#Maxima Plus Individual Option Brochure 2023

Create your aid.
maxima PLUS
2 02 3
INTERACTIVE RATES & BENEFITS GUIDE GET STARTED

Create your aid.
CONTENTS
Welcome to Fedhealth
Unique and additional benefits paid from Risk
maxima PLUS plan

In-hospital benefit overview
Chronic benefit overview
Screening benefit overview
Cancer cover overview
Maternity and childhood benefit overview
Mental health benefit overview
Day-to-day benefit overview
Threshold benefit overview
How much will I pay?
Programmes and wellness initiatives
Contribution and benefit tables

maxima PLUS contributions
maxima PLUS rate calculations
Contact details
WELCOME TO UNIQUE BENEFITS MAXIMA PLUS PROGRAMMES AND CONTRIBUTIONS CONTACT
FEDHEALTH PAID FROM RISK OVERVIEW WELLNESS INITIATIVES & BENEFIT TABLES DETAILS
Comprehensive cover.
Complete peace of mind.
Don’t pay for certain benefits Boasting an 84-year track record, Fedhealth Medical
until you need them with our Scheme has a solvency rate of 43.43% (as at 31 Decem-
30-day upgrade policy ber 2021), and a Global Credit Rating of AA-, retained for
14 consecutive years.
Generous in-hospital,
chronic, screening and Our financial health and expertise aside, it’s our philoso-
day-to-day benefits phy of being run ‘by members for members’ that helps
Don’t pay for certain benefits
us really put our members first in everything we do.
until you need them with our
30-day upgrade policy
Fedhealth pays more benefits from Risk than other
schemes, to help our members’ day-to-day savings last
longer. Some of these valuable benefits include unlimited
network GP visits, as well as seven days’ take-home
medication following a hospital stay, and trauma treat-
Our maxima EXEC and maxima PLUS options give members the peace of mind ment at a casualty ward whether you’re admitted to
that most of their healthcare needs will be met. This range leaves nothing to hospital or not.
chance, with ample in-hospital, chronic, screening and day-to-day cover covered
by the Risk benefit, as well as value-added additional benefits. In addition, it also Our maxiFED range, consisting of maxima EXEC and
features a Medical Savings Account for day-to-day expenses and a Threshold maxima PLUS, gives comprehensive cover that affords
benefit. maxima PLUS also has an Out-of-Hospital Expenses Benefit (OHEB). members total peace of mind. These options are struc-
tured to provide generous in-hospital, screening and
chronic cover, and day-to-day cover, through a Medical
Savings Account (MSA), a Threshold benefit and an
Out-of-Hospital Expenses Benefit (OHEB) (the latter on
CLICK HERE for more detail on the maxiFED benefits and what they offer members. maxima PLUS only).
Create your aid.

Unique benefits paid from Risk

Take a look at our unique benefits paid from Risk (and not the member’s day-to-day benefit) to save the member money:
Upgrades to higher options any time of year Trauma treatment at a casualty ward
Life happens, right? So whether you are diagnosed with a serious illness, get On Fedhealth, injuries that require medical treatment like stitches or the setting
married or discover that a baby is on the way, Fedhealth will let you upgrade to of a fractured bone, are covered whether you’re admitted to hospital or not.
a higher option that better suits your needs within 30 days of your diagnosis or Authorisation must be obtained within 48 hours and a co-payment of R750 per
circumstances changing. visit for non-PMBs applies to all options except maxima PLUS.
Unlimited network doctor’s visits Female contraception

On Fedhealth, members can see their GP as often as they need on most options, Oral, patches, certain injectables, contraceptive rings as well as IUDs that include
by either visiting any network GP or a nominated network GP (depending on the the Mirena® are paid for by Fedhealth. It must, however, be prescribed by a GP or
option). gynaecologist and is not applicable to pills prescribed for acne.
Post-hospitalisation treatment for up to 30 days after discharge

from hospital In-hospital dentistry for children under 7
This means that following a hospital stay, your treatment like physiotherapy, x-rays We pay for dentistry performed in-hospital for children up to the age of 7. The
or pathology is covered by Fedhealth, and not your day-to-day benefit or your own hospital account and anaesthetist costs are paid from the in-hospital benefit while
pocket. Excludes follow-up consultations with GPs or specialists. the dentist’s account comes from day-to-day benefits.
Take-home medication
Fedhealth pays for seven days of take-home medication when you’re discharged Child rates for financially dependent children
from hospital. The medication must however be dispensed by the hospital, and On Fedhealth, you pay child rates for children who still depend on you financially,
must reflect on the original hospital account. are unmarried and don’t earn more than the maximum social pension up to 27 years
of age.
Specialised radiology
Fedhealth covers specialised radiology such as MRI and CT scans from Risk,
whether it’s performed in- or out-of-hospital. A co-payment applies to non-PMB
MRI/CT scans on all options except maxima PLUS.
Create your aid.

maxima PLUS
Fedhealth’s most extensive medical cover for members in their later years
maxima PLUS is a comprehensive medical aid plan that will give you peace of mind that your health is well taken care of.
It features generous unlimited private in-hospital cover, a chronic disease benefit and a screening benefit for various lifestyle, wellness and physical screenings tailored to your
age group.
You will also enjoy day-to-day benefits paid from Risk, such as specialised radiology like MRI and CT scans, a 30-day post-hospitalisation treatment benefit like X-rays and
physio, and seven days of take-home medication upon discharge from hospital.
On this option, you have substantial Fedhealth Savings for your day-to-day medical expenses, a Threshold benefit and an Out-of-Hospital-Expenses Benefit (OHEB).
By choosing maxima PLUS, you can also look forward to rich value added benefits like the 24-hour Fedhealth Nurse Line for medical advice and the MediTaxi transport service.
Let’s take a look:
In-hospital benefit overview More info l Benefit table
Chronic benefit overview More info l Benefit table
Screening benefit overview More info l Benefit table
Cancer cover overview More info l Benefit table
Maternity and childhood benefit overview More info l Benefit table
Mental Health benefit overview More info l Benefit table
Day-to-day benefits More info l Benefit table
Threshold benefit More info l Benefit table How much will I pay?
Create your aid.

maxima PLUS
age group. UNLIMITED PRIVATE HOSPITAL COVER
On maxima PLUS members may use:
Let’s take a look: maxima PLUS covers all admissions at any private hospital except the following hospitals, Zuid-Afrikaans
Hospital (City of Tshwane), Arwyp Medical Centre (Ekurhuleni), Busamed Modderfontein Private Hospital
In-hospital benefit overview More (City of
info Benefit tableHibiscus Hospital (Ugu), Mooimed Private Hospital (Dr Kenneth Kaunda), St Helena
l Johannesburg),
Private Hospital (Lejweleputswa), Capital Hospital (Durban), which have been excluded for 2023.
Emergency treatment at these 7 hospitals, however, will be covered in full without a co-payment but elective
procedures will attract a R7 800 co-payment.
This benefit covers:

Hospital account Doctors and Specialists Other healthcare Certain procedures at 270 hospital-based
e.g. anaesthetists providers day wards, day clinics PMB conditions
Fedhealth Network GPs e.g. X-rays and doctor’s rooms DSPs, formularies
and Specialists covered and referrals may
in full – non-network apply to avoid
GPs and Specialists co-pays.
covered up to
Fedhealth Rate.
Pre-authorisation must be obtained for all planned hospital admissions.

