Fedhealth Maxima Plus: dentistry, optometry and wellness (2024)

Monthly Costs:

Maxima Plus 2024 prices
	Main member:	Adult member:	Child member:
Total Cost pm:	R14,883	R12,846	R4,598 Only pay for 3 children
Savings:	R7,128	R6,144	R2,196
Extended Fund: Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account	R9,794	R7,067	R2,171
Self Payment Gap: (What you need to pay out of pocket before you can access the "Above Threshold" benefit)	R3,878	R2,989	R1,233
"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:	Under 27yrs, provided they are financially dependant, unmarried and don't earn more than the maximum social pension Only pay for 3 children
Note:	Exclusions: Note that all schemes have extensive exclusions. We've tried to list the major ones, but you must consult with your scheme to get the full list. All treatments and procedures are subject to authorisation and protocols All benefits are listed as an indication only. Please verify with your broker and scheme
♦️View all the other benefits for this plan:♦️ Inhospital \| Out of hospital \| Medication \| Maternity \| Cancer \| Mental Health \| Dentistry \| Optometry \| Other/Extra Benefits \| Wellness \| Prosthetics You can also: ♦️Compare any two plans, side by side \| ♦️View all the Fedhealth plans, with costs and brief summary
.

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Dentistry benefits (2024):

Fedhealth: Maxima Plus
Assume scheme pays all these costs, unless otherwise stated
Standard Dentistry:	From day-to-day benefit Unlimited once Threshold is reached.
Specialised Dentistry:	From day-to-day benefit , including Threshold. R8,270 per person and R24,700 per family before and after Threshold Osseo-integrated implants, orthognathic surgery: From day-to-day benefit. Does not accumulate or pay from Threshold
In-Hospital Dentistry:	Maxilo-facial surgery: unlimited, subject approval Children under 7: hospital and anaesthetist paid by scheme. Dentist account paid out-of-pocket	PMBs are always covered by the scheme, and cannot have sublimits or co-payments imposed. These include fracture of face bones, orbit and/or jaw. You can see a full list of maxillo facial PMB benefits here.
Orthodontics:	From day-to-day benefits. Does not accumulate to or pay from Threshold.
Note:	PMBs: Prescribed Minimum Benfits. To read more about PMBs click here DSPs: Designated Service Provders. Where stipulated, you must use specific 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
♦️View all the other benefits for this plan:♦️ Inhospital \| Out of hospital \| Medication \| Maternity \| Cancer \| Mental Health \| Dentistry \| Optometry \| Other/Extra Benefits \| Wellness \| Prosthetics You can also: ♦️Compare any two plans, side by side \| ♦️View all the Fedhealth plans, with costs and brief summary
.

Optometry benefits (2024):

Fedhealth: Maxima Plus
Assume scheme pays all these costs, unless otherwise stated
Optometry:	From day-to-day benefits or Threshold R3,740 per person and R11,400 per family, before and after Threshold
Note:	This section does not apply to opthamology benefits, which fall under "in-hospital" benefits. Some of those are PMBs, and are paid for in full by your scheme. You can read more about PMBs here.
♦️View all the other benefits for this plan:♦️ Inhospital \| Out of hospital \| Medication \| Maternity \| Cancer \| Mental Health \| Dentistry \| Optometry \| Other/Extra Benefits \| Wellness \| Prosthetics You can also: ♦️Compare any two plans, side by side \| ♦️View all the Fedhealth plans, with costs and brief summary
.

Wellness/Preventative benefits (2024):

Fedhealth: Maxima Plus
Assume scheme pays all these costs, unless otherwise stated
Flu vaccination:	Covered
Pneumonia vaccines:	Covered , 65yrs+
Biometric Screening:	Covered
Child Immunisation:	Covered , up to 12yrs
Pap Smear:	Covered , 21yrs-65yrs, every 3 years
Mammogram:	Covered , 40yrs+ every 2 years
PAS Test:	Covered , 45yrs-69yrs
HIV Test:	Covered
Other:	Lipogram: Every 5 yrs Faecal occult blood test: Covered, 50yrs-75yrs, every year
♦️View all the other benefits for this plan:♦️ Inhospital \| Out of hospital \| Medication \| Maternity \| Cancer \| Mental Health \| Dentistry \| Optometry \| Other/Extra Benefits \| Wellness \| Prosthetics You can also: ♦️Compare any two plans, side by side \| ♦️View all the Fedhealth plans, with costs and brief summary
.

Other benefits for 2024:

Maxima Plus
International Insurance:	.
Other:	.
♦️View all the other benefits for this plan:♦️ Inhospital \| Out of hospital \| Medication \| Maternity \| Cancer \| Mental Health \| Dentistry \| Optometry \| Other/Extra Benefits \| Wellness \| Prosthetics You can also: ♦️Compare any two plans, side by side \| ♦️View all the Fedhealth plans, with costs and brief summary
.

Important!

Unless specified, assume that all benefits are paid 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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Fedhealth Maxima Plus: dentistry, optometry and wellness (2024)

Monthly Costs:

Dentistry benefits (2024):

Optometry benefits (2024):

Wellness/Preventative benefits (2024):

Other benefits for 2024:

All the medical aid jargon explained (2024)

How do I make a medical aid plan change (2024)?

Medical Aid waiting periods: what you need to know (2024)

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Sizwe Silver Hospital:
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