape Bellville

Mitchell’s Plain Medical Centre Western Cape Mitchell’s Plain

Maxima StandardElect Hospital Network


BENEFIT LIMIT PER FAMILY PER YEAR


R8 980 per beneficiary per year, R17 800 per family per year be-fore and after Threshold. Subject to Savings, OHEB and Threshold

R6 430 per beneficiary per year, R11 900 per family per year be-fore and after Threshold. Subject to Savings, OHEB and Threshold


Radiology (general)Subject to Savings, OHEB and Threshold. Unlimited once Threshold is reached



Radiology (specialised)Paid from the Major Medical Benefit if pre-authorised

Paid from the Major Medical Benefit if pre-authorised. First R1 900 for non-PMB MRI/CT Scans is for the member’s account

Specialists excluding PsychiatristsFedhealth Network Specialists

Non-Fedhealth Network Specialists

Subject to Savings, OHEB and accumulation at cost to Threshold. Unlimited at cost once Threshold is reached

Subject to Savings, OHEB and accumulation at cost to Threshold. Unlimited at cost once Threshold is reached

Subject to Savings and accumulation at cost to Threshold. Unlimited at cost once Threshold is reached

Subject to Savings, OHEB and Threshold. Accumulation to and refund from Threshold at Fedhealth Rate only

Subject to Savings, OHEB and Threshold. Accumulation to and refund from Threshold at Fedhealth Rate only

Subject to Savings and Threshold. Accumulation to and refund from Threshold at Fedhealth Rate only

Specialists: PsychiatristsFedhealth Network Psychiatrists

Non-Fedhealth Network Psychiatrists

Subject to Additional Medical Services limit of R15 700 per family per year before and after Threshold. Subject to Savings, OHEB and accumulation at cost to Threshold

Subject to Savings and OHEB. Does not accumulate to Threshold. Paid at cost from Threshold up to the Additional Medical Services limit of R15 700 per family per year

Subject to Savings. Does not accumulate to Threshold. Paid at cost from Threshold up to the Additional Medical Services limit of R10 500 per family per year

Subject to Additional Medical Services limit of R15 700 per family per year before and after Threshold. Subject to Savings, OHEB and Threshold. Accumula-tion to & refund from Threshold at Fedhealth Rate only

Subject to Savings and OHEB. Does not accumulate to threshold. Paid at Fedhealth Rate from Threshold up to the Additional Medical Services limit of R15 700 per family per year

Subject to Savings. Does not accumulate to Threshold. Paid at Fedhealth Rate from Threshold up to the Additional Medical Services limit of R10 500 per family per year

OHEB - Out-of-Hospital Expenses Benefit | MPL - Medicine Price List | FR - Fedhealth Rate

Threshold Benefit

The Threshold Benefit pays for certain day-to-day expenses once your day-to-day benefits have been depleted and claims have accumulated up to the required level. The threshold level is reached through the accumulation of claims paid from member’s day-to-day benefits and the member’s own pocket through the year at the Fedhealth Rate. Certain benefit limits do not accumulate to Threshold. Where limits do accumulate, expenses will only accumulate up to this limit and this limit will also apply to refunds from Threshold. A 20% co-payment will apply to all claims paid from the Threshold Benefit on Maxima Standard and StandardElect and a 10% co-payment will apply to all claims paid from the Threshold Benefit on Maxima Exec. No co-payment will apply to FP and Specialist consultations in-network.

Sanlam Gap Cover is underwritten by Centriq Insurance Company Limited. Administered by Xelus (Pty) Ltd. Sanlam is a Licensed Financial Services Provider.Wellworx is an authorised Financial Services Provider, mandated by Fedhealth Medical Scheme to sell Fedhealth and other complimentary financial services products.

38173_FedHealthy_GAP Cover Print ad_Lamp_297x210.indd 1

Sanlam Gap Cover is underwritten by Centriq Insurance Company Limited. Administered by Xelus (Pty) Ltd. Sanlam is a Licensed Financial Services Provider.Wellworx is an authorised Financial Services Provider, mandated by Fedhealth Medical Scheme to sell Fedhealth and other complimentary financial services products.

Often your medical aid won’t cover your hospital

expenses in full. That’s when Sanlam Gap Cover takes

care of the shortfall. We ensure that Fedhealth members

not only end up with a clean bill of wealth, but also

have peace of mind knowing that their claims will be

automatically submitted and paid out without the hassle

of even more paperwork. Because whether it’s your

physical or financial well-being we look after, we strive to

do it really well. That’s what makes us Wealthsmiths™.

For more information or to apply, please contact

Wellworx on 0860 732 524.

KIN

GJA

MES

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38173_FedHealthy_GAP Cover Print ad_Lamp_297x210.indd 1 2016/09/23 3:40 PM

Our saver options at a glance:

The perfect fit for families starting out

Whether you’re single, have a partner or are getting used to sleepless nights brought about by life’s biggest little blessing, making the right healthcare decisions for your family is crucial.

Our saver options give you an excellent combination of hospital cover AND limited day-to-day spending, and are ideal for families just starting out.

Fedhealth offers four saver options: Maxima Advanced, Maxima Basis, Maxima Saver and Maxima EntrySaver.

On Maxima Advanced, Maxima Saver and Maxima Basis, you have access to unlimited hospitalisation at all private hospitals, whilst Maxima EntrySaver offers unlimited hospitalisation at Fedhealth Network hospitals only.

To protect our members’ pockets, we’ve introduced GRID options on Maxima Basis and Maxima Saver. This means that members can pay a lower monthly contribution by opting to use Fedhealth Network providers only.

Please refer to the next page for a summary of all the benefits offered by our saver options.

17

SA

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RA

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E

02

DAY-TO-DAYBENEFIT



FOUNDATION BENEFIT

18

Saver Options



Non-network FPs


Hospitalisation

Oncology

Organ transplant

Renal dialysis



FROM R2 501pm

FROM R2 079pm

Maxima Basis Maxima Saver

FROM R1 640pm



Maxima EntrySaver

No overall annual limit Network hospitals only

R250 000 R250 000 PMBs only

R250 000 R250 000 PMBs only (state facility only)

R250 000 R250 000 PMBs only (state facility only)

No benefit

PMB chronic conditions only from Medi-Rite, Dis-Chem or Pharmacy Direct and subject

to a restrictive formulary. Covers up to 100% of the

Medicine Price List

Quick Comparison

Unlimited FP visits at a nominated Fedhealth Network FP once Savings has been depleted

In and out-of-hospital: unlimited specialised radiology paid from the Major Medical Benefit if pre-authorised. First R1 900 for non-PMB MRI/CT Scans is for the member’s account

R3 168 per principal member p.a.


Optometry - One consultation, one pair

single vision or bifocal lenses per beneficiary and a frame

valued at R182 per beneficiary every two years (Savings

doesn’t have to be depleted to use this Scheme benefit)

Maternity - Two 2D antenatal scans,

antenatal classes, six antenatal or postnatal consultations

and one amniocentesis per year once Savings has been depleted

Basic dentistry - Two annual dentist consultations per beneficiary (incl. scaling and polishing) at a Fedhealth Network dentist once Savings has been

depleted





to a basic formulary. Covers up to 100% of the Medicine Price List

In and out-of-hospital: unlimited specialised radiology paid from the Major Medical Benefit if pre-

authorised. First R2 500 fornon-PMB MRI/CT Scans is for

the member’s account

Day-to-Day Benefit

Foundation Benefit

The option-dependent Foundation benefit offers members a host of valuable benefits, from important health screenings to

maternity benefits

FROM R3 251pm

Maxima Advanced

R400 000

R400 000

R400 000

R156 000

Majo

r M

ed

ical B

enefi

t

51 conditions.R4 240 per beneficiary.