EMERGENCIES: Members must obtain authorisation within 2 working days after hospital admission.
An emergency is unexpected, requiring immediate treatment to avoid lasting damage to organs, limbs or
Threshold benefit More info l Benefit table other body parts, or death. How much will I pay
Create your aid.

maxima PLUS In-hospital benefit

maxima PLUS has an unlimited in-hospital ben- This means that all schemes must provide PMB level
efit.
maxima PLUS is a comprehensive medical aid plan that will give you peace of mind that your health is well taken care of.Pre-authorisation must be obtained for all of care at cost for these conditions. In order for
planned
It features generous unlimited private in-hospital cover, a chronic disease benefit and a screening benefit for various lifestyle, hospital admissions.
wellness and For emergencies,
physical screenings tailored to your members to get funding in full, schemes are allowed
age group. authorisation must be obtained within two work- to require members to use Designated Service Pro-
ing days after going to hospital.
viders (DSPs) and apply formularies and managed
care protocols.
• The in-hospital benefit covers hospital costs
and accounts from doctors, specialists e.g. the • Fedhealth uses network specialists, network GPs
By choosing maxima PLUS, you can also look forward to rich value added benefits like the 24-hour Fedhealth Nurse Line for medical and
anaesthetist advice and
the the MediTaxi
X-ray transport service.
department. and network hospitals for the provision of PMBs.
• It also covers selected procedures in day wards, • Members must use a Fedhealth Network Specialist
day clinics and doctor’s rooms. and a nominated network GP in order for the cost
Let’s take a look: • maxima PLUS covers all admissions at any to be refunded in full.
private hospital except the following hospi-
In-hospital benefit overview tals:
More info l Benefit table Zuid-Afrikaans Hospital (City of Tshwane), • Should you not use these DSPs for PMB treat-
Arwyp Medical Centre (Ekurhuleni), Busamed ment, the Scheme will reimburse treatment at the
Modderfontein Private Hospital (City of Johan- non-network rate.
nesburg), Hibiscus Hospital (Ugu), Mooimed • Co-payments are applicable to the voluntary use
Private Hospital (Dr Kenneth Kaunda), St Helena of non-DSPs. Referral must be obtained from a
Private Hospital (Lejweleputswa), Capital Hospi- Fedhealth Network GP for consultations with
tal (Durban), which will not be covered in full for Fedhealth Network Specialists. If referral is not
2023. Emergency treatment at these 7 hospi- obtained, there will be a co-payment on specialist
tals, however, will be covered in full without a claims paid from the Risk benefit. Co-payments are
co-payment
table but elective procedures will attract option dependent.
Screening benefit overview More info l Benefit
a R7 800 co-payment.
Please note: Qualification for reimbursement as a
Cover for hospital admissions PMB is not based solely on the diagnosis (condition),
• The hospital account is covered from the but also on the treatment provided (level of care).
Cancer cover overview More info l Benefit table benefit.
in-hospital So although a member’s condition may be a PMB
• Specialists and GPs on the Fedhealth network condition, the Scheme would only be obliged to fund
are covered in full. Specialists and GPs not on it in full if the treatment provided was considered
the Fedhealth network are covered up to the PMB level of care.
Maternity and childhood benefit overview More info l Benefit table Rate.
Fedhealth
• Referral by a medical practitioner and Co-payments on certain procedures
pre-authorisation is required for physiotherapy, For some treatments and procedures, members
covered up to the Fedhealth Rate. must pay an amount out of their own pocket.
Co-payments apply to the hospital account and/or
Mental Health benefit overview More info l Benefit table Minimum Benefits (PMBs)
Prescribed certain procedures, depending on the option.
PMBs are a basic level of cover for a defined set
of conditions. What qualifies as an emergency?
An emergency is when the condition is unexpected
By law, all medical schemes are required to cover and requires immediate treatment. This means that if
the treatment of 270 hospital-based conditions there is no immediate treatment, the condition might
and 27 chronic conditions, i.e. the Chronic Disease result in lasting damage to organs, limbs or other
List (CDL), in full without co-payment or body parts, or even death.
deductibles, as well as any emergency treatment
Threshold benefit More info l Benefit table out-of-hospital treatment.
and certain
How much will I pay?
Create your aid.

maxima PLUS
age group.
CHRONIC MEDICATION BENEFIT


27
Cancer cover overview More27info l Benefit

Prescribed table
Minimum Benefit Chronic Disease List conditions Additional chronic conditions
conditions
Paid from formulary. Preferred Covered in full if preferred provider
provider must be used. and medicine on formulary are used. Annual limit up to MPL.
Medicine Price List (MPL)

Mental Health benefit overview MPL
More infois a
l reference price list that is set at a level to ensure that a number of medicines will be
Benefit table
available without any co-payment.

Obtaining chronic medicine
Members must obtain chronic medicines from
the preferred providers.
Threshold benefit More info l Benefit table How much will I pay
Create your aid.

maxima PLUS
age group.
In-hospital benefit overview Chronic

More info l Benefit table medicine benefit
Prescribed Minimum Benefit (PMB) The Medicine Price List (MPL)
conditions Medication will be covered at the MPL rate up to
This option has a benefit for the 27 chronic the limits as specified on the chosen option. MPL is
conditions on the PMB Chronic Disease List a reference price list that benchmarks each product
(CDL). The benefit covers medication for the against generically similar products. It does not
list of CDL conditions paid from a formulary and restrict the member’s choice, but limits the amount
must be obtained from a Preferred Provider. the Scheme will refund for each product. The MPL
Screening benefit overview More info l Benefit table reference price is set at a level to ensure that a number
Chronic Disease Benefit of medicines will be available without any co-payment.
This benefit covers the conditions on the CDL.
This option covers additional conditions. Obtaining chronic medicine
• Must use Preferred Providers or pay a co-payment if
the pharmacy charges a dispensing fee in excess of
Chronic Disease List
Conditions on the CDL are covered in full, 25%/ R27.50, or the agreed courier pharmacy rate.
provided members use the Scheme’s Preferred • Preferred Providers are Clicks, Dis-Chem, Medirite
Providers as well as medicine on the formulary and the following courier pharmacies: Clicks Direct
Maternity and childhood benefit overview More info l Benefit tableto their option. If the medicine on the
applicable Medicines, Dis-Chem Direct, Medirite Courier
formulary is not used, the member will have to pay Pharmacy and Pharmacy Direct.
a 40% co-payment on the cost of the medicine.
Mental Health benefit overview More info l Benefit table for additional chronic
Medication
conditions
This option covers medicine for additional chronic
conditions. The medicine for these conditions is
paid from an annual limit and will be covered in
full up to the Medicine Price List rate.
Create your aid.

maxima PLUS
age group.

