Fedhealth FlexiFed 2 Any medical aid plan: 2019

View all plans in this scheme.
Always consult with your broker before making final decisions regarding your healthcare cover.

FlexiFed 2 Any
2019 Costs:
Total Cost pm:

Main member:

R2,086

Adult:

R1,788

Child:

R615
Savings: R300 R252 R84
NEED HELP?
We can help you manage or change this plan.
Click here to start.

IN HOSPITAL PROCEDURES:
FlexiFed 2 Any
Scheme Benefits: Notes and Links:
Specialists:
  • Contracted GPs and specialists: covered in full
  • Non-network healthcare professionals: 100% scheme rate
  • You or gap cover pay the balance, if any
Gap Cover
  • Gap cover is available for this plan. Budget about R350 for a fully comprehensive gap cover that will increase the scheme rate to 500% and pay most co-payments and increase sublimits.
Hospital Choice:
  • Choose any hospital
Specialised Radiology:
Supplementary Services: (Physio, etc)
  • 100% scheme rate
  • Dietics, OT and speech therapy: from day-to-day benefits
Transplants:
  • R277,900
  • Corneal graft: no benefit
Co-payments:
  • Adenoidectomy: R6,200
  • All open hernia surgery: R4,200
  • Arthroscopic procedure, hip: R7,800
  • Arthroscopic procedure, wrist: R7,800
  • Arthroscopic procedures - other: R7,800
  • Back and neck pain procedures: R6,200
  • Spinal surgery:R6,200
  • Balloon sinuplasty: No benefit
  • Bunion procedures: R6,200
  • Colonoscopy, upper GI endoscopy: R4,200
  • Diagnostic cystoscopy: R6,200
  • Dental Admissions: R6,200
  • Gastritis, dyspepsia, heartburn: R6,200
  • Hysterectomy (unless for cancer): R3,600
  • Joint replacement: single hip and knee with network provider:PMB level of care
  • Joint replacement: single hip and knee with non-network provider:PMB level of care
  • Other joint replacements and voluntary use of non-network provider :PMB level of care
  • Laparoscopic procedures:R6,200
  • Nasal procedures:R6,200
  • Rhizotomies and facet pain blocks (one per person per year):No benefit
  • Skin biopsy/excision:R6,200
  • Wisdom Teeth:R4,200
  • Tonsillectomy, 12yrs+:R6,200
  • Varicose vein procedures:R6,200
Alternatives to hospitals:
  • Nursing services: Unlimited
  • Sub acute facilities, physical rehab: Unlimited, up to PMB level of care
  • Terminal care: R31,000
Casualty:
Other:
  • In and out of hospital appliances, external accessories and orthotics: day-to-day benefit
  • Follow up treatment for 30 days post hospitalisation for physio, x-rays, pathology etc
Note:
  • Gap cover is an add-on to your medical aid, not a stand alone product
  • Gap cover has a maximum benefit payout of R150,000 per person per year for all gap benefits (except dread disease and premium waiver benefits which do not count towards the R150,000 limit)
  • Gap only supplements payment for procedures approved or authorised by your medical aid, and does not cover “penalties” (such as if, for example, you choose a non-DSP doctor for your procedure when the plan required a DSP doctor)
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme.
The gap benefits listed are for AskAdam gaps, unless otherwise stated. Actual benefits depend on gap choice option.

.
.
.
.
OUT OF HOSPITAL BENEFITS (non-PMB):
FlexiFed 2 Any
Scheme Benefits Notes and Links:
Main Member: Adult: Child:
General info:
  • This plan has a nominal savings account
  • In addition, this plan has a Benefit Maximiser for GP visits and dentistry. Once you spend a certain amount on day-to-day claims, Fedhealth will pay for some dental and GP costs. See specific benefit for details.
  • Lastly, you have access to a MediVault, which is a cash lump sum transferred to your Fedhealth Wallet when you need money for day-to-day expenses. It then becomes part of your day-to-day benefit. You pay off this lump amount in 12 equal monthly installments, starting from when you transferred it.
Money available from MediVault: (needs to be paid back in 12 installments)
MR4,200
M+1R7,800
M+2R9,000
M+3R10,800
GP consultations:
  • From day-to-day benefit
  • Once your day-to-day claims (paid from savings, wallet or out-of-pocket) have accumulated to the amounts below, Fedhealth will pay for unlimited consults with nominated GP
  • M =R4,200
    M =R7,800
    M =R9,000
    M =R10,800
Childcare:
  • 1 test with audiologist, birth to 8 weeks
  • 1 consult with paediatrician, up to 12 months
Specialists consultations:
  • From day-to-day benefit, unless PMB
Pathology:
  • From day-to-day benefit, unless PMB
General radiology:
  • From day-to-day benefit, unless PMB
Specialised radiology:
  • MRI, CT scans: R3,000 co-payment, unless PMB
Supplementary Services: (Physio, etc)
  • From day-to-day benefit, unless PMB
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

