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 |