SCREENING BENEFIT
This benefit covers screenings for:
Maternity and childhood benefit overview MoreWomen’s

info l Benefit table
Men’s Children’s Cardiac Over 45s Health risk
health health health health assessments
Create your aid.

maxima PLUS
age group. Screening benefit
physio, and seven days of take-home medication upon discharge from hospital. Packed with screenings for every life stage, Fedhealth’s screening benefit was created to stretch members’
day-to-day benefit by paying
On this option, you have substantial Fedhealth Savings for your day-to-day medical expenses, a Threshold benefit and an Out-of-Hospital-Expenses more(OHEB).
Benefit from Risk. The Scheme pays for screenings for women’s, children’s,
cardiac, as well as general health (like an annual flu vaccine). This benefit covers the tests and assessments
done to help members either prevent illness or address specific conditions they may already have.
Let’s take a look: Women’s Health

Cervical cancer screening Women; ages 21 to 65 1 every 3 years
(Pap smear)
Men’s Health
Prostate Specific Antigen (PSA) Men; ages 45 to 69 1 every year
Children’s Health
Chronic benefit overview More info l Benefit table Programme
Immunisation Birth to 12 years Various
(as per State EPI)
HPV vaccine Girl beneficiaries aged 9 to 14 2 doses per lifetime
years old
Optical Screening (tariff code 11001) All lives, ages 5 to 8 1 per lifetime
Cardiac Health
Cholesterol screening All lives; aged 20 and older 1 every 5 years
(full lipogram)
Cancer cover overview More info l Benefit
Overtable
45’s
Breast cancer screening with mammography All lives; aged 45 and older 1 every 2 years
Colorectal cancer screening All lives; ages 50 to 75 1 every year
(faecal occult blood test)
Pneumococcal vaccination All lives; aged 65 and older 1 per lifetime
General
Flu vaccination All lives 1 every year
Mental Health benefit overview More info l Benefit tableprick test

HIV finger All lives 1 every year
Health risk assessments
Wellness screening (BMI, blood pressure, All lives 1 every year
finger prick cholesterol & glucose tests)
Day-to-day benefits More info l Benefit table screening
Preventative All lives 1 every year
(waist-to-hip ratio, body fat %,
flexibility, posture & fitness)
Create your aid.

maxima PLUS ONCOLOGY BENEFIT

Upon cancer diagnosis, members must register on the:
age group. Fedhealth Oncology Programme
physio, and seven days of take-home medication upon discharge from hospital. NB: Members can upgrade to a higher option within 30 days of cancer diagnosis.

Chronic benefit overview More info l Benefit

Oncology table
treatment Chemotherapy and Radiotherapy Consultations
ICON is the oncology related treatment and visits
Preferred Provider
on this option

Pathology Radiology PET scans Surgery and
General hospitalisation
Specialised. Paid from
Mental Health benefit overview More info l Benefit table in-hospital benefit.
Stoma therapy Terminal care Post-active treatment Alignd benefit for
Paid from terminal palliative care
care benefit up to
annual limit per family.
Create your aid.

Cancer cover
Fedhealth Oncology Programme Radiology – specialised
• Fedhealth members diagnosed with cancer must Specialised radiology (e.g. CT scans, MRIs, angiography,
maxima PLUS register on the Fedhealth Oncology Programme.

• All members can change to a higher option within
30 days of a life-changing diagnosis like cancer
radioisotopes) requires a separate pre-authorisation
and is paid from Risk. These pre-authorisations must
be obtained from the Hospital Authorisation Centre.
Fedhealth’s most extensive medical cover for members in their later years to ensure they receive the required oncology
treatment. PET scans
• Proposed treatment plan must be submitted so PET scans are limited to two per family per annum
maxima PLUS is a comprehensive medical aid plan that will give you peace of mind that your health is well taken care the of. oncology team can approve the appropriate
restricted to staging of malignant tumours. PET scans are
It features generous unlimited private in-hospital cover, a chronic disease benefit and a screening benefit for various lifestyle,
therapy.wellness and physical screenings tailored to your paid from the oncology benefit.
age group. • The oncology benefit can be accessed by obtaining
You will also enjoy day-to-day benefits paid from Risk, such as specialised radiology like MRI and CT scans, a 30-day pre-authorisation from
post-hospitalisation the Fedhealth
treatment benefitOncology
like X-rays and Surgery and hospitalisation
physio, and seven days of take-home medication upon discharge from hospital. Programme team, a team of highly skilled Claims for surgery and hospitalisation will be paid from
healthcare professionals supported by oncologists the in-hospital benefit, provided that the member obtains
and haematologists from the private, public and a valid authorisation from the Hospital Authorisation
By choosing maxima PLUS, you can also look forward to rich value added benefits like the 24-hour Fedhealth Nurse Line for medical
academic advice and the MediTaxi transport service.
sectors. Centre.
Let’s take a look: Independent Clinical Oncology Network (ICON) Stoma therapy
The Scheme has contracted with ICON, a network Stoma therapy will be paid from Risk. Pre-authorisation
of oncologists that includes 75% of all practicing not required.
oncologists
table in South Africa.
In-hospital benefit overview More info l Benefit
Alignd
Chemotherapy and associated medicine Fedhealth has partnered with Alignd to offer members
Chemotherapy and medicine directly associated with serious illnesses, like advanced cancer, extra care.
with the treatment of cancer will be paid from the The benefit covers an initial consultation with a palliative
oncology benefit, provided a valid authorisation has care trained doctor to assess their needs holistically.
been obtained. Counselling for the member and their family is included,
as is putting in place an advance healthcare plan or living
Radiotherapy will. Three follow-up doctor consultations, and two follow-
Radiotherapy will be paid from the oncology benefit, up social worker consultations per year are also covered.
provided a valid authorisation has been obtained.
Terminal care and private nursing
Oncologist consultations and hospital visits • Accommodation in a hospice or terminal care facility
• Paid from the oncology benefit while the member will be covered from the Terminal Care Benefit up to
Cancer cover overview More info l Benefit
hastable
an active chemotherapy or radiotherapy R34 500 per family per year.
authorisation. Prior to starting treatment, consults • Pre-authorisation must be obtained from the Hospital
are paid from Savings. Authorisation Centre.
• Hospital visits are pre-authorised at the same time • Private nursing will be paid from the Alternatives to
as the authorisation for chemotherapy or radiation. Hospitalisation benefit, where available.
Maternity and childhood benefit overview More info l Benefit tableof visits authorised and the period for which
Number
these visits are authorised will be detailed. Post-active treatment
• Post-active refers to the time when the member actually
Pathology had last active treatment (e.g. hormone therapy,
Oncology-related pathology claims are paid from chemotherapy or radiotherapy).
the oncology benefit while the member is receiving • “For life” means that the member will remain on the
chemo or radiotherapy treatment, provided that the oncology programme as long as the cancer is in
member has a valid authorisation. A list of appropriate remission.
pathology codes has been defined and these claims • Whilst in remission, a list of consultation, radiology
and pathology codes has been defined and claims are
Day-to-day benefits More info l are automatically
Benefit table paid from the oncology benefit.
automatically paid for life from the oncology benefit.
Radiology – general Should the condition regress, the active treatment
Claims are paid from the oncology benefit while the benefit will be reinstated upon submission of a new
member is receiving treatment (chemotherapy or treatment plan.
Threshold benefit More info l Benefit table provided that the member has a valid
radiotherapy), How much will I pay
authorisation. A list of appropriate radiology codes
has been defined and these claims are automatically
paid from the oncology benefit.
Create your aid.

