Fedhealth Maxima Core Option
The Fedhealth Maxima Maxima Core option is ideal for families that can afford a little more and is serious about their health.
This option provides the best hospital plan and provides unlimited cover at ALL hospitals across South Africa.
This options covers the following:
- Unlimited private hospital cover at ANY hospital
- Post-hospitalisation treatment for up to 30 days after discharge
- 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, we’ll cover your treatment in full
The Maxima EntryZone also provides you with the following unique benefits and value adds:
- 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
- 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!
- One free FP consultation per beneficiary per year
- Certain female oral contraceptives covered from risk
- 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
Contributions
|
Principal Member |
Adult Dependant |
Child Dependant* |
| Monthly Contribution (Main Option) |
R2 082 |
R1 806 |
R732 |
| Monthly Contribution (Grid Option) |
R1 838 |
R1 596 |
R646 |
* Contributions for the first 3 children only. Child rates up to the age of 27.
Day-to-Day Benefits
The Fedhealth Maxima Core is a hospital plan option, which means is has no day-to-day benefits.
However, should you or one of your dependents have a PMB chronic conditions, then a care plan, which assigns you with a basket of care specific to the condition, will be paid for by the scheme. The care plan will include out-of-hospital treatment like doctor consultations, radiology and pathology tests.
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. |
|
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 |
| 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 |
Foundation Benefit
| Benefit Name |
Benefit Description |
| Women’s Health |
Breast cancer screening with mammography
Cervical cancer screening |
| Children’s Health |
Immunisation Programme (as per State EPI) |
| Cardiac Health |
Cholesterol screening (full lipogram) |
| General Health |
Network family practitioner consultation
Flu vaccination
HIV test |
| Health Risk Assessment |
Wellness screening (BMI, blood pressure, finger prick cholesterol & glucose tests)
Preventative screening (waist-to-hip ratio, body fat %, flexibility, posture & fitness) |
| Doula Benefit |
R1 270 per delivery |
| Postnatal Midwifery Benefit |
4x consultations with a midwife in- and out-of-hospital per pregnancy |
| Newborn Hearing Screening |
Up to the age of 8 weeks |
