Fedhealth FlexiFed 4 Any medical aid plan: 2020

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FlexiFed 4 Any
Total Cost pm:

Main member:

R3,367

Adult:

R3,054

Child:

R1,036
Savings: R R R
Self Payment Gap:
R R R
Above Threshold:

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IN HOSPITAL PROCEDURES:
FlexiFed 4 Any
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 any hospital
Penalty for using other hospital:
  • Choose any hospital
  • n/a
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:
  • R444,700
  • Corneal graft: R20,700
Co-payments:
  • Arthroscopic procedure, hip: R2,400
  • Arthroscopic procedure, wrist: R2,400
  • Arthroscopic procedures - other: R7,800
  • Spinal surgery:R6,200
  • Balloon sinuplasty: R4,200
  • Colonoscopy, upper GI endoscopy: R2,400
  • Joint replacement: single hip and knee with non-network provider:R26,200
  • Other joint replacements and voluntary use of non-network provider :R4,200
  • Laparoscopic procedures:R4,200
  • Laparoscopic varicocelectomy:no co-payment
  • Rhizotomies and facet pain blocks (one per person per year):R4,200
  • Wisdom Teeth:R4,200
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:
  • 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 4 Any
Scheme Benefits Notes and Links:
Main Member: Adult: Child:
Self Payment Gap:
R R R
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:
  • Contracted GPs: Unlimited
  • Non-Contracted GPs: Accummulates and pays from threshold at 100% scheme rate
  • Includes 2 mental health consults
  • See Primary Health Care benefit above
Childcare:
  • 1 test with audiologist, birth to 8 weeks
Specialists consultations:
  • Contracted Specialists: From day-to-day benefit, at cost
  • Non-Contracted Specialists: From day-to-day benefit, 100% scheme rate
  • 20% co-payment if not referred by GP
  • See Primary Health Care benefit above
Pathology:
  • Unlimited from day-to-day benefit
  • See Primary Health Care benefit above
General radiology:
  • Unlimited from day-to-day benefit
  • See Primary Health Care benefit above
Specialised radiology:
  • MRI, CT scans: R2,200 co-payment, unless PMB
Supplementary Services: (Physio, etc)
    Audiology, dietics, genetic counselling, hearing aid acoustics, orthopics, podiatry, private nursing (that falls outside Alternatives to Hospitalisation), psychologists, social workers, speech therapy:
  • From threshold up to R11,600 per family
  • Foot orthotics: R4,340 sublimit
  • Does not accumulate to threshold
  • In and out of hospital
  • Alternative healthcare: does not pay accummulate or pay from threshold
  • Chiropactics, biokinetics and physiotherapy: do not accumulate to threshold

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MATERNITY BENEFITS:
FlexiFed 4 Any
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:
  • Postnatal: 4 consults with midwife
Scans:
  • 2 x2D scans
  • 1 amniocentesis test

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CANCER (ONCOLOGY):
FlexiFed 4 Any
Scheme Benefits Notes and Links:
Overall coverage (in and out of hospital):
  • R444,700 per family, at DSP. (Note that even at this limit, the treatment is still onlly subject to level 1 treatment protocols)
  • You have the option of moving to a higher plan within 30 days of cancer diagnosis

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DENTISTRY:
FlexiFed 4 Any
Scheme Benefits Notes and Links:
Standard Dentistry:
  • Standard dentistry: unlimited from threshold
  • 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: R7,400 per person and R22,100 per family, before and after threshold
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:no co-payment
Orthodontics:
  • See Specialised dentistry, above
Maxillo Facial Surgery:
  • Paid by scheme

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MEDICATION:
FlexiFed 4 Any
Scheme Benefits: Notes and Links:
Chronic: 2020 benefits coming soon
Acute (presrcibed) medication:
  • R5,680 per person and R11,400 per family, from day-to-day benefit
  • 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 savings only. Does not accumulate or pay from threshold.
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 4 Any
Scheme Benefits: Notes and Links:
Optometry:
Limit:R3,340 per person and R10,190 per family. Paid from day-to-day benefit.
Consult:from above limit
Frames:from above limit
Single lensesfrom above limit
Bifocals:from above limit
Multifocalsfrom above limit
Contactsfrom above limit
Refractive Surgery:from above limit
Notes:

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MENTAL HEALTH:
FlexiFed 4 Any
Scheme Benefits Notes and Links:
In-hospital:
  • In-hospital: R25,100 per family. PMBs always paid in full at DSP, and include up to 21 days admission
Out-of-hospital:
    Audiology, dietics, genetic counselling, hearing aid acoustics, orthopics, podiatry, private nursing (that falls outside Alternatives to Hospitalisation), psychologists and psychiatrists, social workers, speech therapy:
  • From threshold up to R11,600 per family
  • Does not accumulate to threshold
  • In and out of hospital
Trauma: 2020 benefits coming soon

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OTHER BENEFITS:
FlexiFed 4 Any
Scheme Benefits Notes and Links:
General Appliances:
    In and out of hospital:
  • From threshold up to R11,600 per family
  • Does not accumulate to threshold
1.1. Hearing Aids:
  • See "General Appliances" limit
1.2. Wheelchairs:
  • See "General Appliances" limit
Dialysis:
  • R444,700
International Insurance: 2020 benefits coming soon
Other: 2020 benefits coming soon

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WELLNESS/PREVENTATIVE BENEFITS:
FlexiFed 4 Any
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 4 Any
Scheme Benefits: Notes and Links:
Overal Limit:
  • Internal:R25,000 unless listed below
  • External:R11,600
Sub-limits:
  • Aorta Stent Grafts:R58,500
  • Cardiac pacemakers:R27,800
  • Cardiac stents:R27,800
  • Cardiac Valves:R27,800
  • Detachable platinum coils:R50,700
  • Elbow replacement:R27,800
  • Hip replacement:R27,800
  • Intraocular lenses:R3,200
  • Knee replacement:R27,800
  • Shoulder Replacement:R27,800

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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