Fedhealth Maxima EntryZone Option

The Fedhealth Maxima EntryZone option is ideal for young, single and healthy individuals that is looking for an affordable hospital plan that also provides solid coverage.

The Fedhealth Maxima EntryZone option falls within Fedhealth’s range of Hospital Plans and includes an in-hospital benefit, a chronic disease benefit and numerous value-added benefits.

This options covers the following:

  • Unlimited private hospital cover at Network Hospitals
  • 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 R2800)
  • 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 be covered 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
  • Certain female oral contraceptives covered
  • 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
Contributions
Principal Member Adult Dependant Child Dependant*
Total Monthly Contribution R1 424 R1 088 R482

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

Day-to-Day Benefits

The Fedhealth Maxima EntryZone is a hospital plan option, which means it has no day-to-day benefits.

However, should you or one of your dependants have a PMB chronic condition, 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.

Day-to-Day Benefits
Subject to formulary? Yes
Co-payment for Non-Formulary 40%
Number of Conditions Covered 25
Annual Limit to PMB Cover 0
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 Diseases Covered
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 R5 900 to R11 000.

Benefit Name Benefit Description
In-hospital Benefit Unlimited
Network Hospital Yes
Any Private Hospital No
Authorisation Required 48 hours before admission
48 hours after admission in case of emergency
Organ Transplants Unlimited – subject to PMB level of care
In-Hospital Specialist 100% Covered, if network specialist
Shortfall if Network Specialist is Not Used Yes
Oncology Covered for PMBs only
Renal Dialysis Unlimited – subject to PMB level of care
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