R7 620 per family


19


SC

RE

EN

ING

BE

NE

FIT

BIR

TH

& B

AB

Y B

EN

EF

IT

Maxima Advanced Maxima Basis Maxima Saver

Maxima EntrySaver


Women's HealthBreast cancer screening with mammography



1 every 3 years


1 every 3 years

Children's HealthImmunisation Programme (as per State EPI)

Various 3 3 3 3


All lives; aged 20

and older1 every 5 years

Over 50sPneumococcal vaccination

Bone densitometry

Colorectal cancer screening (faecal occult blood test)

All lives; older than 65

1 per lifetime N/A N/A N/A

Women; older than 65

1 per lifetime N/A N/A N/A

All lives; 50 to 75

1 every 2 years N/A N/A N/A





Health risk assessmentsWellness screening (BMI, blood pres-sure, finger prick cholesterol & glucose tests)






3 3 3 3

Doula benefit R1 200 per delivery


3 3 3 3

Postnatal midwifery benefit All pregnant members and dependants

4 consultations with a midwife in and out-of-hospital per pregnancy

Maternity benefitAll pregnant

members and dependants

Subject to Savings

2 x 2D antenatal scans per year; Antenatal classes up to R950 by a midwife; a total of 6 ante- or postnatal consultations or a mix thereof with a midwife, network gynaecologist or network FP, 1 amniocen-tesis. Subject to Savings then Risk

Subject to Savings

Unlimited FP visits All lives No benefit Unlimited consultations at a nominated Fedhealth Network FP once your current year's savings has run out

Fedhealth Nurse Line All lives 3 3 3 3

Trauma counselling All lives 3 3 3 3

Emergency transport/ response All lives 3 3 3 3

Comprehensive managed care programmes Pharmacy benefit management, Hospital benefit management, Aid for AIDS (AfA), Oncology disease management

All lives 3 3 3 3

Active disease risk management Conservative Back & Neck Rehabili-tation Programme, Mental health programme, Cardiac rehabilitation programme

All lives 3 3 3 3

Post-hospitalisation treatment benefit

All lives 3 3 3 3

Take-home medicine All lives 3 3 3 3

Specialised radiologyIn and out-of-hospital

All livesUnlimited at Fedhealth Rate.

First R1 900 for non-PMB MRI/CT Scans for member’s account

Unlimited at Fedhealth Rate. First R2 500 for non-

PMB MRI/CT Scans for member’s account

Trauma treatment at a casualty ward

All lives R500 co-payment per visit for non PMBs

Female contraception All lives 3 3 3 3

In-hospital dentistryChildren up to

the age of seven 3 3 3 No benefit

EX

TE

ND

ED

CA

RE

BE

NE

FIT

20


Maxima Advanced Maxima Basis Maxima Saver

Maxima EntrySaver


Dentistry (Basic) All lives Subject to Savings

Subject to Savings. Once Savings is depleted the following benefits will be paid from Risk: 2 annual consultations includ-ing scaling & polishing. Subject to a contracted list of dentists & limited to a list of approved procedures, dental tariff codes & protocols. Plastic dentures limited to one set per beneficiary every two years

Subject to Savings

Optometry: frames, single vision, bifocal, multifocal or special lenses, lens add-ons, contact lenses, Readers and optometric examinations

All lives Subject to Savings

Optical benefits provided by an Optical Network Provider payable from Risk. 1 comprehensive consultation, 1 pair single vision or bifocal lenses, frame (use Savings for enhanced frame) R182 every 24 months

Subject to Savings

Maxima Advanced Maxima Basis Maxima Saver Maxima EntrySaver


Overall annual limit (OAL) Unlimited

Unlimited at network hospitals only. R5 600 co-payment on voluntary use of non-network hospital

Healthcare Professional Tariff in hospital (HPT)Fedhealth Network FPs and Specialists




Covered at cost

Covered at 100% of FR



Covered at cost




Covered at cost




Covered at cost




Prescribed Minimum Benefits (PMB): Treatment for PMB conditions can be funded in two ways:

To have the treatment for PMB conditions covered in full, you will have to use Fedhealth Network FPs & specialists

To have the treatment for PMB conditions covered in full, you

will have to use Fedhealth Network FPs, hospitals &

specialists

Should you choose not to make use of network providers, the Scheme will only refund treatment at 100% of the Fedhealth Rate and you will have a co-payment should the healthcare professional charge more

Hospitalisation costs: accommodation in a general ward, high care ward and intensive care unit, theatre fees, medicine, material and hospital apparatus


Unlimited at negotiated tariff at network hospitals only. R5 600 co-payment on voluntary use of non-network hospitals

Co-payments (per event) applicable on the hospital/ facility bill only

All open hernia repairs



Balloon sinuplasty

Bunion procedures

Cataract surgery


Cystoscopy

Dental admissions

No co-payment

R2 100

No co-payment

R3 700

No co-payment

No co-payment

R2 100

No co-payment

No co-payment

R3 700

R6 900

No co-payment

No benefit

No co-payment

No co-payment

R3 700

No co-payment

No co-payment

R3 700

R6 900

R5 300

No benefit

R5 300

R5 300

R3 700

R5 300

R5 800

R5 300

R6 900

R5 300

No benefit

R5 300

R5 300

R5 300

R5 300

No benefit

EX

TE

ND

ED

CA

RE

BE

NE

FIT

HPT - Healthcare Professional Tariff | FR - Fedhealth Rate | *ICON - Independent Clinical Oncology Network | DSP - Designated Service Provider | MPL - Medicine Price List

21



Elective Caesarean sections



Hysterectomy (unless for cancer)

Joint replacements

Laparoscopic hernia repairs(bilateral inguinal, repeated inguinal hernias & nissen/toupey hernia repairs only)


Nasal procedures

Rhizotomies and facet pain blocks (limited to 1 of either procedure per beneficiary per year)


Spinal surgery




No co-payment

No co-payment

R2 100

No co-payment

R3 700*

R3 700

R3 700

No co-payment

R3 700

No co-payment

R3 700**

R3 700

No co-payment

No co-payment

No co-payment

No co-payment

R6 900

No co-payment

R5 300*

R5 800

R5 800

No co-payment

No benefit

No co-payment

R5 300**

R3 700

No co-payment

No co-payment

R5 300

R5 300

R6 900

R5 300

PMBs in state facility

R5 800

R5 800

R5 300

No benefit

R5 300

R5 300**

R3 700

R5 300

R5 300

R10 000

R5 300


R5 300


R5 800

R5 800

R5 300

No benefit

R5 300

R5 300**

No benefit

R5 300

R5 300


(dietetics, occupational therapy and

speech therapy)In and out-of-hospital: subject to Savings

Physical therapy (physiotherapy

and biokinetics) Subject to referral by a medical practitioner, pre-authorisation and treatment protocols

Alternatives to hospitalisation:

Nursing services, private nurse

practitioners & nursing agencies

Sub-acute facilities, physical

rehabilitation facilities


Unlimited at negotiated tariff Covered up to PMB level of care



and orthoticsIn and out-of-hospital: subject to Savings

Blood, blood equivalents and blood

productsUnlimited

Immune deficiency related to HIV

infectionUnlimited (see HPT)

MaternityHealthcare Professional Tariff in hospital (HPT)Fedhealth Network FPs and Specialists (eg. gynaecologists & paediatricians)



Other Healthcare Professionals Postnatal midwifery

Covered at cost




Covered at cost




Covered at cost




Covered at cost






- Surgical extraction of impacted

wisdom teeth


You pay a co-payment of R3 700 on the hospital bill No benefit

Emergency treatment in a casualty

wardUnlimited at 100% of Fedhealth Rate. Co-payment of R500 per visit for non PMBs

Female Health Benefit:

contraceptivesUnlimited at MPL

* Must use ICPS for non-PMB hip and knee joint replacements. Non-use of ICPS will result in no benefit

** No benefit unless Conservative Back and Neck Rehabilitation Programme has been completed

22



Oncology: Oncologist consultations,

visits, treatment and materials for

chemotherapy and radiotherapy,

approved medication, radiology and

pathology


R400 000 at preferred

provider* & subject to level

2 treatment protocols. DSP*

above limit

R156 000 at cost

R250 000 at designated service provider* and subject to level 1

treatment protocols. 40% co-payment for non-use of DSP

No benefit

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

No benefit

Organ transplant including

immunosuppression medication

Corneal graft

R400 000 (See HPT)

R18 700 per beneficiary

R250 000 (See HPT)

Covered up to PMB level of

care in state facilities

No benefit


Post-hospitalisation Up to 30 days after discharge at 100% of Fedhealth Rate subject to protocols

Prostheses Internal - Various

sub-limits apply

This benefit does not include osseo-integrated implants for the purpose of replacing a missing tooth or teeth.

Hip and knee bilateral replacements will be allowed for up to double the amount for a single hip and knee replacement.

