Fedhealth myFed E medical aid plan: 2019

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myFed E
2019 Costs:
Total Cost pm:

Main member:

R2,804

Adult:

R2,506

Child:

R1,068
Savings (per year):
  • No savings option on this plan
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IN HOSPITAL PROCEDURES:
myFed E
Scheme Benefits: Notes and Links:
Specialists:
  • Contracted GPs and specialists: covered in full
  • Non-Contracted GPs and specialists: 100% scheme rate and limited to R2,220 per person
  • 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 from Network Hospitals, or pay a R11,500 co-payment if you voluntarily choose another hospital
Specialised Radiology:
Supplementary Services: (Physio, etc)
  • 100% scheme rate
  • Physio and biokinetics: PMBs only
Transplants:
  • PMBs only
Co-payments:
  • None, unless DSPs are not used
Alternatives to hospitals:
  • PMBs only
Casualty:
  • R570 co-payment for non-PMB
Other:
  • Transport service, for follow up assistance following hospital stay
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?
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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):
myFed E
Scheme Benefits Notes and Links:
Main Member: Adult: Child:
General info:
GP consultations:
  • Network GP: Unlimited, at nominated GP and 2 consults per person at non-nominated GP
  • Non-network GP: no benefit
Childcare:
  • 1 test with audiologist, birth to 8 weeks
Specialists consultations:
  • Contracted Specialists: 2 consults up to R1,740 per family
  • Non-Contracted Specialists: no benefit
Pathology:
  • Covered, if on list of covered procedures and referred
General radiology:
  • Covered, if on list of covered procedures and referred
Specialised radiology:
  • No benefit, unless PMB
Supplementary Services: (Physio, etc)
  • No 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.

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MATERNITY BENEFITS:
myFed E
Scheme Benefits Notes and Links:
Hospital stay:
  • PMB level of care
  • Elective C-section: R11,500 co-payment
  • Possibility to upgrade to higher option on pregnancy
Consultations:
    Fedhealth pays for:
  • 4 consults with midwife
Scans:
  • Ultrasounds
What next?
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CANCER (ONCOLOGY):
myFed E
Scheme Benefits Notes and Links:
Overall coverage (in and out of hospital):
  • PMBs only, at DSP
  • Possibility to upgrade to higher option post diagnosis of dread disease including cancer
What next?
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DENTISTRY:
myFed E
Scheme Benefits Notes and Links:
Standard Dentistry:
  • Paid by scheme for list of procedures
Specialised Dentistry:
  • Plastic dentures: 1 set per person every two years
In-Hospital Dentistry:
  • PMBs only
Orthodontics:
  • No benefit
Maxillo Facial Surgery:
  • PMBs only
What next?
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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.

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MEDICATION:
myFed E
Scheme Benefits: Notes and Links:
Chronic:
  • Conditions covered:27 CDL conditions
  • Co-payment for use of non-formulary:
Acute (presrcibed) medication:
  • Unlimited, at dispensing network GP
  • Unlimited, at non-dispensing medical practicioners, subject to formulary
Over-the-counter:
  • No benefit
Birth Control:
  • Covered, oral and injectible subject to formulary
On Discharge:
  • 7 days
Biological:
  • No benefit, unless PMB level of care
What next?
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OPTOMETRY:
myFed E
Scheme Benefits: Notes and Links:
Optometry:
Limit:As below, every two years
Consult:1 per person
Frames:R200 per person
Single lenses1 set
Bifocals:
Multifocals
Contacts
Refractive Surgery:
Notes:
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.

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MENTAL HEALTH:
myFed E
Scheme Benefits Notes and Links:
In-hospital:
  • In-hospital: R8,800 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: shared with GP and Specialist benefit
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Trauma:
  • No 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.

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OTHER BENEFITS:
myFed E
Scheme Benefits Notes and Links:
General Appliances:
  • PMBs only
  • No benefit
1.1. Hearing Aids:
  • No benefit, unless PMB
1.2. Wheelchairs:
  • No benefit, unless PMB
Dialysis:
  • PMBs only
HIV:
  • PMB level of care
  • HIV medicine benefit includes treatment for mother-to-child transmission, rape and post-exposure prohylaxis
Emergency Transport:
  • Europe Assistance
International Insurance:
  • No benefit, unless PMB
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.

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WELLNESS/PREVENTATIVE BENEFITS:
myFed E
Scheme Benefits: Notes and Links:
Flu vaccination:
  • Covered
Pneumonia vaccines:
  • No benefit, unless PMB
Back Rehabilitation Programme:
  • Available
Biometric Screening:
  • Covered
Child Immunisation:
  • No benefit, unless PMB
Pap Smear:
  • No benefit, unless PMB
Mammogram:
  • No benefit, unless PMB
PAS Test:
  • Covered, men 45-69yrs
HIV Test:
  • Covered
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.

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PROSTHETICS:
myFed E
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