Fedhealth Maxima Saver Option
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)
|
