• Benefits, Fedhealth Plan, in-hospital, out-hospital, Scheme Plans

Fedhealth FlexiFed 2 Grid:
in-and-out of hospital benefits (2025)

Contents:

This page has overview information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Fedhealth FlexiFed 2 Grid. Please consult and verify with the scheme or your broker for full benefits, and an explanation of all the "fine print".

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: FlexiFed 2 Grid (2026)
Main member: Adult member: Child member:
Total Cost pm:
  • R3,719
  • R3,315
  • R1,098
Savings (per year):
  • This plan offers a flexible savings option, which you only pay for if you use it. This cost is not included above.
Self Payment Gap:
(What you need to pay out of pocket before you can access the "Above Threshold" benefit)		 8,724
"Above Threshold" benefit (ATB):
Additional cover the scheme makes available to you, once you've paid the self payment gap.
  • Some day-to-day claims, like GP consults, are covered by Fedhealth once you've paid the Self Payment Gap
Children Rates:
  • Up to 27yrs if student, otherwise up to 21yrs
  • Only pay for 3 children
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In-hospital Procedures (2025):

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

Fedhealth: FlexiFed 2 Grid
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
GPs and Specialists:
  • Doctors in network: paid in full
  • Doctors not in network: 100% scheme rate
Gap Cover:
Can push payout up to 700% scheme rate
(Plans coming soon)
Hospital Choice:
  • Network Hospitals
Penalty for using other hospital:
  • Use of non-network Hospitals: R15,470 penalty
  • Use of non-network Day Hospital: R2,630 penalty
 Gap Cover:
Can cover the penalty in full
(Plans coming soon)
Co-payments:
  • All open hernia surgery: R5,730 co-payment
  • Arthroscopic procedures: R10,600 co-payment, (wrist and hip: No benefit.)
  • Back and neck pain procedures: R7,940 co-payment
  • Colonoscopy, upper GI endoscopy: R5,370 co-payment
  • Wisdom Teeth extraction: R5,730 co-payment
  • Inguinal hernia: R5,370 co-payment
  • Laparoscopic varicocelectomy: R7,540 co-payment
  • Varicose vein procedures: R7,940 co-payment
  • Bunion procedures, diagnostic cystoscopy, gastritis/ dyspepsia/ heartburn, nasal procedures, skin biopsy/ excision: R7,940
  • MRIs, CT scans etc: R2,960 co-payment
Note:
  • If you use a DSP (designated service provider), you never have to pay a co-payment for protocol treatment of a PMB (Prescribed Minimum Benefit). More info here
  • There might be other co-payments, especially if you don't use a DSP for a PMB or when buying medicine.
 Gap Cover:
Can cover most co-payments
(Plans coming soon)
Specialised Radiology:
  • MRI and CT Scan: R2,960 co-payment, in and out-of hospital
 Gap Cover:
Can cover most co-payments and increase sublimits
(Plans coming soon)
Scopes: Gap Cover:
Can cover most co-payments and increase sublimits
(Plans coming soon)
Supplementary Services: (Physio, etc)
  • 100% scheme rate
  • Dietetics, occupational therapy and speech therapy: from day-to-day benefit
Transplants:
  • R311,900
  • Corneal graft: No benefit
Dialysis:
  • PMBs only
Exclusions:
  • Cataract surgery
  • Joint replacements
  • Spinal surgery
  • NB: See scheme's rules for all exclusions. All schemes have plenty!
 Gap Cover:
Coming soon
Alternatives to hospitals:
  • Nursing services: Unlimited
  • Sub acute facilities, physical rehab: PMBs only
  • Terminal care: R34,500 per person
Casualty/ER:
  • Emergency treatment, like stitches: R850 co-payment, unless PMB
 Gap Cover:
Can cover ER claims
(Plans coming soon)
Other:
  • Physio, x-rays, pathology etc: Follow up treatment for 30 days post hospitalisation
PMBs = Prescribed Minimum Benefits (more info) | DSP = Designated Service Provider

