Maxima Saver - Medical Aid Search

The Fedhealth Maxima Saver option is ideal for 20-something professional that is serious about their health and willing to pay a little more for medical cover

An innovative hospital plan, this option provides unlimited cover at all private hospitals. This option also includes a nice day-to-day medical cover. You will enjoy unlimited FP visits at nominated FPs on the Fedhealth FP Network once your savings is depleted.

If you are looking for a hardworking hospital plan with added day-to-day medical cover, the Maxima Saver is for you.

This options covers the following:

Unlimited private hospital cover at all private hospitals
Post-hospitalisation treatment for up to 30 days after discharge from hospital
7 days of take-home medication
Unlimited 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)
Unlimited specialist cover at cost with Fedhealth Network Specialists – while under the care of a network specialist in hospital, your treatment will always be covered in full. Use of non-Fedhealth contracted healthcare professionals is covered at up to 100% of the Fedhealth Rate

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
Female contraceptives covered: oral, patches, contraceptive rings and certain injectables, as well as IUDs including Mirena® device
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!
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 259	R1 887	R657
Monthly Contribution (Grid Option)	R2 003	R1 678	R584

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

Day-to-Day Benefits

	Principal Member	Adult Dependant	Child Dependant*
Benefits Available	R4 068	R3 396	R1 188

Basic Dentistry

Even if your Savings run out, we’ll still take care of you. Your Savings account refunds your day-to-day expenses at cost, until it is finished. If you use a Fedhealth Network FP, your consultations will continue to be covered unlimited for the remainder of the year. You and your dependents must however nominate a network FP. A different can be nominated for every depended if required.

Chronic Diseases Benefits

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.

Please Note: You have to apply for your Chronic Disease Benefit to be activated, even if you’ve declared your condition on your application form.

	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 Co-payment if a Network Hospital is NOT used: R11 000 (not applicable if admitted to a non-network hospital in an emergency)
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	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
Extended Care Benefits	Unlimited Network FP visits Fedhealth Nurse Line Trauma counselling Emergency Transport/Response Comprehensive managed care programmes (weight management, smoking cessation, Aid for AIDS (AfA), oncology disease management) Active disease risk management (conservative back & neck rehabilitation programme, mental health programme) Post-hospitalisation treatment Take-home medicine Specialised radiology (in- and out-of-hospital) Trauma treatment at a casualty ward Female contraception In-hospital dentistry (children up to age of 7) Dentistry (basic)