Fedhealth Maxima Exec:
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 Maxima Exec.

Monthly Costs (2025)

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

Maxima Exec 2025 prices
Main member: Adult member: Child member:
Total Cost pm:
  • R10,719
  • R9,304
  • R3,312
  • Only pay for 3 children
Savings:
  • R12,156
  • R10,548
  • R3,744
Self Payment Gap:
(What you need to pay out of pocket before you can access the "Above Threshold" benefit)
  • R9,044
  • R5,052
  • R1,156
"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, 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: Maxima Exec
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
non-Network Specialists:
  • 200% 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:
  • 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),
    • St Helena Private Hospital (Lejweleputswa),
    • Capital Hospital (Durban).
  • Elective procedures at these 7 hospitals: R8,400 co-payment
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:
  • Elective procedures at the 7 excluded hospitals: R8,400 penalty
 You don't pay a penalty if admission was unavoidable due an emergency
Other Co-payments:
  • Arthroscopic procedures: R3,170 co-payment
  • Colonoscopy, upper GI endoscopy: R3,170 co-payment
  • Wisdom Teeth: R5,100 co-payment
  • Laparoscopic hernia repairs (bilateral inguinal, repeated inguinal hernias & Nissen/ Toupet hernia repairs only), laparoscopic procedures, rhizotomies and facet pain blocks: R5,100 co-payment
  • Single hip and knee replacement: no co-payment if contracted
  • Other joint replacements: R5,440 co-payment
  • Spinal Surgery: R7,130 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, R19,400 per family. Does not accumulate to Threshold, but does pay from it.
No limits or co-payments for PMB level care and/or for emergency
Transplants:
  • R624,000
  • Corneal graft: R36,300 per person
Dialysis:
  • R624,000
Exclusions: Exclusions:
  • Note: 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.
 * Treatment required for PMB level of care is always paid by scheme, if you follow the protocols. It cannot be excluded. More info here.

Alternatives to hospitals:
  • Nursing services: Unlimited
  • Sub acute facilities, physical rehab: Unlimited
  • Terminal care: R34,500 per person
Casualty:
  • Emergency treatment, like stitches: R660 co-payment, unless PMB
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: Maxima Exec
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
Summary of day-to-day benefits:
Main Member: Adult: Child:
Savings:
  • R12,156
  • R10,548
  • R3,744
Self Payment Gap:
(What you need to pay out of pocket before you can access the "Above Threshold" benefit)
  • R9,044
  • R5,052
  • R1,156
"Above Threshold" benefit (ATB):
Additional cover the scheme makes available to you, once you've paid the self payment gap.
  • Unlimited
  • Unlimited
  • Unlimited
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:
  • This plan also has a savings account and a self payment gap that accumulates to a "threshold". After the threshold is reached, Fedhealth will pay some day-to-day claims.
  • There is a 10% co-payment for all benefits paid from Threshold.
GP consultations:
  • Network GP: From day-to-day benefit, then paid by scheme
  • Non-Network GP: From day-to-day benefit. Does not accumulate to Threshold, but does pay from it.
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:
  • Fedhealth Network: from day-to-day benefit, unlimited at cost once Threshold is reached. 10% co-payment if no GP referral
  • Non-Network: as above, but at scheme rate and does not accumulate to Threshold
 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, or Threshold
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)
  • In and out of hospital
  • From day-to-day benefit
  • Does not accumulate to Threshold.
  • Paid from Threshold up to R19,400 per family.
General Appliances:
  • Appliances, external accessories and orthotics: From day-to-day benefit, unless PMB
  • Does not accumulate to Threshold, but paid from it up to R17,300 per family
  • Foot orthotics: R4,860 sub-limit per person
  • In and out of hospital
1.1. Hearing Aids:
  • See above
1.2. Wheelchairs:
  • See above
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: Maxima Exec
Assume scheme pays all these costs, unless otherwise stated
Summary of day-to-day benefits:
Main Member: Adult: Child:
Savings:
  • R12,156
  • R10,548
  • R3,744
Self Payment Gap:
(What you need to pay out of pocket before you can access the "Above Threshold" benefit)
  • R9,044
  • R5,052
  • R1,156
"Above Threshold" benefit (ATB):
Additional cover the scheme makes available to you, once you've paid the self payment gap.
  • Unlimited
  • Unlimited
  • Unlimited
Chronic:
  • Additional 43 conditions
  • Overall benefit: R7,890 per person and R14,500 per family. Thereafter, the 27 PMB conditions only
 You might be required to use specific pharmacies and be limited to specific medicines
Acute (presrcibed) medication:
  • From day-to-day benefits
  • R7,940 per person and R14,700 per family, before and after Threshold
Over-the-counter:
  • From day-to-day benefits
  • Does not accumulate or pay from Threshold
Birth Control:
  • Oral, patches, contraceptive rings, certain injectables, and IUDs (including Mirena): Paid by scheme, if prescribed
On Discharge:
  • 7 days
Biological:
  • R194,600, per family
 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.


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