Out-of-hospital Procedures (2025):

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

Fedhealth: FlexiFed 2 Grid
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
Main Member: Adult: Child:
Savings (per year):
  • This plan offers a flexible savings option, which you only pay for if you use it. This cost is not included above.
Self Payment Gap:
(What you need to pay out of pocket before you can access the "Above Threshold" benefit)		 8,724
"Above Threshold" benefit (ATB):
Additional cover the scheme makes available to you, once you've paid the self payment gap.
  • Some day-to-day claims, like GP consults, are covered by Fedhealth once you've paid the Self Payment Gap
Other Day-to-Day Funds:
PMBs out of hospital:
  • All schemes must pay for the diagnosis, treatment and management of all PMB conditions, in or out of hospital. You can see a full list of the conditions here.
  • This can include consults with specialists, blood or other tests, radiology and medicine.
  • PMB benefits must never be paid from your savings account.
  • Schemes usually impose the use of specific providers for treatment of PMBs. Read more about that here.
  • See our Guide to PMBs for more information.
GP consultations:
  • Nominated and Network GPs: From day-to-day benefit
  • non-Network GPs: From savings
  • When in Threshold: unlimited consults with nominated GP, with a 20% co-payment and 2 consults with non-network GP
Childcare:
  • Paediatrician: 1 consult, 0-1yr
  • Immunisations: Covered, 0-12yrs
  • Childhood illness specialised drugs: Covered, 0-18yrs
  • Vision Screening in Neonates for Retinopathy of prematurity
 Gap Cover:
Can pay for child ER visits
(Plans coming soon)
Specialist consultations:
  • From day-to-day benefit
Pathology:
  • From day-to-day benefit
General radiology:
  • From day-to-day benefit
Specialised radiology:
  • MRI and CT Scan: R2,960 co-payment, in and out-of hospital
 Gap Cover:
Can pay co-payments and increase sublimits
(Plans coming soon)
Scopes: Gap Cover:
Can pay co-payments and increase sublimits
(Plans coming soon)
Supplementary Services: (Physio, etc)
  • Supplementary medical services: From day-to-day benefit
  • Alternative medical services (acupuncture, homeopathy, naturopathy, osteopathy and phytotherapy): From day-to-day benefit .
General Appliances:
  • Appliances, external accessories and orthotics: From day-to-day benefit , unless PMB
1.1. Hearing Aids:
  • From day-to-day benefit
1.2. Wheelchairs:
  • From day-to-day benefit
PMBs = Prescribed Minimum Benefits (more info) | DSP = Designated Service Provider

All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme. The benefits listed here are an indication only. Please verify all benefits and their conditions with the scheme.

Medication Benefit (2025):

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

Fedhealth: FlexiFed 2 Grid
Assume scheme pays all these costs, unless otherwise stated
Main Member: Adult: Child:
Savings (per year):
  • This plan offers a flexible savings option, which you only pay for if you use it. This cost is not included above.
Self Payment Gap:
(What you need to pay out of pocket before you can access the "Above Threshold" benefit)		 8,724
"Above Threshold" benefit (ATB):
Additional cover the scheme makes available to you, once you've paid the self payment gap.
  • Some day-to-day claims, like GP consults, are covered by Fedhealth once you've paid the Self Payment Gap
Other Day-to-Day Funds:
Chronic: .
Acute (prescribed) medication:
  • From day-to-day benefit
Over-the-counter:
  • From day-to-day benefit
Birth Control:
  • Oral, patches, contraceptive rings, certain injectables, and IUDs (including Mirena): Paid by scheme, if prescribed
On Discharge:
  • 7 days
Biological:
  • PMBs only
PMBs = Prescribed Minimum Benefits (more info) | DSP = Designated Service Provider

All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme. The benefits listed here are an indication only. Please verify all benefits and their conditions with the scheme.

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