MATERNITY & CHILDHOOD BENEFIT

maxima PLUS
Fedhealth’s most extensive medical cover for members in their later years PREGNANCY AND BIRTH
age group.
2D antenatal
By choosing maxima PLUS, you can also look forward to rich value added benefits like the 24-hour Fedhealth scans
Nurse Line for medicalAnte-
adviceand postnatal
and the Antenatal
MediTaxi transport service. classes Amniocentesis
consultations with a
midwife, network GP or
Let’s take a look: gynaecologist

Fedhealth Baby Private ward cover Doula Midwife consultations
Programme for delivery (birthing coach) in- and out-of-hospital

CHILDHOOD
Paed-IQ telephonic Paediatric consultations Infant hearing Childhood

advice line without GP referral screening immunisations
Optical screening Only pay for 3 children Trauma treatment in a Child rates for
Threshold benefit More info l Benefit
for children agedtable
5 casualty ward How much
financially will I pay
dependent
to 8 years children up to age 27
APPLIANCES
Breast pumps and nebulisers covered from Savings (NAPPI code required).
Create your aid.
maxima PLUS
age group.
Maternity and childhood benefit

Fedhealth provides rich maternity benefits across • Childhood immunisations – immunisation from
the maxiFED option range, so that parents-to-be can birth up to 12 years as per the state EPI
focus on the joy of their pregnancy journey. • HPV vaccine for girl beneficiaries aged 9 to 14 years,
2 doses per lifetime
Some of Fedhealth’s maternity and childhood • Optical screening for children aged 5 to 8 years –
benefits members on maxima PLUS can expect: 1 per lifetime
Chronic benefit overview More info l Benefit table • Trauma treatment in a casualty ward – we cover
Maternity benefits emergency treatment, like stitches, in a casualty
• Two x 2D antenatal scans ward, whether the member is admitted to hospital
• Twelve ante- and postnatal consultations with or not. Authorisation must be obtained
a midwife, network GP or gynaecologist • Childhood illness specialised drug benefit up to
• Antenatal classes up to R1 160 18 years old
• Amniocentesis • Child rates up to the age of 27 – financially
• Fedhealth Baby Programme – a free programme dependent children up to 27 are covered under
for all expecting beneficiaries offering support, child rates, provided they don’t earn more than the
advice and a free Fedhealth baby bag filled with maximum social pension
items for baby • Only pay for three children – we cover fourth and
• Private ward cover (when available) for delivery subsequent children for free
• Doula benefit – R3 000 per delivery for a doula
(birthing coach) to assist mom during natural Appliances
childbirth We pay for breast pumps and nebulisers from the
• Postnatal midwifery benefit – four consultations member’s Savings provided they have a NAPPI
per delivery with a midwife in- and out-of-hospital code. This will accumulate to Threshold up to the
appliances, external accessories and orthotics limit.
Mental Health benefit overview More info l Benefit
Greattable
childhood benefits
• Paed-IQ – free access to a 24/7 paediatric
telephonic advice line
• Paediatric consultations – without referral from a GP
• Infant hearing screening benefit – one test
from birth up to the age of eight weeks with an
audiologist up to the Fedhealth Rate
Create your aid.

maxima PLUS
age group.

MENTAL HEALTH COVER
Chronic benefit overview More info l Benefit table This benefit covers:
Mental Health Chronic medication Ambulatory care In-hospital cover Mental Health
Cancer cover overview MoreResource
info l Benefit
Hub
table plans Programme
Manages diagnoses PMB conditions: Qualifying members

out-of-hospital. Paid Up to 21 days with mental health
Maternity and childhood benefit overview More info l Benefit table from Scheme limits if in-hospital OR up conditions e.g.
Fedhealth Network to 15 psychotherapy bipolar mood
providers are used, sessions disorder.
then from Risk. out-of-hospital.
Mental Health benefit overview More info l Benefit table PMB conditions:
Up to 21 days
in-hospital OR up
to 15 psychotherapy
sessions
out-of-hospital.
NB: Hospital admissions for mental health

Doctor must obtain authorisation first Fedhealth Network GPs/Specialists covered in full
Create your aid.

maxima PLUS
Mental health benefit
Fedhealth
It features generous unlimited private in-hospital cover, a chronic disease benefit and a screening benefit for various supports
lifestyle, wellness and members with mental
physical screenings health
tailored to your Factors to consider before an admission:
age group. conditions by making the following benefits available Is the member’s doctor on the Fedhealth Network?
to members:
You will also enjoy day-to-day benefits paid from Risk, such as specialised radiology like MRI and CT scans, a 30-day post-hospitalisation treatment benefit like X-rays and All Scheme options have a GP and specialist network
physio, and seven days of take-home medication upon discharge from hospital. applicable. Should the member choose not to use
Mental
On this option, you have substantial Fedhealth Savings for your day-to-day medical expenses, a Threshold benefit and Health Resource Hub
an Out-of-Hospital-Expenses Benefit (OHEB). network providers, the Scheme will only refund
The Mental Health Resource Hub provides credible treatment up to the Fedhealth Rate for non-network
mental health information and support channels. It’s GPs and specialists. The member will have a shortfall
available via the Fedhealth Family Room or members should the healthcare professional charge more.
Let’s take a look: can visit www.medscheme.com/mental-wellness-
resource-hub/ Mental Health Programme
• Fedhealth’s Mental Health Programme is available
Chronic Benefit to all qualifying members who’ve been diagnosed
• Funding of chronic medicine for non-PMB mental with mental health conditions, including depression
health conditions is limited to a diagnosis list and and bipolar mood disorder.
chronic limits: refer to benefit tables for more • The programme uses innovative solutions for
information. member empowerment and education with the
Chronic benefit overview More info l Benefit table support of a dedicated Care Manager.
Ambulatory Care Plans
• A care plan is a list of the type and number of Panda Mental Health Support App
services that’s likely to be needed for management Panda makes mental health benefits and support
Screening benefit overview More info l Benefit
of atable
diagnosis in an out-of-hospital setting. available through the Fedhealth Member App.
• Fedhealth covers these costs from the member’s • Fedhealth members have FREE access to all
available Scheme limits, subject to the use of the aspects of the Panda Bamboo Forest; videos and
Fedhealth Network Providers. Once the member’s exercises; training; reading materials; and live
Scheme limits are used up, further services, as virtual group sessions.
listed in their care plan, will continue to be paid • Individual virtual consultations with registered
from Risk. To ensure payment from the correct counselors are subject to standard scheme
benefit, the member must make sure that every benefits.
claim sent has an ICD-10 code reflected on it.
Maternity and childhood benefit overview More info l Benefit
• Thetable
PMBs allow for a combined benefit of up to
21 days in-hospital or up to 15 out-of-hospital
psychotherapy sessions for major affective
disorders. These out-of-hospital psychotherapy
sessions are made available as part of the
member’s care plan on request from their treating
healthcare provider.
In-hospital Benefits
Day-to-day benefits More info l Benefit tablethe PMBs allow for a combined benefit of
As above,
up to 21 days in-hospital or up to 15 out-of-hospital
psychotherapy sessions for major affective disorders.
Admission into a facility for a mental health
Threshold benefit More info l Benefit tablediagnosis requires authorisation. How much will I pay
Create your aid.

maxima PLUS
Fedhealth’s most extensive medical cover for members in their later years DAY-TO-DAY BENEFIT
age group.
Let’s take a look: Unlimited Treatment for 30 Take-home Specialised Trauma

network GP days after medicine radiology treatment at a
visits discharge from casualty ward
hospital (post-hos-
pitalisation benefit)
Screening benefit overview More info In-hospital

l Benefit table Savings Maternity benefit Fedhealth Baby
dentistry for Programme
children up to the
age of 7

