Fedhealth FlexiFed 3 Any:
in-and-out of hospital benefits (2025)

This page has overview information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Fedhealth FlexiFed 3 Any. Please consult and verify with the scheme or your broker for full benefits, and an explanation of all the "fine print".

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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 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
• 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.

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 3 Any
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:	Choose any hospital except: Zuid-Afrikaans Hospital (City of Tshwane), Arwyp Medical Centre (Ekurhuleni), Busamed Modderfontein Private Hospital (City of Johannesburg), Hibiscus Hospital (Ugu), Mooimed Private Hospital (Dr Kenneth Kaunda), Capital Hospital (Durban). Elective procedures at these 7 hospitals: R8,840 co-payment
Penalty for using other hospital:	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 Back and neck pain procedures: R5,260 co-payment Colonoscopy, upper GI endoscopy: R5,370 co-payment Wisdom Teeth extraction: R5,730 co-payment Inguinal hernia: R5,730 co-payment Laparoscopic varicocelectomy: R7,940 co-payment Varicose vein procedures: R5,370 co-payment Joint replacements: R8,460 co-payment Spinal surgery: R10,000 co-payment MRIs, CT scans etc: R2,960 co-payment Note: A co-payment is a fee your medical aid can insist you pay, regardless of how much the doctor/charges. It's not the same as an "excess" payment (which is when a doctor charges more than the medical aid rate). 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 if you don't use a DSP, especially if you are being treated 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:	R311,900 per family
Exclusions:	Rhizotomies and facet pain blocks 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 3 Any
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) Main= R7,900 Main+1= R13,700 Main+2= R15,600 Main+3= R18,400 "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, 0-2yr 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)
Specialists 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

Medication Benefit (2025):

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

Fedhealth: FlexiFed 3 Any
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) Main= R7,900 Main+1= R13,700 Main+2= R15,600 Main+3= R18,400 "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:	27 PMB conditions: Covered. You can see the full PMB list here. Unlimited cover for: Allergic rhinitis (6-18yrs) Acne (0-21yrs) Eczema (6-18yrs) ADHD (6-18yrs) Depression, Generalised Anxiety Disorder, Post-Traumatic Stress Disorder: R3,200 per family
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
View other benefits for this plan: In-hospital | 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. Find all other open medical aid plans here.
PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider