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