.
.
MATERNITY BENEFITS:
FlexiFed 2 Any
Scheme Benefits Notes and Links:
Hospital stay:
  • Covered
  • Doula benefit: R1,300
Consultations:
    Fedhealth pays for:
  • Antenatal: 8 consults
  • Postnatal: 4 consults with midwife
  • Antenatal classes: R1,050
Scans:
  • 2 x2D scans
  • 1 amniocentesis test
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

.
.
CANCER (ONCOLOGY):
FlexiFed 2 Any
Scheme Benefits Notes and Links:
Overall coverage (in and out of hospital):
  • R277,900 per family, at DSP
  • You have the option of moving to a higher plan within 30 days of cancer diagnosis
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

.
.
DENTISTRY:
FlexiFed 2 Any
Scheme Benefits Notes and Links:
Standard Dentistry:
  • Once your day-to-day claims (paid from savings, wallet or out-of-pocket) have accumulated to the amounts below, Fedhealth will pay for 2 consults per person, including x-rays and scaling and polishing, fillings, extractions and root canal
  • M =R4,200
    M =R7,800
    M =R9,000
    M =R10,800
Specialised Dentistry:
  • Specialised dentistry: From day-to-day benefit
In-Hospital Dentistry:
  • Maxilo-facial surgery: unlimited, subject to approval
  • In-hospital, children under 7: hospital and anaesthetist paid by scheme. Dentist account paid out-of-pocket
  • Surgical extraction of wisdom teeth: R4,200 co-payment
  • Dental admissions:R6,200 co-payment
Orthodontics:
  • From day-to-day benefits
Maxillo Facial Surgery:
  • Paid by scheme
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

.
.
MEDICATION:
FlexiFed 2 Any
Scheme Benefits: Notes and Links:
Chronic:
  • Conditions covered:27 CDL conditions
  • Co-payment for use of non-formulary:
Acute (presrcibed) medication:
  • From day-to-day benefits
Over-the-counter:
  • From day-to-day benefits
Birth Control:
  • Oral, patches, rings, certain injectables,as wella s IUDs (incl Mirena): paid by scheme
On Discharge:
  • 7 days
Biological:
  • No benefit, unless PMB level of care
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

.
.
OPTOMETRY:
FlexiFed 2 Any
Scheme Benefits: Notes and Links:
Optometry:
Limit:From day-to-day benefit
Consult:n/a
Frames:n/a
Single lensesn/a
Bifocals:n/a
Multifocalsn/a
Contactsn/a
Refractive Surgery:n/a
Notes:n/a
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

.
.
MENTAL HEALTH:
FlexiFed 2 Any
Scheme Benefits Notes and Links:
In-hospital:
  • In-hospital: R23,700 per family. PMBs always paid in full at DSP, and include up to 21 days admission
Out-of-hospital:
  • Out of hospital PMBs: always paid in full
  • Non-PMBs: sfrom day-to-day benefit
/td>
Trauma:
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

.
.
OTHER BENEFITS:
FlexiFed 2 Any
Scheme Benefits Notes and Links:
General Appliances:
    In and out of hospital:
  • Appliances, external accessories and orthotics: day-to-day benefit
  • No benefit
1.1. Hearing Aids:
  • From day-to-day benefits
1.2. Wheelchairs:
  • From day-to-day benefits
Dialysis:
  • R277,900
HIV:
Emergency Transport:
International Insurance:
Other:
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

.
.
WELLNESS/PREVENTATIVE BENEFITS:
FlexiFed 2 Any
Scheme Benefits: Notes and Links:
Flu vaccination:
  • Covered
Pneumonia vaccines:
  • Covered
Back Rehabilitation Programme:
  • Covered
Biometric Screening:
  • Covered
Child Immunisation:
  • Covered
Pap Smear:
  • Covered, every 3 years
Mammogram:
  • Covered
PAS Test:
  • Covered
HIV Test:
  • Covered
Other:
  • Lipogram: every 5 yrs
  • Faecal occult blood test:
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

.
.
PROSTHETICS:
FlexiFed 2 Any
Scheme Benefits: Notes and Links:
Overal Limit:
  • PMBs only
Sub-limits:
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.


    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