Detachable platinum coils

Cardiac stents

Cardiac valves

Cardiac pacemakers

Carotid Stents

Aorta Stent Grafts

Peripheral Arterial Stent Grafts

Embolic Protection Devices

Shoulder replacement

Elbow replacement

Hip replacement

Knee replacement

Total ankle replacement

Bone lengthening devices

Spinal plates and screws

Other approved spinal implantable devices

Intraocular lenses (per lens)

†Combined benefit limit for all unlisted internal prosthesis

R47 800

R45 078

R40 109

R53 123

R19 286

R53 124

R36 086

R47 800

R42 594

R42 594

R42 594

R42 594

See combined benefit limit for all unlisted internal prosthesis†

R42 594

R42 594

R42 594

R2 958

†R33 010

R45 670

PMBs only

PMBs only

PMBs only


R52 651







No benefit




R2 958

†R22 480


External R15 600 at cost R10 500 at cost R9 940 at costCovered up to PMB level

of care

Psychiatric Services: Accommodation in a general ward, procedures, ECT, materials and hospital equipment, consultations and visits, medicines and injection material

R26 400 (see HPT) R22 600 (see HPT) R21 400Covered up to PMB level

of care

Renal dialysis (chronic): Consultations, visits, all services, materials and medicines associated with the cost of renal dialysis

R400 000 at 100% Fedhealth Rate

R250 000 at 100% Fedhealth RateCovered up to PMB level of care in state facilities


(eg. biologicals) Benefit (oncology &

non-oncology)

R156 000 at cost No benefit

Specialised radiologyUnlimited at the Fedhealth Rate. First R1 900 for non-PMB MRI/ CT scans for the

member’s account

Unlimited at the Fedhealth

Rate. First R2 500 for

non-PMB MRI/ CT scans for


Spinal Surgery No benefit unless Conservative Back and Neck Rehabilitation Programme has been completed



* Preferred provider and DSP (Designated Service Provider) is ICON (Independent Clinical Oncology Network)

23

Day-to-Day Benefit Day-to-day expenses are covered from available funds in your Savings Account




and orthotics: Hearing aids,

wheelchairs etc

Subject to Savings

Alternative healthcare:

Acupuncture, homeopathy,

naturopathy, osteopathy

and phytotherapy (including

prescribed medication)

Subject to Savings

Additional medical services:

Audiology, dietetics, genetic

counselling, hearing aid

acoustics, occupational therapy,

orthoptics, podiatry, private

nursing*, psychologists, social

workers, speech therapy

Subject to Savings

LIST 1: PMB conditions (all options) LIST 2: (Maxima Advanced)

Addison’s DiseaseAsthmaBipolar Mood DisorderBronchiectasisCardiac FailureCardiomyopathyCOPD/ Emphysema/ Chronic BronchitisChronic Renal DiseaseCoronary Artery DiseaseCrohn’s DiseaseDiabetes InsipidusDiabetes Mellitus type 1 & 2DysrhythmiasEpilepsyGlaucomaHaemophiliaHyperlipidaemiaHypertensionHypothyroidismMultiple SclerosisParkinson’s DiseaseRheumatoid ArthritisSchizophreniaSystemic Lupus ErythematosusUlcerative Colitis

AnginaAnkylosing SpondylitisAnorexia NervosaAttention Deficit Disorder (in children only)Barrett’s OesophagusBulimia NervosaConn’s SyndromeCushing’s SyndromeDeep Vein ThrombosisDepressionDermatomyositisGastro-Oesophageal Reflux DiseaseGeneralised Anxiety DisorderNarcolepsyObsessive Compulsive DisorderPanic DisorderParaplegia/ Quadriplegia (associated medicine)Polyarteritis NodosaPost-Traumatic Stress SyndromePulmonary Interstitial FibrosisSclerodermaThromboangitis ObliteransThrombocytopaenic PurpuraTourette’s SyndromeValvular Heart DiseaseZollinger-Ellison Syndrome




Limit

R4 240 per beneficiary, subject to an overall limit of R7 620 per

family per year

Prescribed Minimum Benefits only

IN-BENEFIT

Conditions covered51 Chronic Conditions.

See lists 1 & 2 below25 Chronic Conditions. See list 1 below

Formulary Restrictive formulary Basic formulary

Designated Service Provider Medi-Rite, Dis-Chem & Pharmacy Direct

OUT-OF-BENEFIT (List 1 below)

Formulary Restrictive formulary

Out-of-benefit does not applyDesignated Service Provider

Medi-Rite, Dis-Chem & Phar-macy Direct


Limit Unlimited


24



Dentistry Advanced: Inlays,

crowns, bridges, mounted study

models, metal base partial

dentures, osseo-integrated

implants, orthognathic surgery,

oral surgery, orthodontic

treatment, periodontists,

prosthodontists and dental

technicians

Subject to Savings

Dentistry (Basic) Subject to Savings

Subject to Savings. Once Savings is depleted the following benefits

will be paid from Risk:

2 annual consults pb incl scaling & polishing. Subject to a contracted

list of dentists and limited to a list of approved procedures, dental

tariff codes and protocols. Plastic dentures limited to one set per

beneficiary every two years

Subject to Savings

Radiology (general) and

PathologySubject to Savings

Family Practitioners

Fedhealth Network FPs


Subject to Savings

Subject to Savings. Unlimited FP visits at nominated Fedhealth Network FP once Savings is depleted.

Use of non-nominated FP limited to two visits per beneficiary per year at a network FP (referred to as

out-of-area)

Subject to Savings

Maternity benefit Subject to Savings

Subject to Savings. Once Savings

is depleted the following benefits

will be paid from Risk:

2 x 2D antenatal scans; Antenatal

classes up to R950 by a midwife;

a total of 6 ante-or postnatal

consultations or a mix thereof

with a midwife, network

gynaecologist or network FP, 1

amniocentesis. All benefits and

limits are per year

Subject to Savings

Optometry Subject to Savings

Optical benefits provided

by an Optical Network

Provider payable from Risk. 1

comprehensive consultation pb, 1

pair single vision or bifocal lenses

pb, frame pb (use savings for

enhanced frame) R182 pb every

24 months

Subject to Savings

Over-the-counter medication Subject to Savings

Physical therapy: Biokinetics,

chiropractics and physiotherapySubject to Savings

Prescribed medication Subject to Savings

Specialised RadiologyPaid from the Major Medical Benefit if pre-authorised. First R1 900 for non-PMB

MRI/CT scans is for the member’s account

Paid from the Major Medical

Benefit if pre-authorised. First

R2 500 for non-PMB MRI/CT

scans for

member’s account

Specialists

Fedhealth Network Specialists


Specialists

Subject to Savings

Subject to Savings

1971N_September 2016 Fedhealth Advert.indd 1

25

There’s nothing quite like having the freedom of choice. That’s why

Fedhealth now gives members, a choice between regular and ‘GRID’

options on Maxima Basis and Maxima Saver.

This innovation provides members with a choice between regular and

network hospitals – or hospitals on the Fedhealth GRID – on selected

options. By committing to a GRID option members will still be able to

enjoy all the same great benefits of the regular option, but they will just

have to make use of our approved network hospitals. In return, members will benefit from a lower monthly premium, which can be up to 10% less than the normal contribution!

We’ve introduced this option for those members who don’t mind using

a network hospital, especially since there are so many excellent network

hospitals conveniently located around the country. Simply refer to page

27-30 to see the complete list of Fedhealth network hospitals.

With these new GRID options, we are giving our members the freedom to

choose, and ultimately, protecting their pocket!

Maxima SaverGRID options

NETWORK HOSPITALS ONLY

or a co-payment of R10 000 will apply

Only use a nominated Fedhealth network FP

to get UNLIMITED FP VISITS

Refer to the list of Fedhealth network hospitals on page 27-30

Pay up to 10% less by opting to use network hospitals only!

Members on GRID options should note:

Risk Savings TOTAL

Member 2 126 375 2 501

Adult Dependant 1 810 319 2 129

Child Dependant 641 113 754

Maxima Basis

+ = Risk Savings TOTAL

Member 1 913 338 2 251



Maxima BasisGRID

+ =

Risk Savings TOTAL

Member 1 767 312 2 079



+ =

Maxima Saver

Risk Savings TOTAL

Member 1 590 281 1 871



+ =

Maxima SaverGRID

Just see how much your clients can save by choosing the

GRID option!

Brand new Brand new Brand new Brand new Brand new from Sanlam Reality!Sanlam Reality!

All Fedhealth members not on Reality Health All Fedhealth members not on Reality Health will get FREE registration as Reality Access will get FREE registration as Reality Access members and enjoy free international travel

insurance from 1 January 2017.