Doula benefit Postnatal Early childhood Paed-IQ
midwifery benefit benefits

Optometry benefit Dentistry benefits Female
contraception
Create your aid.

maxima PLUS
age group.
Day-to-day benefits
Let’s take a look: Unlimited network GP visits Medical Savings Account 2. Infant hearing screening benefit
The Savings Account pays for day-to-day expenses first
Unlimited GP consultations at a Fedhealth Network GP We pay for a screening test including the consultation
(from the beginning of the year) and pays expenses
once OHEB has been depleted on maxima PLUS. from birth up to the age of 8 weeks with an audiologist.
up to the actual cost. In some cases, if the member has This benefit is covered up to the Fedhealth Rate.
Treatment for 30 days after discharge from hospital money available in their Savings Account, they can use
(post-hospitalisation benefit) this to pay co-payments. However, a co-payment for a Paed-IQ advice line
We pay for follow-up treatment that may be required Prescribed Minimum Benefit (PMB) condition cannot be Paed-IQ is a 24/7 telephone advisory service available
after a hospital event for up to 30 days after the date paidtable
from the Savings Account. The Savings Account to all parents with children under the age of 14 years.
Chronic benefit overview of discharge. This treatment includes More info l Benefit
physiotherapy, works differently to other benefits in that the member This service aims to support and advise parents on any
x-rays and pathology, but does not cover follow-up carries any remaining amount over to the next year. healthcare related childcare issues.
consultations with specialists or GPs. Call 0860 444 128 to access this great service.
Maternity benefit
Screening benefit overviewTake-home medicine More info l Benefit Thistable
benefit covers two x 2D scans, antenatal classes up Female contraception
We pay for seven days of take-home medicine when the to R1 160, twelve ante- and/ or postnatal consultations Female contraception like oral, patches, contraceptive
member is discharged from hospital. The medicine can with a midwife, network GP or gynaecologist, rings, certain injectables, and IUDs that include Mirena®
either be dispensed by the hospital and reflect on the amniocentesis. Thereafter, paid from Savings and OHEB. is paid from Risk. Must be prescribed by a GP or
original hospital account or be dispensed by a pharmacy gynaecologist; not applicable to pills prescribed for acne.
Cancer cover overview More info
on the same day as the member is discharged from l Benefit table Baby Programme
Fedhealth
hospital. We offer a free maternity programme for pregnant
members and beneficiaries offering support, advice and
Specialised radiology a handy baby bag.
MRI/ CT scans are covered whether they’re performed
Maternity and childhood benefit overview
in- or out-of-hospital.
More info l Benefit table
Doula benefit
maxima PLUS Unlimited at Fedhealth Rate. no We pay up to R3 000 per delivery for a Doula (a labour
co-payment applies on this option. coach during natural childbirth).
Mental Health benefit overview

Trauma treatment at a casualty wardMore info l Benefit tablemidwifery benefit
Postnatal
Emergency treatment, like stitches, at a casualty ward We pay for four consultations per pregnancy with
whether the member is admitted to hospital or not a midwife. This benefit applies to consultations both
(unlimited up to the Fedhealth Rate). Authorisation must in- and out-of-hospital.
be obtained in 48 hours.
Early childhood benefits
In-hospital dentistry for children up to the age of 7 1. Paediatric consultations
The hospital account and anaesthetist costs are paid • One consultation per beneficiary with a network
from the in-hospital benefit while the dentist’s account paediatrician up to 24 months of age. No GP referral
comes from day-to-day benefits. required.
Create your aid.

maxima PLUS
age group.

Threshold benefit
The Threshold benefit pays for certain day-to-day expenses once the member’s claims
have accumulated up to the required level. The Threshold level is reached through the
accumulation of claims paid from the member’s day-to-day benefit or self-funded through
the year at the Fedhealth Rate. Certain benefit limits do not accumulate to Threshold.
Where limits do accumulate, expenses will only accumulate up to this limit and this limit will
Day-to-day benefits More info l Benefit
alsotable
apply to refunds from Threshold.
Create your aid.

maxima PLUS In-hospital Benefit

In-hospital benefit
This benefit covers all treatments and procedures that have to be done in a hospital and that are covered by the maxiFED options.
maxima PLUS maxima PLUS

Benefit All limits are per family per year unless Immune deficiency related to HIV infection Unlimited (see HPT)
otherwise specified Maxillo-facial surgery Unlimited, subject to approval (see HPT)
Overall annual limit (OAL) Unlimited at negotiated tariff Surgical extraction of impacted wisdom teeth
maxima PLUS covers all admissions at any private In-hospital dentistry benefit for children under 7 We cover the hospital and anaesthetist. Dentist will be
paid from day-to-day benefits
hospital except the following hospitals: Zuid-Afrikaans
Hospital (City of Tshwane), Arwyp Medical Centre Oncology: oncologist consultations, visits, treatment Unlimited at preferred provider* and paid from
(Ekurhuleni), Busamed Modderfontein Private Hospital and materials for chemotherapy and radiotherapy, Enhanced protocol
(City of Johannesburg), Hibiscus Hospital (Ugu), approved medication, radiology and pathology
Mooimed Private Hospital (Dr Kenneth Kaunda), St He- Reimbursement rate if you don’t use preferred Up to the Fedhealth Rate
lena Private Hospital (Lejweleputswa), Capital Hospital providers
(Durban), which will not be covered in full for 2023. Organ transplant including immunosuppression Unlimited (see HPT)
Emergency treatment at these 7 hospitals, however, medication
will be covered in full without a co-payment but Corneal graft R36 300 per beneficiary
elective procedures will attract a R7 800 co-payment.
Pathology, radiology (general) Unlimited up to the Fedhealth Rate
Healthcare Professional Tariff in-hospital (HPT)
Physiotherapy Unlimited subject to medical practitioner referral
Fedhealth Network GPs and Specialists Covered unlimited. Paid in full
Psychiatric services: accommodation in a general R45 100 (See HPT)
Non-network GPs Paid up to the Fedhealth Rate ward, procedures, ECT, materials and hospital
Non-network Specialists Paid up to 200% of the Fedhealth Rate equipment, consultations and visits, medicines and
injection material
Other Healthcare Professionals Paid up to 300% of the Fedhealth Rate
Renal dialysis (chronic): consultations, visits, Unlimited up to the Fedhealth Rate at Designated
Prescribed Minimum Benefits (PMB): Treatment for PMB To have the treatment for PMB conditions covered in all services, materials and medicines associated with Service Provider (DSP). A 40% co-payment applies
conditions can be funded in two ways: full, you will have to use Fedhealth Network GPs and the cost of renal dialysis where a DSP provider is not used
Specialists.
Specialised Medication (e.g. biologicals) Benefit R390 400 at cost
Should you choose not to make use of network (oncology & non-oncology)
providers, the Scheme will only refund treatment up
to the Fedhealth Rate for non-network GPs and 200% Specialised radiology Unlimited at Fedhealth Rate
of the Fedhealth Rate for non-network specialists. You Spinal surgery No benefit unless utilisation of Conservative Back &
will have a shortfall should the healthcare professional Neck Rehabilitation Programme has been completed
charge more
Terminal care benefit R34 500 at Fedhealth Rate
Hospitalisation costs: accommodation in a general ward, Unlimited at negotiated tariff. Private ward cover
high care ward and intensive care unit, theatre fees, when available for maternity admissions * ICON – Independent Clinical Oncology Network.
medicine, material and hospital apparatus
Additional medical services (dietetics, occupational Unlimited subject to medical practitioner referral
therapy and speech therapy)
Alternatives to hospitalisation:
Nursing services, private nurse practitioners & nursing
agencies Unlimited at negotiated tariff
Sub-acute facilities, physical rehabilitation facilities
Appliances, external accessories and orthotics Unlimited at cost
Blood, blood equivalents and blood products Unlimited
Create your aid.

maxima PLUS In-hospital Benefit

Prosthesis benefit Co-payments
Co-payments may apply on certain in-hospital procedures, which will be for the member’s account.

