Fedhealth myFed E medical aid plan: 2020

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myFed E
Total Cost pm:

Main member:

R3,133

Adult:

R2,854

Child:

R1,194
Savings (per year):
  • No savings option on this plan
Income band:

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IN HOSPITAL PROCEDURES:
myFed E
Scheme Benefits: Notes and Links:
non-Network Specialists:
  • 100% scheme rate, with a R2,300 per person
  • sublimit, shared with non-network GPs
network Specialists:
  • Covered in full
non-Network GPs:
  • 100% scheme rate, with a R2,300 per person
  • sublimit, shared with non-network specialists
network GPs:
  • Covered in full
Hospital Choice:
  • Choose from Network Hospitals
Penalty for using other hospital:
  • R12,000 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:
  • R14,000 per person and R28,300 per family
Supplementary Services: (Physio, etc)
  • 100% scheme rate
  • The Blue Plan gap cover will increase this to 500% scheme rate
Transplants:
  • PMBs only
Co-payments:
  • None, unless DSPs are not used
Alternatives to hospitals:
  • PMBs only
Casualty:
  • PMB only
  • 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:
  • 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 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):
myFed E
Scheme Benefits Notes and Links:
Main Member: Adult: Child:
Savings /yr: No savings option on this plan
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:
  • Network GP: Unlimited, at nominated GP and 2 consults per person at non-nominated GP
  • Non-network GP: no benefit
  • See Primary Health Care benefit above
Childcare:
  • 1 test with audiologist, birth to 8 weeks
Specialists consultations:
  • Contracted Specialists: 2 consults up to R1,800 per family
  • Non-Contracted Specialists: no benefit
  • See Primary Health Care benefit above
Pathology:
  • Covered, if on list of covered procedures and referred
  • See Primary Health Care benefit above
General radiology:
  • Covered, if on list of covered procedures and referred
  • See Primary Health Care benefit above
Specialised radiology:
  • No benefit, unless PMB
Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

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MATERNITY BENEFITS:
myFed E
Scheme Benefits Notes and Links:
Hospital stay:
  • Elective C-section: R12,000 co-payment
  • R38,100 per event and R56,400 per family, unless PMB
  • The Blue Plan gap cover will increase this to 500% scheme rate
Consultations:
  • In addition tot eh GP and specialist benefit, Fedhealth pays for 4 postnatal consults with midwife
Scans:
  • Ultrasounds

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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

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DENTISTRY:
myFed E
Scheme Benefits Notes and Links:
Standard Dentistry:
  • Paid by scheme for list of procedures, at contracted dentists
  • 1 set plastic dentures per person, every 2 years
Specialised Dentistry:
  • No benefit
In-Hospital Dentistry:
  • PMBs only
Orthodontics:
  • No benefit
Maxillo Facial Surgery:
  • PMBs only

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MEDICATION:
myFed E
Scheme Benefits: Notes and Links:
Chronic:
Acute (presrcibed) medication:
  • Unlimited, at dispensing network GP
  • Unlimited, with script from non-dispensing GP, subject to formulary
Over-the-counter:
  • No benefit
Birth Control:
  • Covered, oral and injectible subject to formulary
On Discharge:
  • 7 days
Biological:
  • No benefit

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OPTOMETRY:
myFed E
Scheme Benefits: Notes and Links:
Optometry:
Limit:As below, every two years
Consult:1 per person
Frames:R210 per person
Single lenses1 set
Bifocals:1 set
Multifocals
Contacts
Refractive Surgery:

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MENTAL HEALTH:
myFed E
Scheme Benefits Notes and Links:
In-hospital:
  • In-hospital: R9,100 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
Trauma: 2020 benefits coming soon

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OTHER BENEFITS:
myFed E
Scheme Benefits Notes and Links:
General Appliances:
  • PMBs only
1.1. Hearing Aids:
  • No benefit, unless PMB
1.2. Wheelchairs:
  • No benefit, unless PMB
Dialysis:
  • PMBs only
International Insurance: 2020 benefits coming soon
Other: 2020 benefits coming soon

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WELLNESS/PREVENTATIVE BENEFITS:
myFed E
Scheme Benefits: Notes and Links:
Flu vaccination:
  • Covered
Pneumonia vaccines:
  • No benefit, unless PMB
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: 2020 benefits coming soon

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PROSTHETICS:
myFed E
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