Fedhealth Maxima Plus: cancer, maternity and mental health (2024)

This page has information on: Costs, Maternity, Oncology, Mental Health for Fedhealth Maxima Plus

We also have information on: In-hospital, Out of hospital, Medicine, Dentistry, Optometry, Other/Extra Benefits, Wellness and Preventative and Prosthetics

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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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Cancer/ Oncology benefits for 2024:

Fedhealth: Maxima Plus
Assume scheme pays all these costs, unless otherwise stated
Overall coverage (in and out of hospital):	Unlimited, from Enhanced Protocol	Treatment required for PMB conditions is always paid by scheme, with no co-payment, if you follow the protocols. Most cancers are PMBs! More info here Most schemes require use of specific providers (DSPs) for oncology treatment.
♦️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
.

Maternity benefits for 2024:

Fedhealth: Maxima Plus
Assume scheme pays all these costs, unless otherwise stated
Hospital stay:	Doula benefit: R3,000 Private ward	Usually covered for 2 nights* for natural birth, and 3 nights for C-sections. All newborns receive immediate full medical aid cover at birth, even if parents are on a waiting period.*
Consultations:	Consults: 12 consults paid by scheme Ante-natal classes: R1,160 Thereafter, From day to day benefit
Scans:	2 x2D ultrasound scans 1 amniocentesis test Threshold does not pay for extra scans
Note:	If you are pregnant and don't have medical aid, your pregnancy will most likely be excluded for new cover, but your baby will be covered from birth. Read more about pregnancy cover if you don’t have medical aid.
♦️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
.

Mental Health benefits for 2024:

Fedhealth: Maxima Plus
Assume scheme pays all these costs, unless otherwise stated
In-hospital:	PMBs: 21 days admission Alcoholism/Drug Addiction: 21 days admission Otherwise, R45,100
Out-of-hospital:	PMBs: 10+ consults, paid by scheme Network Psychiatrist: from day-to-day benefit. Once in Threshold, benefit is shared with Additional Medical Services at R19,400 per family, before and after Threshold, and paid at cost. Non-Network Psychiatrist: as above, but paid at scheme rate
Trauma:	.
Note:	PMBs: Prescribed Minimum Benefits. Here is a list of PMB conditions: Mental Illness. 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
.

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

All the medical aid jargon explained (2024)

Medical aid and PMBs? DSPs? PPNs? We decipher the medical aid jargon in plain English so that you are not as confused 🙂

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

A quick guide to how you can change your medical aid plan, including the resignation procedure, and things to look out for, such as imposed waiting periods from your new scheme

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

Waiting periods can prevent you from getting the cover that you need – but they are not always applied. Find out rules here.

Fedhealth Maxima Plus: cancer, maternity and mental health (2024)

Monthly Costs:

Cancer/ Oncology benefits for 2024:

Maternity benefits for 2024:

Mental Health 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)

Also see these:

Sizwe Value Core:
cancer, maternity and mental health (2024)

Sizwe Value Core:
prosthetic benefits (2024)

Sizwe Value Core:
in-and-out of hospital benefits (2024)

Sizwe Value Core:
dentistry, optometry and wellness (2024)

Sizwe Silver Hospital:
prosthetic benefits (2024)