1971N_September 2016 Fedhealth Advert.indd 1 2016/09/28 10:21 AM

27

HOSPITAL NAME PROVINCE TOWN

Life Beacon Bay Hospital Eastern Cape East London

Life St James Hospital Eastern Cape East London

Greenacres Hospital Eastern Cape Greenacres

Port Alfred Hospital Eastern Cape Port Alfred

Settlers Hospital Eastern Cape Grahamstown

East London Eye Hospital Eastern Cape East London

Matatiele Private Hospital Eastern Cape Matatiele

Cuyler Clinic Eastern Cape Uitenhage

Mthatha Private Hospital Eastern Cape Mthatha

Pelonomi Private Hospital Free State Bloemfontein

Universitas Private Hospital Free State Bloemfontein

Vaalpark Hospital Free State Sasolburg

Busamed Harrismith Free State Harrismith


Cairnhall Hospital Free State Bloemfontein

Kroon Hospital Free State Kroonstad


Clinix Botshelong - Empilweni Private Hospital Gauteng Vosloorus

Clinix Dr SK Matseke Memorial Hospital Gauteng Soweto

Clinix Solomon Stix Morewa Memorial Hospital Gauteng Johannesburg

Clinix Tshepo - Themba Private Hospital Gauteng Dobsonville

Akasia Hospital Gauteng Akasia

Bougainville Hospital Gauteng Daspoort

Clinton Hospital Gauteng Alberton

Femina Hospital Gauteng Arcadia

Garden City Hospital Gauteng Mayfair West

Jakaranda Hospital Gauteng Muckleneuk

Krugersdorp Hospital Gauteng Krugersdorp

Linksfield Hospital Gauteng Linksfield West

Linkwood Hospital Gauteng Linksfield West

Linmed Hospital Gauteng Benoni

Milpark Hospital Gauteng Parktown West

Montana Hospital Gauteng Montana Park

Moot Algemene Hospital Gauteng Rietfontein

Mulbarton Hospital Gauteng Mulbarton

N17 Hospital Gauteng Springs

Olivedale Hospital Gauteng Olivedale

Optiklin Hospital Gauteng Benoni

Park Lane Hospital Gauteng Parktown

Pinehaven Hospital Gauteng Krugersdorp

Pretoria East Hospital Gauteng Moreleta Park

Rosebank Hospital Gauteng Rosebank

Sunward Park Hospital Gauteng Boksburg

Union Hospital Gauteng Alberton

Unitas Hospital Gauteng Centurion

Waterfall City Hospital Gauteng Midrand

Arwyp Medical Centre Gauteng Kempton Park


Lakeview Hospital Gauteng Benoni

Lenmed Health Ahmed Kathrada Private Hospital Gauteng Lenasia

Lenmed Health Daxina Private Hospital Gauteng Lenasia

Lenmed Health Randfontein Private Hospital Gauteng Randfontein

Lenmed Health Zamokuhle Private Hospital Gauteng Tembisa

Louis Pasteur Private Hospital Gauteng Pretoria

Medfem Clinic Gauteng Bryanston

Urolocare Hospital Gauteng Hatfield

Zuid-Afrikaanse Hospitaal Gauteng Pretoria

Naledi-Nkanyezi Private Hospital Gauteng Sebokeng

Cormed Clinic Gauteng Vanderbijlpark

Maxima Saver Option Range - Network HospitalsMaxima BasisGRID, Maxima SaverGRID and Maxima EntrySaver

28


Midvaal Private Hospital Gauteng Vereeniging

Kingsway Hospital KwaZulu-Natal Amanzimtoti

Parklands Hospital KwaZulu-Natal Overport

St Augustine’s Hospital KwaZulu-Natal Durban

Umhlanga Hospital KwaZulu-Natal uMhlanga Rocks

Ethekwini Hospital And Heart Centre KwaZulu-Natal Durban

Gateway Private Hospital KwaZulu-Natal Umhlanga Rocks

Hillcrest Private Hospital KwaZulu-Natal Hillcrest

Lenmed Health Shifa Private Hospital KwaZulu-Natal Mayville

Alberlito Hospital KwaZulu-Natal Ballito

Hibiscus Hospital KwaZulu-Natal Port Shepstone


Margate Private Hospital KwaZulu-Natal Margate

St Anne’s Hospital KwaZulu-Natal Pietermaritzburg

The Bay Hospital KwaZulu-Natal Richards Bay

Kokstad private Hospital KwaZulu-Natal Kokstad

Pholoso Hospital Limpopo Polokwane

Clinix Phalaborwa Private Hospital Limpopo Phalaborwa

Quality Care Private Hospital Limpopo Louis Trichardt

Zoutpansberg Private Hospital Limpopo Louis Trichardt

St Vincents Hospital Limpopo Bela-Bela

Emalahleni Private Hospital Mpumalanga Witbank

Kiaat Private Hospital Mpumalanga Nelspruit

Lowveld Hospital Mpumalanga Nelspruit

Nelspruit Surgiclinic Private Hospital Mpumalanga Nelspruit

Ferncrest Hospital North West Rustenburg

Fochville Hospital North West Fochville

Leslie Williams Hospital North West Carletonville

Mooimed Private Hospital North West Potchefstroom

Rustenburg Medi Care Hospital North West Rustenburg

Sunningdale Hospital North West Klerksdorp

Vryburg Private Hospital North West Vryburg

Wilmed Park Private Hospital North West Klerksdorp

Clinix Victoria Private Hospital North West Mafikeng

Jane Keyser Clinic Northern Cape Hartswater


Mediclinic Kimberley Northern Cape Kimberley

Life Bay View Hospital Western Cape Mossel Bay

Life West Coast Private Hospital Western Cape Vredenburg

Blaauwberg Hospital Western Cape Sunningdale

Ceres Hospital Western Cape Ceres

Christiaan Barnard Memorial Hospital Western Cape Cape Town

Kuils River Hospital Western Cape Kuils River

N1 City Hospital Western Cape Goodwood


Busamed Paardevlei Private Hospital Western Cape Somerset West

Cape Eye Institute Western Cape Bellville

Gatesville Medical Centre Western Cape Gatesville

Mitchells Plain Medical Centre Western Cape Mitchells Plain

Tokai Medical Centre Western Cape Tokai

Rondebosch Medical Centre Western Cape Lansdowne

Maxima Saver Option Range - Network HospitalsMaxima BasisGRID, Maxima SaverGRID and Maxima EntrySaver


Med Forum Theatre Eastern Cape Port Elizabeth

Bethlehem Medical Centre Day Theatre Free State Bethlehem

Citymed Day Theatre Free State Bloemfontein

Cure Day Clinics - Bloemfontein Free State Bloemfontein

Welkom Medical Centre Free State Welkom

Boksburg Medical and Dental Centre Gauteng Boksburg

Constantia Clinic Gauteng Florida

Constantia Park Medical and Dental Centre Gauteng Garsfontein

Germiston Medical and Dental Centre Gauteng Germiston

Silverton Medical and Dental Theatre Gauteng Pretoria

The Berg Day Theatre Gauteng Bergbron

Protea Clinic Gauteng Krugersdorp

Advanced Groenkloof Day Hospital Gauteng Groenkloof

Medgate Day Hospital Gauteng Roodepoort

Advanced Soweto Eye Hospital Gauteng Soweto

Birchmed Surgical Centre Gauteng Kempton Park

Centre For Gynaecological Endoscopy Gauteng Morningside

Centre Of Advanced Medicine Gauteng Waverly

Centurion Eye Hospital Gauteng Centurion

Cure Day Clinics - Erasmuskloof Gauteng Erasmuskloof

Cure Day Clinics - Fourways Gauteng Fourways

Medkin Clinic Gauteng Pretoria

Cure Day Clinics - Midstream Gauteng Midstream

Edenvale Day Clinic Gauteng Edenvale

Ekurhuleni Surgiklin Day Clinic Gauteng Kempton Park

Fordsburg Day Clinic Gauteng Fordsburg

Intercare Day Hospital - Hazeldean Gauteng Silverlakes

Intercare Day Hospital - Irene Gauteng Irene

Sandton Day Clinic Gauteng Sandton

Johannesburg Eye Hospital Gauteng Randburg

Kilnerpark Narkokliniek Gauteng Pretoria

Mayo Clinic Gauteng Roodepoort

Ocumed Eye And Laser Institute Gauteng Vanderbijlpark

Optimed Clinic Gauteng Johannesburg

Sandhurst Eye Centre Gauteng Sandton

The Healthy Eye Theatre Gauteng Benoni

Twenty Twenty Eye Surgery Centre Gauteng Mulbarton

Visiclin Eye Clinic Gauteng Three Rivers

Visiomed Eye And Laser Centre Gauteng Randburg

Bluff Medical and Dental Centre KwaZulu-Natal Bluff

Malvern Medical and Dental Centre KwaZulu-Natal Malvern

Pinetown Medical and Dental Centre KwaZulu-Natal Pinetown

Westridge Surgical KwaZulu-Natal West Ridge

Howick Day Clinic KwaZulu-Natal Howick

KZN Day Clinic KwaZulu-Natal Umhlanga

Lorne Street Anaesthetic Clinic KwaZulu-Natal Durban

Shelly Beach Day Clinic KwaZulu-Natal Shelly Beach

Emalahleni Day Hospital Mpumalanga Witbank

Highveld Eye Hospital Mpumalanga Witbank

Potchefstroom Medical and Dental Centre North West Potchefstroom

Rustenburg Private Eye Clinic North West Rustenburg

Medi-Harts Day Clinic Northern Cape Hartswater

Kraaifontein Medical and Dental Centre Western Cape Kraaifontein

Monte Vista Clinic Western Cape Monte Vista

Parow Medical and Dental Centre Western Cape Parow

Tokai Medical and Dental Centre Western Cape Tokai

Advanced Knysna Surgical Centre Western Cape Knysna

Advanced Panorama Surgical Centre Western Cape Panorama

29

Maxima Saver Option Range - Network Day ClinicsMaxima BasisGRID, Maxima SaverGRID and Maxima EntrySaver