External prosthesis R24 300 at cost Co-payments per event applicable on the hospital/ facility bill only
Internal prosthesis Arthroscopic procedures – hip, wrist, knee, shoulder, No co-payments
ankle, other arthroscopic procedures, colonoscopy,
Bi-ventricular pacemakers and implantable cardioverter See combined benefit limit for all unlisted internal
upper GI endoscopy
defibrillators (ICDs), bone lengthening devices, carotid prosthesis*
stents, embolic protection devices, other approved spinal Other joint replacements, laparoscopic hernia repairs No co-payments
implantable devices and intervertebral discs, peripheral (bilateral inguinal, repeated inguinal hernias & Nissen/
arterial stent grafts, spinal plates and screws, total ankle Toupet hernia repairs only), laparoscopic procedures,
replacement rhizotomies and facet pain blocks (limited to 1 of
either procedure per beneficiary per year), surgical
Aorta stent grafts R65 500
extraction of impacted wisdom teeth
Cardiac pacemakers R65 500
Spinal surgery** No co-payment
Cardiac stents R56 100
Joint replacements
Cardiac valves R49 800 Single hip and knee replacements with CP* No co-payment
Detachable platinum coils R56 700 Single hip and knee replacements - voluntary use of R31 400
Elbow, hip, knee and shoulder replacement R49 800 non-CP*
Intraocular lenses (per lens) R3 500 Other joint replacements and involuntary use of No co-payment
non-CP* for single hip and knee replacements
*Combined benefit limit for all unlisted internal *R40 400
prosthesis * Contracted Provider: Must use ICPS Hip and Knee network, JointCare or Major Joints for Life for single non-PMB hip and knee joint
replacements. Non-use of Contracted Provider (CP) will result in co-payment.
** No benefit unless utilisation of Conservative Back & Neck Rehabilitation Programme has been completed.
Chronic disease benefit

Chronic conditions on the Chronic Disease List (CDL)
Cover for conditions that require long-term medication or can be life-threatening.
Addison’s Disease, Asthma, Bipolar Mood Disorder, Bronchiectasis, Cardiac Failure, Cardiomyopathy, COPD/ Emphysema/
maxima PLUS Chronic Bronchitis, Chronic Renal Disease, Coronary Artery Disease, Crohn’s Disease, Diabetes Insipidus, Diabetes Mellitus Type-1,
Diabetes Mellitus Type-2, Dysrhythmias, Epilepsy, Glaucoma, Haemophilia, HIV, Hyperlipidaemia, Hypertension, Hypothyroidism,
Limit R16 700 per beneficiary, subject to an overall limit Multiple Sclerosis, Parkinson’s Disease, Rheumatoid Arthritis, Schizophrenia, Systemic Lupus Erythematosus, Ulcerative Colitis
of R31 300 per family per year. Thereafter unlimited
cover for conditions on the CDL.
Formulary Comprehensive formulary Additional chronic conditions covered on maxima PLUS
Preferred Provider Clicks, Dis-Chem, Medirite & Pharmacy Direct Acne (up to the age of 21), Allergic rhinitis (up to the age of 18), Alzheimer’s Disease, Angina, Ankylosing Spondylitis,
Anorexia Nervosa, Attention Deficit Hyperactivity Disorder (from 6 to the age of 18), Barrett’s Oesophagus, Benign Prostatic
Hyperplasia, Bulimia Nervosa, Conn’s Syndrome, Cushing’s Syndrome, Cystic Fibrosis, Deep Vein Thrombosis, Depression,
Dermatomyositis, Eczema (up to the age of 18), Gastro-Oesophageal Reflux Disease, Generalised Anxiety Disorder, Gout,
Hypoparathyroidism, Menopause, Motor Neuron Disease, Muscular Dystrophy, Myasthenia Gravis, Narcolepsy, Obsessive
Compulsive Disorder, Osteoporosis, Paget’s Disease, Pancreatic Disease, Panic Disorder, Paraplegia/ Quadriplegia
(associated medicine), Pemphigus, Polyarteritis Nodosa, Post-Traumatic Stress Disorder, Pulmonary Interstitial Fibrosis,
Scleroderma, Stroke, Thromboangitis Obliterans, Thrombocytopaenic Purpura, Tourette’s Syndrome, Valvular Heart Disease,
Zollinger-Ellison Syndrome
Create your aid.

