• Benefits, Fedhealth Plan, prosthetics, Scheme Plans

Fedhealth Maxima Exec:
prosthetic benefits (2025)

Contents:

This page has information on: Costs and Prosthetics for Fedhealth Maxima Exec

Terminology:

  • PMBs: Prescribed Minimum Benefits. You can read more about PMBs, see a list of all PMB conditions or read more what "PMB only" benefit means.
  • DSPs: Designated Service Providers. Where stipulated, you must use specific providers to get full benefit.
  • Co-payment: Paid out of pocket, or out of savings account. Sometimes this is refundable to you if you have a gap product.
  • All schemes have extensive exclusions. We've tried to list the non-common ones here, but please consult your scheme or broker to get the full list.

Monthly Costs (2026)

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Fedhealth: Maxima Exec (2026)
Main member: Adult member: Child member:
Total Cost pm:
  • R12,273
  • R10,653
  • R3,792
Savings:
  • R12,528
  • R10,872
  • R3,864
Self Payment Gap:
(What you need to pay out of pocket before you can access the "Above Threshold" benefit)
  • R9,322
  • R5,208
  • R1,186
"Above Threshold" benefit (ATB):
Additional cover the scheme makes available to you, once you've paid the self payment gap.
  • Unlimited
  • Unlimited
  • Unlimited
Children Rates:
  • Up to 27yrs if student, otherwise up to 21yrs
  • Only pay for 3 children
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Prosthetics benefits (2025):

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Fedhealth: Maxima Exec
Assume scheme pays all these costs, unless otherwise stated
Overall Limit:
  • Internal: R32,700 unless listed below
  • External: R19,300
  • Prosthetics required for PMB conditions are always paid in full by scheme, with no co-payment, if you follow the protocols. More info here
 Gap Cover:
Can cover most co-payments and increase sublimits
(Plans coming soon)
Sub-limits:
  • Aorta Stent Grafts: R65,500
  • Cardiac pacemakers: R54,500
  • Cardiac stents: R56,100
  • Cardiac valves: R49,800
  • Detachable platinum coils: R56,700
  • Intraocular lenses: R3,500 per lens
  • Elbow, hip, knee and shoulder replacement:: R38,900
 Gap Cover:
Can cover most co-payments and increase sublimits
(Plans coming soon)
Note:
  • PMBs: Prescribed Minimum Benefits. PMBs cannot have sublimits or co-payments if protocols are followed. You can read more about PMBs here.
  • DSPs: Designated Service Providers. Where stipulated, you must use specific providers to get full benefit.
  • Co-payment: Paid out of pocket, or out of savings account. Sometimes this is refundable to you if you have a gap product.
    Important!
  • Unless specified, assume that all benefits are paid at 100% scheme rate.
  • No limits or co-payments can apply to treatment of PMBs, which is always unlimited, although subject to strict protocols and scheme rules.
  • "Unlimited" benefits are still subject to authorisation, protocols and sublimits.
  • Assume that all benefits need to be pre-authorised.
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