Advanced Vergelegen Surgical Centre Western Cape Somerset West

Advanced Worcester Surgical Clinic Western Cape Worcester

Cape Dental Theatres Western Cape Wynberg

Cure Day Clinics - Bellville Western Cape Parow

Cure Day Clinics - Somerset West Western Cape Somerset West

Cure Day Clinics - St Stephens Paarl Western Cape Paarl

Driftwood Clinic Western Cape Constantia

George Surgical Centre Western Cape George

Intercare Day Hospital - Century City Western Cape Century City

Kango Clinic (Kannaland Medical Clinic) Western Cape Oudtshoorn

The Surgical Institute Western Cape Durbanville

Thembani Theatres Western Cape Khayelitsha

Vidamed Day Hospital Western Cape Mossel Bay

Wesfleur Private Clinic Western Cape Atlantis

30

Maxima Saver Option Range - Network Day ClinicsMaxima BasisGRID, Maxima SaverGRID and Maxima EntrySaver

HO

SP

ITA

L O

PT

ION

RA

NG

E

03

31

Our hospital options at a glance:

A safety net when you need it most

When accidents and illness happen, or you’re about to welcome a new life into your family, it pays to be prepared by having appropriate hospital cover.

Our hospital plans can take care of you and your loved ones, with unlimited private hospitalisation at either private or Fedhealth Network hospitals, and chronic medication cover for 25 chronic conditions.

Fedhealth offers two hospital plans: Maxima Core and Maxima EntryZone.

On Maxima Core, you have access to unlimited hospitalisation at all private hospitals, whilst Maxima EntryZone offers unlimited hospitalisation at Fedhealth Network hospitals only.

To protect our members’ pockets, we’ve introduced a GRID option on Maxima Core. This means that members can pay a lower monthly contribution by opting to use Fedhealth Network hospitals only.

Please refer to the next page for a summary of all the benefits offered by our hospital plans.


FOUNDATION BENEFIT


32

Hospital Options



Non-network FPs


MajorMedicalBenefit

Hospitalisation

Oncology

Organ transplant

Renal dialysis







FROM R1 907pm

FROM R1 326pm

Maxima Core Maxima EntryZone

R250 000 PMBs only

R250 000 PMBs only (state facility only)

R250 000 PMBs only (state facility only)

No benefit

PMB chronic conditions only from Medi-Rite, Dis-Chem or Pharmacy Direct

and subject to a basic formulary. Covers up to 100% of the Medicine Price List

No overall annual limit Network hospitals only

Unlimited specialised radiology paid from the Major Medical Benefit if pre-authorised. Unlimited at Fedhealth Rate. First R1 900

for non-PMB MRI/CT Scans is for the member’s account

No Day-to-Day Benefit

PMB level of care applies at the designated pharmacy providers,

FP Network and Specialist Network only

Unlimited specialised radiology paid from the Major Medical Benefit if pre-authorised.

Unlimited at Fedhealth Rate. First R2 500 for non-PMB MRI/CT Scans is

for the member’s account

Day-to-Day Benefit

Quick Comparison

Foundation BenefitThe option-dependent Foundation benefit offers members a host of valuable benefits,

from important health screenings to maternity benefits


to a restrictive formulary. Covers up to 100% of the Medicine Price List

33




Overall annual limit (OAL) UnlimitedUnlimited at network hospitals only. R5 600 co-payment on voluntary use of non-network hospital

Healthcare Professional Tariff in hospital (HPT)Fedhealth Network FPs and Specialists




Covered at cost




Covered at cost







Women’s HealthBreast cancer screening with mammography



1 every 3 years


1 every 3 years

Children’s HealthImmunisation Programme (as per State EPI)

Various 3 3


All lives; aged 20 and older

1 every 5 years

GeneralFamily practitioner consultation (in network only)

Flu vaccination





Health risk assessments Wellness screening (BMI, blood pressure, finger prick cholesterol & glucose tests)





All pregnant members and dependants 3 3

Doula benefit R1 200 per delivery


Postnatal midwifery benefit4 consultations with a midwife in and out-of-hospital per pregnancy


Fedhealth Nurse Line All lives 3 3

Trauma counselling All lives 3 3

Emergency transport/response All lives 3 3

Comprehensive managed care programmes Pharmacy benefit management, Hospital benefit management, Aid for AIDS (AfA), Oncology disease management

All lives 3 3

Active disease risk management Conservative Back & Neck Rehabili-tation, Mental Health Programme, Cardiac rehabilitation programme

All lives 3 3

Post-hospitalisation treatment All lives 3 3

Take-home medicine benefit All lives 3 3

Specialised radiology benefitIn and out-of-hospital All lives

Unlimited at Fedhealth Rate. First

R1 900 for non-PMB MRI/CT scans

for member’s account

Unlimited at Fedhealth Rate. First

R2 500 for non-PMB MRI/CT

scans for member’s account

Trauma treatment at a casualty wardAll lives

Unlimited at 100% of Fedhealth rate. Co-payment of R500 per visit for

non PMBs

Female contraception benefit All lives Oral contraceptives subject to the acute formulary

In-hospital dentistryChildren up to the age

of seven 3 No benefit

SC

RE

EN

ING

BE

NE

FIT

BIR

TH

& B

AB

Y

BE

NE

FIT

EX

TE

ND

ED

CA

RE

BE

NE

FIT

34



Prescribed Minimum Benefits (PMB): Treatment for PMB conditions can be funded in two ways:

To have the treatment for PMB conditions covered in full, you will have to use Fedhealth Network FPs & Specialists

To have the treatment for PMB conditions covered in full, you will have to use Fedhealth Network FPs, hospitals & Specialists

Should you choose not to make use of network providers, the Scheme will only refund treatment at 100% of the Fedhealth Rate and you will have a co-payment should the healthcare professional charge more

Hospitalisation costs: Accommodation in a general ward, high care ward and intensive care unit, theatre fees, medicine, material and hospital apparatus

UnlimitedUnlimited at negotiated tariff at network hospitals only. R5 600 co-payment on voluntary use of non-network hospitals

Co-payments (per event) applicable on the hospital/ facility bill onlyAll open hernia repairs



Balloon sinuplasty

Bunion procedures

Cataract surgery


Cystoscopy

Dental admissions

Elective caesarean sections



Hysterectomy (unless for cancer)

Joint replacements

Laparoscopic hernia repairs (bilateral inguinal, repeated inguinal hernias & nissen/toupey hernia repairs only)


Nasal procedures

Rhizotomies and facet pain blocks (limited to 1 of either procedure per beneficiary per year)


Spinal surgery




R3 700

R6 900

No co-payment

No benefit

No co-payment

No co-payment

R3 700

No co-payment

No co-payment

No co-payment

No co-payment

R6 900

R3 700

R5 300*

R5 800

R5 800

No co-payment

No benefit

No co-payment

R5 300**

R3 700

No co-payment

R3 700

R5 300

R6 900

R5 300

No benefit

R5 300

R5 300

R5 300

R5 300

No benefit

R10 000

R5 300


R5 300


R5 800

R5 800

R5 300

No benefit

R5 300

R5 300**

No benefit

R5 300

R5 300

Additional medical services (dietetics, occupational therapy and speech therapy)


Physical therapy (physiotherapy and biokinetics)

Subject to referral by a medical practitioner, pre-authorisation and treatment protocols

Alternatives to hospitalisation: Nursing services, private nurse practitioners & nursing agencies

Sub-acute facilities, physical rehabilitation facilities




Appliances, external accessories and orthotics


Blood, blood equivalents and blood products

Unlimited

Immune deficiency related to HIV infection

Unlimited (see HPT)

* Must use ICPS for non-PMB hip and knee joint replacements. Non-use of ICPS will result in no benefit** No benefit unless Conservative Back and Neck Rehabilitation Programme has been completed

