Maxima Core - Medical Aid Search

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