Fedhealth Maxima Plus:
prosthetic benefits (2025)

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This page has information on: Costs and Prosthetics for Fedhealth Maxima Plus

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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.

Monthly Costs (2025)

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

Fedhealth:Maxima Plus (2025 prices)
Main member: Adult member: Child member:
Total Cost pm:
  • R16,937
  • R14,619
  • R5,233
  • Only pay for 3 children
Savings:
  • R7,500
  • R6,468
  • R2,316
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • R10,310
  • R7,440
  • R2,290
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:
  • Up to 27yrs if student, otherwise up to 21yrs
  • Only pay for 3 children

Monthly Costs (2026)

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

Fedhealth:Maxima Plus (2026 prices)
Main member: Adult member: Child member:
Total Cost pm:
  • R19,393
  • R16,739
  • R5,992
  • Only pay for 3 children
Savings:
  • R7,728
  • R6,672
  • R2,388
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • R10,630
  • R7,680
  • R2,370
Self Payment Gap:
(What you need to pay out of pocket before you can access the "Above Threshold" benefit)
  • R5,042
  • R3,898
  • R1,632
"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:
  • Up to 27yrs if student, otherwise up to 21yrs
  • Only pay for 3 children

Prosthetics benefits (2024):

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

Fedhealth: Maxima Plus
Overal Limit:
  • Internal: R40,400 unless listed below
  • External: R24,300
 Gap Cover:
Can cover most co-payments and increase sublimits
(Plans coming soon)
Sub-limits:
  • Aorta Stent Grafts: R65,500
  • Cardiac pacemakers: R65,100
  • Cardiac stents: R56,100
  • Cardiac valves: R49,800
  • Detachable platinum coils: R56,700
  • Intraocular lenses: R3,500 per lens
  • Elbow, hip, knee and shoulder replacement:: R49,800
 Gap Cover:
Can cover most co-payments and increase sublimits
(Plans coming soon)
Note:
  • PMBs: Prescribed Minimum Benfits. PMBs cannot have sublimits or co-payments if protocols are followed. You can read more about PMBs 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
Always consult with your broker before making final decisions regarding your healthcare cover.

    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
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What does a “PMBs only” restriction mean?
In this case, the scheme will only pay for diagnosis, treatment and management of a claim for one of 270 pre-defined conditions (PMBs). Read more, and see full list of PMB conditions. 

What does “From Risk” mean?
The scheme will pay for this claim from its own funds, not from your savings or other day-to-day benefits. 

What is a DSP?
A Designated Service Provider. The scheme has a network of providers, and will often only pay claims in full if you use a DSP. If you choose another provider, you might have a co-payment, or even no cover. 

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