35



MaternityHealthcare Professional Tariff in hospital (HPT)Fedhealth Network FPs and Specialists (eg. gynaecologists & paediatricians)




Postnatal midwifery benefit

Covered at cost




Covered at cost






Including surgical extraction of impacted wisdom teeth



No benefit

Emergency treatment in a casualty ward Unlimited at 100% of Fedhealth Rate. Co-payment of R500 per visit for non PMBs

Female Health Benefit: Contraceptives Oral contraception only subject to acute formulary

Oncology: Oncologist consultations, visits, treatment and materials for chemotherapy and radiotherapy, approved medication, radiology and pathology


R250 000 at designated service provider* & subject to level 1 treatment protocols. 40% co-payment for non-use of DSP

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

No benefit

Organ transplant including immunosuppression medication

Corneal graft

R250 000 (See HPT)Covered up to PMB level of care in state

facilities

No benefit


Post-hospitalisation benefit Up to 30 days after discharge at 100% of Fedhealth Rate. Subject to protocols

Prostheses

Internal - Various sub-limits apply

This benefit does not include osseo-integrated implants for the purpose of replacing a missing tooth or teeth. Hip and knee bilateral replacements will be allowed for up to double the amount for a single hip and knee replacement

Detachable platinum coils

Cardiac stents

Cardiac valves

Cardiac pacemakers

Carotid Stents

Aorta Stent Grafts

Peripheral Arterial Stent Grafts

Embolic Protection Devices

Shoulder replacement

Elbow replacement

Hip replacement

Knee replacement

Bone lengthening devices

Spinal plates and screws

Other approved spinal implantable devices

Intraocular lenses (per lens)

†Combined benefit limit for all unlisted internal prosthesis

R45 670

PMBs only

PMBs only

PMBs only

PMBs only


R52 651


R2 958

†R22 480

Prostheses External

R10 500 at cost Covered up to PMB level of care

Psychiatric Services: Accommodation in a general ward, procedures, ECT, materials and hospital equipment, consultations and visits, medicines and injection material

R22 600 (See HPT) Covered up to PMB level of care

Renal dialysis (chronic): Consultations, visits, all services, materials and medicines associated with the cost of renal dialysis

R250 000 at Fedhealth RateCovered up to PMB level of care in state

facilities

Specialised Medication (eg. biologicals) Benefit (oncology & non-oncology)

No benefit


Unlimited at the Fedhealth Rate.

First R1 900 for non-PMB MRI/ CT scans for


Unlimited at the Fedhealth Rate. First R2 500

for non-PMB MRI/ CT scans for the

member’s account

Spinal surgeryNo benefit unless Conservative Back and Neck Rehabilitation Programme

has been completed



*Designated Service Provider (DSP) is ICON - Independent Clinical Oncology Network | FR - Fedhealth Rate | MPL - Medicine Price List

36

Prepared for all life’s adventures

37



The following 25 chronic conditions are covered (all options)

Addison’s DiseaseAsthmaBipolar Mood DisorderBronchiectasisCardiac FailureCardiomyopathyCOPD/ Emphysema/ Chronic BronchitisChronic Renal DiseaseCoronary Artery Disease

Crohn’s DiseaseDiabetes InsipidusDiabetes Mellitus type 1 & 2DysrhythmiasEpilepsyGlaucomaHaemophiliaHyperlipidaemiaHypertension

HypothyroidismMultiple SclerosisParkinson’s DiseaseRheumatoid ArthritisSchizophreniaSystemic Lupus ErythematosusUlcerative Colitis

Day-to-Day Benefit


BENEFIT

Appliances, external accessories and orthotics: Hearing aids, wheelchairs etc

PMB level of care at specialist network, FP network and designated pharmacy provider only

Alternative healthcare: Acupuncture, homeopathy, naturopathy, osteopathy and phytotherapy (including prescribed medication)

Additional medical services: Audiology, dietetics, genetic counselling, hearing aid acoustics, occupational therapy, orthop-tics, podiatry, private nursing*, psycholo-gists, social workers, speech therapy

Dentistry Advanced: Inlays, crowns, bridges, mounted study models, metal base partial dentures, osseo-integrated implants, orthognathic surgery, oral sur-gery, orthodontic treatment, periodontists, prosthodontists and dental technicians

Dentistry (Basic)

Biokinetics, Chiropractics, Dentistry (Basic), Radiology (general), Pathology and Physiotherapy

Family PractitionersFedhealth Network FPs


Maternity benefit

Optometry: Frames, single vision, bifocal, multifocal or special lenses, lens add-ons, contact lenses, Readers and optometric examinations

Over-the-counter medication


SpecialistsFedhealth Network Specialists


Specialised Radiology

Paid from the Major Medical Benefit if

pre-authorised. First R1 900 for non-PMB

MRI/ CT scans for member’s account

Paid from the Major Medical Benefit if

pre-authorised. First R2 500 for non-PMB

MRI/ CT scans for member’s account

Limit Prescribed Minimum Benefits only

Conditions covered 25 Chronic Conditions below

Formulary Restrictive formulary Basic formulary

Designated Service Provider Medi-Rite, Dis-Chem & Pharmacy Direct


Limit Unlimited



There’s nothing quite like having the freedom of choice. That’s why

Fedhealth now gives our members, a choice between regular and ‘GRID’

options on Maxima Core.

This innovation provides members with a choice between regular and

network hospitals – or hospitals on the Fedhealth GRID – on selected

options. By committing to a GRID option members will still be able to

enjoy all the same great benefits of the regular option, but they will just

have to make use of our approved network hospitals. In return, members will benefit from a lower monthly premium, which can be up to 10% less than the normal contribution!

We’ve introduced this option for those members who don’t mind using

a network hospital, especially since there are so many excellent network

hospitals conveniently located around the country. Simply refer to page

39-42 to see the complete list of Fedhealth network hospitals.

With these new GRID options, we are giving our members the freedom to

choose, and ultimately, protecting their pocket!

Maxima Hospital GRID option

NETWORK HOSPITALS ONLY

or a co-payment of R10 000 will apply

Only use a nominated Fedhealth network FP

to get UNLIMITED FP VISITS

Refer to the list of Fedhealth network hospitals on page 39-42

Pay up to 10% less by opting to use network hospitals only!

Members on GRID options should note:

Just see how much your clients can save by choosing the

GRID option!

38

Member 1 907

Adult Dependant 1 616

Child Dependant 667

Maxima Core

Member 1 716


Child Dependant 600

Maxima CoreGRID

39





Port Alfred Hospital Eastern Cape Port Alfred


East London Eye Hospital Eastern Cape East London


Cuyler Clinic Eastern Cape Uitenhage

Mthatha Private Hospital Eastern Cape Mthatha




Busamed Harrismith Free State Harrismith






Clinix Dr SK Matseke Memorial Hospital Gauteng Soweto






Femina Hospital Gauteng Arcadia

Garden City Hospital Gauteng Mayfair West












Optiklin Hospital Gauteng Benoni













Lenmed Health Daxina Private Hospital Gauteng Lenasia




Medfem Clinic Gauteng Bryanston

Urolocare Hospital Gauteng Hatfield

Zuid-Afrikaanse Hospitaal Gauteng Pretoria

Naledi-Nkanyezi Private Hospital Gauteng Sebokeng


Maxima Hospital Option Range - Network HospitalsMaxima CoreGRID and Maxima EntryZone

40

Maxima Hospital Option Range - Network HospitalsMaxima CoreGRID and Maxima EntryZone





St Augustine’s Hospital KwaZulu-Natal Durban

Umhlanga Hospital KwaZulu-Natal uMhlanga Rocks


Gateway Private Hospital KwaZulu-Natal Umhlanga Rocks


Lenmed Health Shifa Private Hospital KwaZulu-Natal Mayville


Hibiscus Hospital KwaZulu-Natal Port Shepstone


Margate Private Hospital KwaZulu-Natal Margate



Kokstad private Hospital KwaZulu-Natal Kokstad





St Vincents Hospital Limpopo Bela-Bela









Rustenburg Medi Care Hospital North West Rustenburg







Mediclinic Kimberley Northern Cape Kimberley

Life Bay View Hospital Western Cape Mossel Bay









Cape Eye Institute Western Cape Bellville




Rondebosch Medical Centre Western Cape Lansdowne

41


Med Forum Theatre Eastern Cape Port Elizabeth









Silverton Medical and Dental Theatre Gauteng Pretoria




Medgate Day Hospital Gauteng Roodepoort

Advanced Soweto Eye Hospital Gauteng Soweto




Centurion Eye Hospital Gauteng Centurion



Medkin Clinic Gauteng Pretoria

Cure Day Clinics - Midstream Gauteng Midstream







Johannesburg Eye Hospital Gauteng Randburg

Kilnerpark Narkokliniek Gauteng Pretoria


Ocumed Eye And Laser Institute Gauteng Vanderbijlpark

Optimed Clinic Gauteng Johannesburg

Sandhurst Eye Centre Gauteng Sandton

The Healthy Eye Theatre Gauteng Benoni

Twenty Twenty Eye Surgery Centre Gauteng Mulbarton

Visiclin Eye Clinic Gauteng Three Rivers

Visiomed Eye And Laser Centre Gauteng Randburg










Highveld Eye Hospital Mpumalanga Witbank


Rustenburg Private Eye Clinic North West Rustenburg








Maxima Hospital Option Range - Network Day ClinicsMaxima CoreGRID and Maxima EntryZone