Day clinic/ doctor’s room procedures

covered from the in-hospital benefit
The following procedures will be paid from the in-hospital benefit if done in a day clinic, day ward or an outpatient section of a hospital. Overnight admissions will not be covered except for Prescribed Minimum Benefits.
These procedures must be pre-authorised. If the procedure is performed without pre-authorisation, the full amount will be paid from day-to-day benefits or self-funded by the member and will not accumulate towards the Threshold level.
If authorisation is requested after the procedure has taken place, a R1 000 penalty will apply which will be paid from day-to-day benefits or self-funded by the member, without accumulating to the Threshold level.
Gynaecology Meatotomy for meatal stenosis Dressings under anaesthesia Biopsy - all eye structures Excision of benign lesions (scalp/neck/hands/
Bartholin cyst drainage/excision/ Orchidopexy for undescended testis Excision lipoma/cysts/tumours Blepheroplasty feet/trunk/limbs)
marsupialisation Urethrocystoscopy for urinary incontinence Excision of sweat glands (axilla Canthotomy Excision of malignant lesions and margins
Biopsy - vulva, vagina, cervix, perineum inguinal) and simple repair Cataract surgery (face, lips, nose, ears, eyelids) + flap
Cauterisation of warts – all methods Orthopaedics Excision skin/subcutaneous tissue Choroid related procedures Flaps – delay/sectioning
Colposcopy Amputation Fistula related procedures Ciliary body procedures Malignant lesions – destruction and removal via
Diagnostic hysteroscopy Arthrocentesis Foreign body removal Conjunctival procedures e.g. pterygium surgery non-incision intervention
Endometrial and cervical procedures (includes Arthrodesis of hand/elbow/foot/wrist Frenumectomy/frenulectomy/frenectomy Cornea related procedures z-plasty
dilatation and curettage endometrial ablation, Arthroscopy Gastroscopy/ oesophagogastroduodenoscopy, Enucleation/Implant insertion/removal
cervical cerclage, LLETZ) Arthrotomy - all joints & biopsy & synovectomy Hernia repair Fine needle aspiration - all eye structures Procedures performed in a doctor’s room
Fine needle aspiration - cytology Aspiration/intra-articular injection of joints Implant removal/reinsertion Foreign body removal or suitably equipped procedure room
Foreign body removal – vagina Biopsy – bone Nail/nail bed related procedures Intra ocular injection e.g. Avastin, including In addition, the following procedures will be
Laparoscopic gynaecological procedures Bunionectomy Proctoscopy and removal of polyps Glaucoma paid from the in-hospital benefit if performed in
Ovarian cyst(s) drainage Capsulectomy/Capsulotomy Sigmoidoscopy Iris related procedures e.g. iridectomy a doctor’s room or
Sterilisation Carpal tunnel release Small bowel endoscopy Orbitotomy suitably equipped procedure room, at up to
Cartilage grafts Wound debridement (skin/ subcutaneous Probing & repair of tear ducts 100% of the Fedhealth Rate. Pre-authorisation
Urology Closed fracture procedures tissue) Ptosis must be obtained and should no pre-
Adults Contracture release Retinal surgery authorisation take place, reimbursement will
Bilateral total orchidectomy for prostate cancer Dislocation ENT Surgery Sclera related procedures be restricted to the member’s available
Bladder biopsy (cancer and other conditions) Excision/Resection bone Adenoidectomy Strabismus repair day-to-day benefit or self-funded by the
Bouginage for urethral stricture Foreign body removal - muscle tendon sheath Antrostomy Treatment of progressive retinopathy member. This will not accumulate to the
Circumcision Ganglionectomy Biopsies, including DPP (Diagnostic Trichiasis correction (non forceps) Threshold Level:
Cystotomy with insertion of ureteric catheter Grafts - bone/tendon Proof Puncture)
or stent Injection of tendon/ligament ENT Endoscopy (nasal endoscopy, Neurosurgery Gastroscopy (no general anaesthetic will be
Cystourethroscopy & urethrotomy trigger points/ganglion cyst laryngoscopy, diagnostic and Biopsy of spinal cord/nerve paid for)
Cystourethroscopy therapeutic Injection therapeutic carpal tunnel interventional) Injection of diagnostic/therapeutic agents Colonoscopy (no general anaesthetic will be
DJ stent removal post pyeloplasty Implant/wire/pin insertion or removal Foreign body removal - auditory canal with/without catheter/needle insertion into paid for)
Foreign body removal Ligament repair/reconstruction Middle ear procedures including intrathecal space with/without imaging Flexible sigmoidoscopy
Hydrocelectomy for vaginal hydrocele Manipulation stapes surgery guidance Indirect laryngoscopy
Laparoscopy for ureteroneocystostomy & Minor joint arthroplasty Mastoidectomy Injection of neurolytic agents - all agents, all Removal of impacted wisdom teeth
cystoscopy and ureteral stent placement (intercarpal, carpometacarpal and Tympanic membrane related procedures sites Intravenous administration of bolus injections
Open cystolithotomy for bladder stone metacarpophalangeal, interphalangeal (includes myringotomy with/without grommets, Intraneural Injection of anaesthetic agents with/ for medicines that include antimicrobials and
Penile biopsy joint arthroplasty) tympanoplasty, tympanolysis) without continous infusion immunoglobulins (payment of immunoglobulins
Penile lesions removal - all methods Muscle transfer/release Nasal surgery/procedures (includes nasal Electroconvulsive therapy is subject to the Specialised Medication Benefit)
Scope and pyelogram Open treatment fracture bleeds (control), reduction of nose fracture, Fine needle aspiration biopsy
Second stage urethroplasty post stage 1 Orthopaedic casts/spica procedures rhinoplasty, septoplasty, turbinectomy, nasal Dental Excision of nailbed
Testicular biopsy for infertility Tenotomy - all areas turbinate repair) Dental procedures Drainage of abscess or cyst
Urethrocystoscopy for bladder outlet Oral cavity related procedures, including Injection of varicose veins
obstruction General Surgery biopsies Maxillofacial Surgery Excision of superficial benign tumours
Urethrolithotomy - lower 1/3 ureter Anal procedures, including dilatations, biopsies, Salivary gland related procedures Fixation device application Superficial foreign body removal
Varicocelectomy for varicocele fissure repairs, haemorrhoidectomies Sinus related surgery Nasal plugging for epistaxis
Vasectomy Biopsy - lymph node, muscle, skin, soft tissue Tonsillectomy Plastic and Reconstructive Surgery Cauterisation of warts
Paediatrics Breast biopsy/ removal lesion (s) Repair wound with layers (scalp/axillae/ Bartholin cyst excision
Circumcision - all indications Colonoscopy Ophthalmology trunk/limbs)
Glandulo-cavernous shunt for priapism Drainage of abscesses/ haematomas/cysts Anterior and/or posterior chamber related Repair wound lesions (scalp/hands/neck/
Hydrocelectomy for congenital hydrocele (subcutaneous/submucosal) procedures e.g. vitrectomy feet/face)
Create your aid.

maxima PLUS Day-to-Day benefits

Day-to-day benefits paid from Savings (OHEB on maxima PLUS)
Under the day-to-day benefit, we cover services like physiotherapy and dentistry.

Benefit Optometry Paid from Savings, OHEB and Threshold. R3 740
Tariff Up to the Fedhealth Rate per beneficiary per year, R11 400 per family per year
before and after Threshold
Co-payments in Threshold No co-payment
Appliances, external accessories and orthotics: Paid from Savings, OHEB and Threshold. R17 300 per Over-the-counter medication Paid from Savings only. Does not accumulate to or
Hearing aids, wheelchairs, etc. family per year before and after threshold. pay from Threshold
(R4 860 sub-limit per beneficiary for foot orthotics)
Pathology & radiology Paid from Savings, OHEB and Threshold. Unlimited
Alternative healthcare: Acupuncture, homeopathy, Paid from Savings and OHEB. Does not accumulate to once Threshold is reached
naturopathy, osteopathy and phytotherapy or pay from Threshold
(including prescribed medication) Physical therapy: Chiropractics, biokinetics & Paid from Savings, OHEB and Threshold. Unlimited
physiotherapy once Threshold is reached
Additional medical services: Audiology, dietetics, Paid from Savings, OHEB and Threshold. R19 400 per
genetic counselling, hearing aid acoustics, family per year before and after Threshold Prescribed medication Paid from Savings, OHEB and Threshold. R11 060
occupational therapy, orthoptics, podiatry, private per beneficiary per year, R22 010 per family per year
nursing*, psychologists, social workers, speech therapy before and after Threshold
Dentistry advanced: inlays, crowns, bridges, mounted Paid from Savings, OHEB and Threshold. R8 270
Radiology specialised Paid from Risk if pre-authorised
study models, metal base partial dentures, per beneficiary per year, R24 700 per family per year
oral surgery, orthodontic treatment, periodontists, before and after Threshold Specialists excluding psychiatrists
prosthodontists and dental technicians
Osseo-integrated implants, orthognathic surgery Paid from Savings and OHEB. Does not accumulate to Fedhealth Network Specialists Paid from Savings, OHEB and accumulation at
or pay from Threshold cost to Threshold. Unlimited at cost once Threshold
is reached
Dentistry (basic) Paid from Savings, OHEB and threshold. Unlimited
once threshold is reached Non-network Specialists Paid from Savings, OHEB and Threshold. Accumulation
to and refund from Threshold at Fedhealth Rate only
General Practitioners
Fedhealth Network GPs Paid from OHEB then unlimited from Risk. Once OHEB Specialists: psychiatrists
is depleted, Fedhealth gives unlimited cover for GP
consultations as long as themember uses a GP who is Fedhealth Network Psychiatrists Paid from Savings, OHEB and accumulation to and
on the Network refund from Threshold at cost. Subject to Additional
Medical Services limit of R19 400 per family per year
Non-network GPs Paid from Savings, OHEB and Threshold. Unlimited before and after Threshold
accumulation to and refund from Threshold up to the
Fedhealth Rate Non-network Psychiatrists Paid from Savings, OHEB and accumulation to and
refund from Threshold at the Fedhealth Rate. Subject
Maternity benefit See maternity benefit HERE > to Additional Medical Services limit of R19 400 per
Thereafter, paid from Savings, OHEB and Threshold. family per year before and after Threshold
Limited to 2 x 2D antenatal scans per pregnancy before
and after Threshold
Create your aid.


