Fedhealth FlexiFed 2 Elect medical aid plan: 2020

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FlexiFed 2 Elect
Total Cost pm:

Main member:

R1,703

Adult:

R1,484

Child:

R508
Savings: R R R

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IN HOSPITAL PROCEDURES:
FlexiFed 2 Elect
Scheme Benefits: Notes and Links:
non-Network Specialists: 2020 benefits coming soon
network Specialists: 2020 benefits coming soon
non-Network GPs: 2020 benefits coming soon
network GPs: 2020 benefits coming soon
Hospital Choice:
  • Choose an Elect Network Hospital, or pay a R11,500 co-payment if you voluntarily choose another hospital
Penalty for using other hospital:
  • R11,500 co-payment if you voluntarily choose another hospital
  • The Blue Plan gap cover will pay one "penalty co-payment" up to R10,000 per policy per year
Specialised Radiology:
  • MRI, CT scans: R2,200 co-payment
Supplementary Services: (Physio, etc) 2020 benefits coming soon
  • The Blue Plan gap cover will increase this to 500% scheme rate
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: 2020 benefits coming soon
  • Both the Blue Plan and Red Plan gap cover will pay up to R10,000 per person for unpaid casualty costs in event of emergency
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 R165,000 per person per year for all gap benefits (except dread disease and premium waiver benefits which do not count towards the R165,000 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)

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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.

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OUT OF HOSPITAL BENEFITS (non-PMB):
FlexiFed 2 Elect
Scheme Benefits Notes and Links:
Main Member: Adult: Child:
General info:
  • Consider getting Primary Health Care (PHC) (medical insurance) that will cover you for all GP visits, some specialist visits, acute meds, minor out of hospital procedures, some radiology and pathology, dentistry, optometry and more. It's an excellent complement to a hospital plan.
  • R370/main | R245/adult | R110/child
  • Read more here
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
  • See Primary Health Care benefit above
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
  • See Primary Health Care benefit above
Pathology:
  • From day-to-day benefit, unless PMB
  • See Primary Health Care benefit above
General radiology:
  • From day-to-day benefit, unless PMB
  • See Primary Health Care benefit above
Specialised radiology:
  • MRI, CT scans: R3,000 co-payment, unless PMB
Supplementary Services: (Physio, etc)
  • From day-to-day benefit, unless PMB

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MATERNITY BENEFITS:
FlexiFed 2 Elect
Scheme Benefits Notes and Links:
Hospital stay:
  • Covered
  • Doula benefit: R1,300
  • The Blue Plan gap cover will increase this to 500% scheme rate
Consultations:
    Fedhealth pays for:
  • Antenatal: 8 consults
  • Postnatal: 4 consults with midwife
  • Antenatal classes: R1,050
Scans:
  • 2 x2D scans
  • 1 amniocentesis test

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CANCER (ONCOLOGY):
FlexiFed 2 Elect
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

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DENTISTRY:
FlexiFed 2 Elect
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
  • Consider getting Primary Health Care (medical insurance) that will cover you for a lot of out of hospital claims, including standard dentistry like scaling, polishing, fillings, extractions, root canals and more. It's an excellent complement to a hospital plan.
  • R370/main | R245/adult | R110/child
  • Read more here
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

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MEDICATION:
FlexiFed 2 Elect
Scheme Benefits: Notes and Links:
Chronic: 2020 benefits coming soon
Acute (presrcibed) medication:
  • From day-to-day benefits
  • Consider getting Primary Health Care (medical insurance) that will cover you for all GP visits, some specialist visits, acute meds, minor out of hospital procedures, some radiology and pathology, dentistry, optometry and more. It's an excellent complement to a hospital plan.
  • R370/main | R245/adult | R110/child
  • Read more here
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: 2020 benefits coming soon

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OPTOMETRY:
FlexiFed 2 Elect
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
  • Consider getting Primary Health Care (medical insurance) that will cover you for all GP visits, some specialist visits, acute meds, minor out of hospital procedures, some radiology and pathology, dentistry, optometry and more. It's an excellent complement to a hospital plan.
  • R370/main | R245/adult | R110/child
  • Read more here

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MENTAL HEALTH:
FlexiFed 2 Elect
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
Trauma: 2020 benefits coming soon

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OTHER BENEFITS:
FlexiFed 2 Elect
Scheme Benefits Notes and Links:
General Appliances:
    In and out of hospital:
  • Appliances, external accessories and orthotics: day-to-day benefit
1.1. Hearing Aids:
  • From day-to-day benefits
1.2. Wheelchairs:
  • From day-to-day benefits
Dialysis:
  • R277,900
International Insurance: 2020 benefits coming soon
Other: 2020 benefits coming soon

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WELLNESS/PREVENTATIVE BENEFITS:
FlexiFed 2 Elect
Scheme Benefits: Notes and Links:
Flu vaccination:
  • Covered
Pneumonia vaccines:
  • Covered
Biometric Screening:
  • Covered
Child Immunisation:
  • Covered
Pap Smear:
  • Covered, every 3 years
Mammogram:
  • No cover
PAS Test:
  • Covered
HIV Test:
  • Covered
Other:
  • Lipogram: every 5 yrs
  • Faecal occult blood test:

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PROSTHETICS:
FlexiFed 2 Elect
Scheme Benefits: Notes and Links:
Overal Limit:
  • PMBs only
Sub-limits: 2020 benefits coming soon

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    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