42


Advanced Vergelegen Surgical Centre Western Cape Somerset West







George Surgical Centre Western Cape George


Kango Clinic (Kannaland Medical Clinic) Western Cape Oudtshoorn





Maxima Hospital Option Range - Network Day ClinicsMaxima CoreGRID and Maxima EntryZone

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Blue Door Plus at a glance:

Because everyone is welcome in the Fedhealth family

Most of us want to know that our family enjoys quality healthcare, and through our Blue Door Plus option, Fedhealth strives to make this more achievable.

This affordable, entry-level medical aid option takes care of previously uncovered, lower-income employees, and ensures that their health is in good hands. It’s competitively priced and is the ideal option to offer employees who’ve never had medical aid before.

A free annual flu vaccine paid from Risk, access to the free Fedhealth Baby programme, and trauma treatment at a casualty ward paid from Risk if the member is admitted to hospital, are just some of the great benefits offered by the option.

Please refer to the next page for a summary of all the benefits offered by Blue Door Plus.

DAY-TO-DAYBENEFIT



FOUNDATION BENEFIT

44

Blue Door Plus

Foundation BenefitThe Foundation benefit covers a host of valuable benefits available to all Fedhealth members, ranging from important health screenings to an annual flu vaccination for the whole family

Major Medical Benefit All costs for hospitalisation are covered from this benefit

BENEFIT ALL LIMITS PER FAMILY PER YEAR UNLESS OTHERWISE SPECIFIED

Overall annual limit (OAL)Unlimited at Fedhealth Network Hospitals only. A R10 000 co-payment on voluntary use

of non-network hospitals will apply

Healthcare Professional Tariff in hospital (HPT)

Fedhealth Network FPs and Specialists

Non-Fedhealth Network FPs and Specialists


Unlimited

Covered at cost

Covered at 100% of Fedhealth Rate. Limited to R2 000 pb


Alternatives to hospitalisation

Acute facilities and rehabilitation facilities (does not include Hospice)


Ambulance services Unlimited with Europ Assistance

Appliances, external accessories, orthotics Covered up to PMB level of care

Blood, blood equivalents and blood products Unlimited

Physical therapy (physiotherapy and biokinetics) Unlimited at PMB level of care

Immune deficiency related to HIV infection

Hospitalisation

Anti-retroviral & related medication

Related pathology

Unlimited at PMB level of care




All lives1 every year


Health risk assessmentsWellness screening (BMI, blood pressure, finger prick cholesterol & glucose tests)


Fedhealth Blue Door Plus Baby maternity programme All pregnant members and dependants 3

Postnatal midwifery beneift4 consultations with a midwife in and out-of-hospital per pregnancy

All pregnant members and dependants 3

Fedhealth Nurseline All lives 3

Trauma counselling All lives 3

Emergency transport/response All lives 3

Comprehensive managed care programmesAid for AIDS, Oncology Disease Management Programme, Pharmacy Benefit Management, Hospital Benefit Management

All lives 3

Take-home medicine benefit All lives 3

Specialised radiology benefitIn-hospital

All livesR12 100 per beneficiary, subject to an overall

limit of R24 400 per family per year

Trauma treatment at a casualty ward All livesUnlimited at 100% of Fedhealth rate. Co-

payment of R500 per visit for non PMBs

Female contraception benefit All livesOral contraceptives subject to the

acute formulary

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BENEFIT ALL LIMITS PER FAMILY PER YEAR UNLESS OTHERWISE SPECIFIED

MaternityR32 900 per maternity event with a limit of R48 700 per family per year.

Elective Caesarean sections subject to a R10 000 co-payment

Oncology

Oncologists, haematologists and credentialed medical

practitioners, consultations, visits, treatment and materials used in

radiotherapy and chemotherapy at designated service provider*

and subject to standard treatment protocols

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

Organ, tissue and haemopoietic stem cell transplant and

immunosuppression medicationPMBs only in state facilities

Pathology and medical technology Unlimited

Prostheses and devices

Internal and ExternalPMBs only in state facilities

Psychiatric services R8 010

Radiology

General


Unlimited

R12 100 per beneficiary, subject to an overall limit of R24 400 per family per year

Renal dialysis (chronic)

Haemodialysis and peritoneal dialysis, radiology and pathology.

Consultations, visits, all services, materials and medicines

associated with the cost of renal dialysis

PMBs only in state facilities

Take-out medicines Up to 100% of MPL. Limited to 7 days medication per hospital event

Limit Prescribed Minimum Benefits only

Conditions covered 25 chronic conditions below

Formulary Basic formulary

Designated Service Provider Medi-Rite & Pharmacy Direct


Limit Unlimited

The following 25 chronic conditions are covered:

Addison’s DiseaseAsthmaBipolar Mood DisorderBronchiectasisCardiac FailureCardiomyopathyCOPD/ Emphysema/ Chronic BronchitisChronic Renal DiseaseCoronary Artery Disease

Crohn’s DiseaseDiabetes InsipidusDiabetes Mellitus type 1 & 2DysrhythmiasEpilepsyGlaucomaHaemophiliaHyperlipidaemiaHypertension

HypothyroidismMultiple SclerosisParkinson’s DiseaseRheumatoid ArthritisSchizophreniaSystemic Lupus ErythematosusUlcerative Colitis


BENEFIT COVER ALL LIMITS PER FAMILY PER YEAR UNLESS OTHERWISE SPECIFIED

Family PractitionersContracted

Not contracted

Agreed tariffUnlimited at contracted nominated FP subject to protocols and utilisation monitoring after 6 visits per beneficiary

Limited to tariff for contracted FPs

Limited to 2 consultations per family

SpecialistsFedhealth Network Specialists


At cost

No benefit

2 specialist consultations per family per year. Must be referred by contracted FP

No benefit

Dentistry (basic)Removal of teeth & roots & suturing of traumatic wounds. Oral medical procedures: diagnosis & treatment of oral & associated conditions, plastic dentures & dental technician’s fees for all such dentistry

Agreed tariff Subject to a contracted list of dentists and limited to a list of approved procedures, dental tariff codes and protocols. Plastic dentures limited to one set per beneficiary every two years

Mental health No benefit See FP benefit. Limited to 2 psychiatric consultations per family

Optometry Agreed tariff

Subject to ISO Leso network optometrists. Frame to the value of R182 or R182 off any other frame. 1 pair of single vision clear CR39 lenses or 1 pair of bifocal clear CR39 lenses. 1 comprehensive consultation. This benefit is available in a two-year benefit cycle

Over-the-counter medication No benefit No benefit

Maternity Up to 100% of FR 2 x 2D scans per beneficiary per maternity event

Pathology Up to 100% of FRUnlimited subject to basic protocols and limited list of tests and procedures. Must be referred by contracted medical practitioner

Prescribed medicationDispensing FP

Non-dispensing medical practitioner (eg. Fedhealth Network Specialists, FPs and dentists)

Unlimited

Up to 100% of MPL

Unlimited at contracted FP

Unlimited subject to acute formulary for all medical practitioners

Physiotherapy No benefit No benefit

RadiologyGeneral

Specialised

Up to 100% of FR

No benefit

Unlimited subject to basic protocols and a limited list of tests and procedures. Must be referred by contracted medical practitioner

No benefit

Day-to-Day Benefit Day-to-day benefits provided through the contracted Blue Door Plus network providers


*Designated Service Provider (DSP) is ICON - Independent Clinical Oncology Network | FR - Fedhealth Rate | MPL - Medicine Price List

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Looking after your company’s greatest assets… its people

47

Blue Door Plus - Network Hospitals




Cuyler Hospital Eastern Cape Uitenhage



Mthatha Sub-acute Hospital Eastern Cape Mthatha








St Helena Hospital (Africa Healthcare) Free State Welkom


Clinix Dr SK Matseke Memorial Hospital Gauteng Diepkloof

Clinix Naledi - Nkanyezi Private Hospital Gauteng Sebokeng






Garden City Hospital Gauteng Johannesburg
























Lenmed Health Daxina Private Hospital Gauteng Lenasia South





Zuid-Afrikaans Hospital Gauteng Pretoria




Kokstad Private Hospital KwaZulu-Natal Kokstad

Margate Hospital KwaZulu-Natal Margate



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Netcare St Augustine’s Hospital KwaZulu-Natal Durban



Hibiscus Private Hospital KwaZulu-Natal Port Shepstone


Lenmed Health La Verna Private Hospital KwaZulu-Natal Ladysmith

Lenmed Health Shifa Private Hospital KwaZulu-Natal Sydenham


Mediclinic Lephalale Limpopo Onverwacht



St Vincent Hospital Limpopo Bela-Bela














Mediclinic Kimberley Northern cape Kimberley


Lenmed Health Kathu Private Hospital Northern cape Kathu

Life Bay View Private Hospital Western Cape Mossel Bay







Belville Medical Centre Western Cape Bellville




Rondebosch Medical Centre Western Cape Rondebosch


Blue Door Plus - Network Hospitals

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Silverton Medical and Dental Centre Gauteng Pretoria








Cure Day Clinics - Midstream Gauteng Midrand






Kilnerpark Narcokliniek Gauteng Pretoria


Medgate Day Clinic Gauteng Roodepoort

Medkin Kliniek Gauteng Pretoria

















Advanced Durbanville Surgical Centre Western Cape Durbanville



Advanced Vergelegen Medical Centre Western Cape Somerset West








Kango Clinic (Kannaland Medical Centre) Western Cape Oudtshoorn





Blue Door Plus - Network Day Clinics

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Family takes care of family

Rand amounts paid monthly to the Scheme for cover received as well as annual benefit values

Risk Savings TOTALAnnual

Threshold*Annual OHEB

Member 6 369 371 6 740 13 038 7 850

Adult Dependant 5 418 315 5 733 10 028 5 670

Child Dependant 1 910 111 2 021 3 477 1 740


Threshold*Annual OHEB

Member 3 988 314 4 302 11 200 5 390

Adult Dependant 3 398 268 3 666 8 600 4 200

Child Dependant 1 190 94 1 284 2 880 700

Risk Savings TOTAL

Member 2 926 325 3 251




Threshold*

Member 2 486 546 3 032 11 200

Adult Dependant 2 118 465 2 583 8 600

Child Dependant 744 163 907 2 880

+ =

Maxima Plus (including Savings and OHEB)

Maxima Exec (including Savings and OHEB)

Maxima Standard (including Savings)

Maxima Advanced (including Savings)

+ =

+ =

+ =

Risk Savings TOTAL

Member 1 767 312 2 079



+ =

Maxima Saver

Risk Savings TOTAL

Member 1 376 264 1 640

Adult Dependant 991 190 1 181


+ =

Maxima EntrySaver

Risk Savings TOTAL

Member 2 126 375 2 501



Maxima Basis

+ =

Contributions


Threshold*

Member 1 899 417 2 316 11 200

Adult Dependant 1 619 355 1 974 8 600

Child Dependant 569 125 694 2 880

Maxima StandardElect (including Savings)

+ =

*Up to a maximum of three children

Risk Savings TOTAL

Member 1 913 338 2 251



Maxima BasisGRID

+ =

Risk Savings TOTAL

Member 1 590 281 1 871



+ =

Maxima SaverGRID

Comprehensive Contributions Saver Contributions

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Member 1 907


Child Dependant 667

Hospital Contributions

Maxima Core

Maxima EntryZone

Member 1 326

Adult Dependant 991

Child Dependant 446

Member 1 716


Child Dependant 600

Maxima CoreGRID

Household income per month Member

Adult Dependant

Child Dependant

< - 5 200 776 644 369

5 201 - 8 500 984 813 475

8 501 - 10 500 1 380 1 145 522

10 501 - 12 000 1 754 1 375 677

12 001 - > 2 378 2 061 895

Blue Door Plus

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Great savings with Sanlam Reality!

Health

Planet Fitness Gym

Save as much as 80% on monthly fees!

JustGym


Virgin Active Gym


Entertainment

Nu Metro Movies and Refreshments

Pay R15 for a 2D ticket, R30 for a 3D ticket and R20 for a refreshments combo!.

Computicket Shows and Sport

By one ticket up to R300 and get another ticket free!

Dining

Save as much as R120 when you buy two main meals!

Reality Magazine

Enjoy a free quarterly lifestyle magazine!

Simfy

Get six months free, then 7.5% off music streaming.

Wi-Fi

Get 1GB free Wi-Fi every month!

Day-to-Day Savings

Money Saver Card

Get as much as 10% off your shopping with the Money Saver card.

Personal Assistant

Free help with quotes, directions and more!

Travel

Mango Flights

Save as much as 30% on local flights!

Protea Hotels

Save as much as 30% on accommodation. Benefit coming soon.

Uber Airport Transfers

Save as much as 30% on airport transfers!

Emirates Flights

Save as much as 25% on international flights!

Tempest Car Hire

Save as much as 50% on car hire!

Bidvest Premier Lounge

Enjoy free access!

Wealth

Wealth Sense

Your online guide to help you become financially fit.

Sanlam Product Benefi ts

Get generous savings on gap cover, Sanlam Premier risk products and primary asset management charges.

Sanlam Reality is a lifestyle, wellness, rewards and financial education programme available to all Fedhealth medical aid members. All Fedhealth members not on Reality Health will be registered for FREE as Reality Access members and enjoy free International Travel Insurance.. The Reality Health option has been specifically tailored to help Fedhealth medical aid members save money on wellness, travel, entertainment and day-to-day expenses, and to learn more about achieving financial fitness. These are the benefits available on the Reality Health option:

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FHQ 09/16/E.

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2016/09/23 1:57 PM

Membership fees (per month):Reality Health – R170 (Single); R215 (Family)

Contact usGo to www.sanlamreality.co.za to find out more about the programme.

What does Sanlam Reality offer Reality Health clients?

Benefits of Reality HealthReality Health Single & Family

Wealth

Sanlam Premier risk products Up to 30% off

Sanlam savings products Up to 100% off primary asset management charges

Sanlam Gap Cover Extra cover for your hospital stay

Wealth Sense Online financial platform

Day-to-Day Savings

Money Saver Card Cash-back bonus of as much as 10%

Health

Virgin Active Gym As much as 60% off

Planet Fitness Gym As much as 80% off

JustGym As much as 80% off

Travel

Mango Flights As much as 30% off

Emirates Flights As much as 25% off

Protea Hotels As much as 30% off

Tempest Car Hire As much as 50% off

Uber Airport Transfers As much as 30% off

Bidvest Premier Lounge Free access

International Travel Insurance Free access

Entertainment

Nu Metro Movies and Refreshments 30 tickets (2D or 3D); 30 refreshments combos

Computicket Shows and Sport Buy one, get one free (up to R300)

Dining As much as R120 off second main meal

Simfy Africa Music Streaming Get six months free, then 7.5% off music streaming

Wi-Fi Get 1GB free Wi-Fi monthly

Reality Magazine Quarterly

Personal Services

Personal Assistant 24/7, 365 days a year

• More than 20 benefits to help save time and money.• Family membership options, enabling all

immediate family members to join the programme.

• A Bronze, Silver and Gold tiering structure that allows members to earn more discounts.

• A day-to-day transactional shopping card called Money Saver, which pays out a quarterly or annual cash-back bonus.

• An online platform called Wealth Sense, with free access to money calculators, tools, tips, digital magazines and more…

• Reality Health has been specifically tailored to the Fedhealth market.

• All Fedhealth members not on Reality Health will automatically be registered free of charge as Reality Access members and enjoy free International Travel Insurance. Fedhealth members have the option to opt out.

FHQ 09/16/E.

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Fedhealth Customer Contact Centre 0860 002 153Ground Floor, Park View Building Number 10, Constantia Office Park, Vlakhaas Ave, off Hendrik Potgieter Rd,

Weltevreden Park X81, Roodepoort • Private Bag X3045, Randburg 2125

www.fedhealth.co.za

Please note: All Fedhealth benefits are subject to registered Scheme Rules, and as such, this document only aims to provide a summary of such benefits. For the full Scheme Rules, please visit fedhealth.co.za or contact the Fedhealth Customer Contact Centre on 0860 002 153 to obtain a copy.

Family takes care of family

2017 - compendium insurance group · 5 days average claim turnaround 8 seconds average call waiting...

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