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

What's on this page:

This page has information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Fedhealth FlexiFed 3 Grid.

Monthly Costs (2025)

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

FlexiFed 3 Grid 2025 prices
Main member: Adult member: Child member:
Total Cost pm:
  • R3,874
  • R3,553
  • R1,374
  • Only pay for 3 children
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
Children Rates:
  • Under 27yrs, if financially dependant, unmarried and don't earn more than max 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:
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.
.

In-hospital Procedures (2024):

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

Fedhealth: FlexiFed 3 Grid
Assume scheme pays all these costs, unless otherwise stated
non-Network Specialists:
  • 100% scheme rate
Scheme rate is set by Fedhealth
network Specialists:
  • Covered in full
non-Network GPs:
  • 100% scheme rate
network GPs:
  • Covered in full
Hospital Choice:
  • Network Hospitals
Day Hospitals:
  • Many procedures will be paid from in-hospital benefit if done in a day clinic, day ward or an outpatient section of a hospital.
Penalty for using other hospital:
  • non-network Hospitals: R14,700 co-payment
  • non network Day Hospital: R2,500 co-payment
 You don't pay a penalty if admission was unavoidable due an emergency
Other Co-payments:
  • All open hernia surgery: R5,440 co-payment
  • Arthroscopic procedures: R10,700 co-payment
  • Back and neck pain procedures: R5,000 co-payment
  • Colonoscopy, upper GI endoscopy: R7,540 co-payment
  • Wisdom Teeth: R5,440 co-payment
  • Inguinal hernia: R8,040 co-payment
  • Laparoscopic hernia repairs (bilateral inguinal, repeated inguinal hernias & Nissen/ Toupet hernia repairs only), laparoscopic procedures: R7,540 co-payment
  • Laparoscopic varicocelectomy: R7,540 co-payment
  • Varicose vein procedures: R5,100 co-payment
  • Single hip and knee replacement: no co-payment if contracted
  • Other joint replacements: R8,040 co-payment
  • Spinal Surgery: R9,500 co-payment
 * There might be other co-payments if you don't use scheme-chosen provider for some services.

* Treatment required for PMB level care is always paid by scheme, with no co-payment, if you follow the protocols.
That means that these co-payments might not apply in your case! More info here
Specialised Radiology:
  • MRI and CT Scan: R2,810 co-payment, in and out-of hospital
 No limits or co-payments for PMB level care and/or for emergency
Scopes: No limits or co-payments for PMB level care and/or for emergency
Supplementary Services: (Physio, etc)
  • 100% scheme rate
  • Dietetics, occupational therapy and speech therapy: from day-to-day benefit
 No limits or co-payments for PMB level care and/or for emergency
Transplants:
  • R311,900
  • Corneal graft: No benefit
Dialysis:
  • R311,900 per family
Exclusions:
  • Rhizotomies and facet pain blocks
 * Treatment required for PMB level of care is always paid by scheme, if you follow the protocols. It cannot be excluded. More info here.

* All schemes have extensive exclusions. We've tried to list the major ones here, but please consult your scheme or broker to get the full list
Alternatives to hospitals:
  • Nursing services: Unlimited
  • Sub acute facilities, physical rehab: PMBs only
  • Terminal care: R34,500 per person
Casualty:
  • Emergency treatment, like stitches: R660 co-payment, unless PMB
 All medical emergencies are PMBs, and are always fully paid by scheme, regardless of your "Casualty" benefit. More info here
Other:
  • Appliances, external accessories and orthotics, in and out of hospital: From day-to-day benefit
  • Physio, x-rays, pathology etc: Follow up treatment for 30 days post hospitalisation
Note:
  • 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
View all the 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.
.

Out-of-hospital Procedures (2024):

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

Fedhealth: FlexiFed 3 Grid
Assume scheme pays all these costs, unless otherwise stated
Summary of day-to-day benefits:
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
PMBs out of hospital:
  • All medical aids 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
  • The benefit is paid by the scheme, and not out of your savings account
  • If you have no day-to-day funds, you still have cover for PMBs
  • 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.
General info:
  • The amount of money available for your day-to-day expenses (self-fund) is determined by you on a fixed or flexible basis
  • You then pay off that amount in 12 equal instalments. The quoted premium above does not include this portion, as it is flexible to your needs
  • This plan also has a "self payment gap" that accumulates to a "threshold". After the threshold is reached (i.e once you have self-funded this amount), Fedhealth will pay some day-to-day claims.
GP consultations:
  • From day-to-day benefit
  • Otherwise, when in Threshold: unlimited consults with nominated GP
 Treatment required for PMB conditions is always paid paid by scheme, with no co-payment, if you follow the protocols. More info here
Childcare:
  • Paediatrician: 1 consult, 0-1yr
  • Immunisations: Covered, 0-12yrs
  • Childhood illness specialised drugs: Covered, 0-18yrs
Specialists consultations:
  • From day-to-day benefit
 Treatment required for PMB conditions is always paid paid by scheme, with no co-payment, if you follow the protocols. More info here
Pathology:
  • From day-to-day benefit
General radiology:
  • From day-to-day benefit
Specialised radiology:
  • MRI, CT scans: R2,810 co-payment. In and out-of hospital
 Scans required for PMB level care are paid paid by scheme, with no co-payment, if you follow the protocols. More info here
Scopes: No limits or co-payments for PMB level care and/or for emergency
Supplementary Services: (Physio, etc)
  • Chiropractics, biokinetics & physiotherapy: 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 benefits
1.2. Wheelchairs:
  • From day-to-day benefits
Note:
  • PMBs: Prescribed Minimum Benefits. 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:
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.
.

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 (2024):

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

Fedhealth: FlexiFed 3 Grid
Assume scheme pays all these costs, unless otherwise stated
Summary of day-to-day benefits:
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
Chronic:
    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
You might be required to use specific pharmacies and be limited to specific medicines
Acute (presrcibed) medication:
  • From day-to-day benefits
Over-the-counter:
  • From day-to-day benefits
Birth Control:
  • Oral, patches, contraceptive rings, certain injectables, and IUDs (including Mirena): Paid by scheme, if prescribed
On Discharge:
  • 7 days
Biological:
  • PMBs only
Treatment that is required (by law) for PMB conditions is always paid paid by scheme, with no co-payment, if you follow the protocols. More info here.)
Note:
  • Schemes have very strict rules about where you can get your medicine to get full benefit. We do not list the requirements here, so confirm with your scheme before you collect your medicine.
  • Formulary: A pre-defined list of approved medicines. Each plan has a different list, and might not pay for non-listed medicine. Confirm with your scheme whether your required medicine is covered by them.
  • 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:
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.
.

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.