Maxima Basis

Whether your family is about to grow, or still young, the Fedhealth Maxima Basis is your perfect option.

The Fedhealth Maxima Basis option gives you access to unlimited cover at all private hospitals, unlimited visits to your family practitioner (FP) and ample day-to-day savings.

You also enjoy exceptional optometry benefits, which is not deductible from your savings account, but risk.

The Fedhealth Maxima Basis further offers excellent maternity, dentistry and chronic disease benefits. Plus, after paying a co-payment, this option covers unlimited specialised radiology, which is also paid from your major medical benefits, if pre-authorised.

In fact, with Fedhealth you always get more unique benefits that are paid from risk instead of your savings. Plus, because family takes care of family, the Fedhealth Maxima Basis option also takes care of you after a hospital stay with 7 days worth of take-home medicine and 30 days of post-hospitalisation treatment included as part of your cover.

The Fedhealth Maxima Basis option features a grid version. By selecting the grid version, rather than the regular option, you will save 10% on your monthly contribution, restricted you to make use of Fedhealth Network Hospitals.

Contributions
Principal Member Adult Dependant Child Dependant*
Monthly Contribution (Main Option) R2 722 R2 374 R826
Monthly Contribution (Grid Option) R2 407 R2 106 R732

* Contributions for the first 3 children only. Child rates up to the age of 27.

Included Medical Cover
  • Unlimited hospital cover in any private hospital
  • Female contraceptives covered: oral, contraceptive rings, patch and IUDs including Mirena® device
  • Post-hospitalisation treatment for up to 30 days after discharge from hospital
  • 7 days of take-home medication
  • Specialised radiology like MRI and CT Scans covered from Risk after the first R2 100
  • Trauma treatment at a casualty ward whether you’re admitted to hospital or not (a R550 co-payment per visit for non-PMBs will apply if you are not admitted to hospital straight from casualty)
  • Contracted fixed rates at Fedhealth Network Specialists – while under the care of a network specialist in hospital, your treatment will always be covered in full
  • Unlimited FP visits at your nominated Fedhealth Network FP that are paid for by the Scheme once your Savings have been depleted
Additional Unique Benefits
  • Chronic medicine cover for 25 Prescribed Minimum Benefit (PMB) chronic conditions from a pharmacy of your choice.
  • Cover for non-Fedhealth contracted healthcare professionals up to 100% of the Fedhealth rate
  • Day-to-day cover for essential expenses such as x-rays, prescribed medication and specialist consultations
  • Scheme funded benefits after Savings have been depleted, for basic dentistry and maternity expenses.
  • Optometry benefits covered by the Scheme and not from your Savings
  • Access to our FREE 24-Hour Fedhealth Nurse Line
  • An innovative screening benefit (part of the new foundation benefit) that covers specific women’s, children’s and cardiac health, as well as wellness and preventative screenings
  • Free flu vaccinations for the whole family
  • NEW! From January 2018 qualifying members benefit from a 12-week biokineticist led programme with access to a dietician and behavioural psychologist to help them lose the weight for good.
  • NEW! From January 2018 all smokers can have their GoSmokeFree consultation paid from risk (once per beneficiary per year). Nicotine replacement therapy will be paid from savings on options with a savings benefit
Day-to-Day Benefits

Annual Day-to-Day Available

Benefit Option Principal Member Adult Dependant Child Dependant
Main Option R4 896 R4 272 R1 488
Grid Option R4 332 R3 792 R1 320

Dentistry, Maternity & Optometry

Even if your Savings runs out, we’ll still take care of you. Your Savings account refunds your day-to-day expenses at cost, until it is finished. If you use a Fedhealth Network Family Practitioners, your consultations will continue to be covered unlimited for the remainder of the year. You and your dependents must however nominate a network FP. A different FP can be nominated for every dependent, if required.

Chronic Diseases Covered
Subject to formulary? Yes
Co-payment for Non-Formulary 40%
Number of Conditions Covered 25
Annual Limit to PMB Cover none
Medicine Medicine can be obtained from a service provider of choice. Fedhealth pays up to an agreed rate for dispensing fees on prescribed medicine. Member will pay difference if pharmacy charges more.

Note: You have to apply for your Chronic Disease Benefit to be activated, even if you’ve declared your condition on your application form.

Chronic Disease
CD-1 Addison’s Disease
CD-2 Asthma
CD-3 Biopolar Mood Disorder
CD-4 Bronchiectasis
CD-5 Cardiac Failure
CD-6 Cardiomyopathy
CD-7 COPD / Emphysema / Chronic Bronchitis
CD-8 Chronic Rental Disease
CD-9 Coronary Artery Disease
CD-10 Crohn’s Disease
CD-11 Diabetes Insipidus
CD-12 Diabetes Mellitus Type 1 & 2
CD-13 Dysrhythmias
CD-14 Epilepsy
CD-15 Glaucoma
CD-16 Haemophilia
CD-17 Hyperlipidaemia
CD-18 Hypertension
CD-19 Hypothyroidism
CD-20 Multiple Sclerosis
CD-21 Parkinson’s Disease
CD-22 Rheumatoid Arthritis
CD-23 Schizophrenia
CD-24 Systemic Lupus Erythematosus
CD-25 Ulcerative Colitis
In-Hospital Benefits

Please note that certain procedures performed in-hospital are subject to a co-payment ranging from R4 000 to R7 500.

Benefit Name Benefit Description
In-hospital Benefit Unlimited
Network Hospital Yes
Any Private Hospital Yes
Authorisation Required 48 hours before admission
48 hours after admission in case of emergency
Organ Transplants R264 500
In-Hospital Specialist
  • Covered in full if network specialists are used
  • Co-payment of R11 000 if a Network Hospital is NOT used (not applicable if admitted to a non-network hospital in an emergency)
Shortfall if Network Specialist is Not Used Yes
Oncology R264 500 at designated service providers and subject to level 1 treatment protocols.
40% co-payment for non-use of DSP
Renal Dialysis R264 500
Specialised Medication No benefit
In-Hospital Benefits
Specialists:
  • 100% scheme rate
  • Network specialists covered in full
  • You or gap cover pay the balance, if any
Hospital Choice:
  • Choose any hospital
Specialised Radiology:
  • You or your gap pay R2 100 co-payment
Supplementary Services: (Physio, etc)
  • Physio: subject to protocols
  • Dietetics, occupational therapy and speech therapy: from day-to-day benefit
  • Otherwise, 100% scheme rate
Transplants:
  • R264 000 per family
  • Corneal graft: no benefit
Co-payments:
  • All open hernia repairs
  • colonoscopy, upper GI endoscopy
  • surgical removal of wisdom teeth
  • R4 000 co-payment paid by you or by your gap cover
  • Laparoscopic hernia repairs, laparoscopic procedures
  • spinal surgery
  • Joint replacements (except hip and knee)
  • Involuntary use of non-DSP for hip or knee replacement
  • R5 900 co-payment paid by you or by your gap cover
  • Arthroscopic procedures: R7 500 co-payment paid by you or by your gap cover
  • Hip and Knee replacement, voluntary use of non-DSP: R25 000 co-payment
Alternatives to hospitals:
  • Terminal care: R29 500 per family
  • Physical rehabilitation, sub-acute facilities: PMBsonly
  • Nursing services, private nurse practitioners, nursing agencies: Unlimited, at negotiated rate
Casualty:
  • Paid by scheme at 100% scheme rate
  • R550 co-payment if not PMB
Other:
  • Post hospitalization treatment for up to 30 days after discharge, paid for by scheme. Includes physio, occupational therapy, speech therapy, ultrasounds, standard radiology and pathology
    Excluded procedures:

  • Balloon sinuplasty
  • Rhizotomies and facet pain blocks
  • Corneal grafts
  • non-PMB joint replacements