We give our members more value and support when they need it through
additional programmes, benefits and initiatives.
AfA (HIV Management)
Alignd
Corporate wellness days
Diabetes Care
Emergency transport/response
Fedhealth Conservative Back and Neck Rehabilitation Programme
GoSmokeFree Smoking Cessation Programme
Health Risk Assessments
Hospital at Home
MediTaxi
24-hour Nurse Line
Paed-IQ
Sisters-on-Site
SOS Call Me
Weight Management Programme
Create your aid.



Fedhealth offers the AfA programme to help members who are
HIV-positive manage their condition.
Alignd
The benefits of being on the programme, (over and above the
Corporate wellness days payment of the necessary medicine and pathology claims), include
clinical and emotional support with the utmost confidentiality.
Diabetes Care
Hospital at Home
MediTaxi
24-hour Nurse Line
Paed-IQ
Sisters-on-Site
SOS Call Me
Create your aid.



Alignd
Alignd
Fedhealth has partnered with Alignd to offer members with serious
illnesses, like advanced cancer, extra care. The benefit covers an
Corporate wellness days initial consultation with a palliative care trained doctor to assess
their needs holistically. Counselling for the member and their family
Diabetes Care is included, as is putting in place an advance healthcare plan or living
will. Three follow-up doctor consultations, and two follow-up social
worker consultations per year are also covered so the member is
Emergency transport/response supported throughout their treatment journey.
More intensive support is available where the illness has progressed

Fedhealth Conservative Back and Neck Rehabilitation Programme further. Members can call Fedhealth on 0860 002 153 and asked to
be referred to Alignd, or email [email protected]
Hospital at Home
MediTaxi
24-hour Nurse Line
Paed-IQ
Sisters-on-Site
SOS Call Me
Create your aid.


Alignd
Corporate wellness days provide the opportunity to create
awareness, education, prevention, screening and targeted
Diabetes Care interventions that support positive lifestyle changes. These days are
well-received, as it is convenient for Fedhealth members to have
Emergency transport/response these services at their place of work. In addition to the clinical value
that can be derived from wellness days, they provide Fedhealth
with the opportunity to market the Scheme to clients and potential
Fedhealth Conservative Back and Neck Rehabilitation Programme clients.
Hospital at Home
MediTaxi
24-hour Nurse Line
Paed-IQ
Sisters-on-Site
SOS Call Me
Create your aid.


Alignd

Diabetes Care
Diabetes Care
We provide members with access to a comprehensive diabetes
programme that is tailored to their needs and other chronic
Emergency transport/response conditions they might have. This includes continued access
to a treating doctor, authorised chronic medicine, blood and
Fedhealth Conservative Back and Neck Rehabilitation Programme laboratory tests, a Health Coach, online tools and information to
empower the member. Members can call 0860 002 153 or email
[email protected]
Hospital at Home
MediTaxi
24-hour Nurse Line
Paed-IQ
Sisters-on-Site
SOS Call Me
Create your aid.


Alignd
Diabetes Care
Emergency transport/ response
Through our partner Europ Assistance, we provide all members
with emergency transport in an emergency situation.
Hospital at Home
MediTaxi
24-hour Nurse Line
Paed-IQ
Sisters-on-Site
SOS Call Me
Create your aid.


Alignd
Diabetes Care
Fedhealth Conservative Back and
Neck Rehabilitation Programme
GoSmokeFree Smoking Cessation Programme Fedhealth has an established intervention for members suffering
from back and neck problems. Built on the principle of active
muscle reconditioning, it’s supported by clinical studies showing
Health Risk Assessments that exercise reduces pain and can normalise function in many
instances. The programme takes a comprehensive and holistic
Hospital at Home approach to chronic back and neck pain and offers individualised
treatment to qualifying members. After an initial assessment,
beneficiaries may receive treatment up to twice a week for six
MediTaxi weeks and a home based protocol for long-term care. Email
[email protected] for more information about the
programme.
24-hour Nurse Line
Paed-IQ
Sisters-on-Site
SOS Call Me
Create your aid.


Alignd
Diabetes Care

GoSmokeFree Smoking Cessation
Programme
Health Risk Assessments Fedhealth is encouraging members who smoke to sign up for
the GoSmokeFree service that’s available at 200 pharmacies
countrywide, including Dis-Chem, Clicks and independent
Hospital at Home pharmacies.
MediTaxi All smokers have a yearly benefit for the GoSmokeFree programme
which is payable from risk benefits. The service comprises a pre-quit
assessment and support sessions and features an individual plan to
24-hour Nurse Line help with smoking cessation. Visit gosmokefree.co.za to find out
more about this benefit.
Paed-IQ
Sisters-on-Site
SOS Call Me
Create your aid.


Alignd
Diabetes Care

This benefit aims to identify members who are at risk of developing
lifestyle diseases, and either help them prevent the onset through
Hospital at Home suitable lifestyle interventions, or help them manage their disease
with practical advice and utilisation of Scheme benefits. A Health
MediTaxi Risk Assessment can be requested at participating pharmacies and
BASA registered biokineticists
24-hour Nurse Line
Paed-IQ
Sisters-on-Site
SOS Call Me
Create your aid.


Alignd
Diabetes Care

Hospital at Home
Hospital at Home
Fedhealth’s technology-enabled Hospital at Home service, in
partnership with Quro Medical, brings the essential elements of
MediTaxi in-patient care to a patient’s home, including real-time patient
monitoring. It’s available in the Eastern Cape, Western Cape and
24-hour Nurse Line Gauteng, as well as Bloemfontein, with rollout to other areas to
follow in due course. This service gives Fedhealth members the
option to receive active
Paed-IQ treatment for a specified period at home instead of a general
hospital ward, without compromising on the quality of care.
Visit www.quromedical.co.za or call 010 141 7710.
Sisters-on-Site
SOS Call Me
Create your aid.


Alignd
Diabetes Care
Hospital at Home
MediTaxi
MediTaxi
MediTaxi is a medical taxi service available to Fedhealth members
who’ve had hospital authorisations in Cape Town, Johannesburg,
24-hour Nurse Line Pretoria and Durban. Members can access the 24/7 MediTaxi
benefit to take them to follow-up doctor’s appointments, if
Paed-IQ they’ve undergone an authorised operation or medical treatment
that prevents them from driving. Limited to two return trips per
member/ beneficiary per annum.
Sisters-on-Site
SOS Call Me
Create your aid.


Alignd
Diabetes Care
Hospital at Home
MediTaxi
24-hour Nurse Line

24-hour Fedhealth Nurse Line
Professional nurses are always on the other end of our toll-free
Paed-IQ 24-hour line to provide advice on issues like medical emergencies,
symptoms, medicine side-effects, stress management and teenage
support. Call 0860 333 432
Sisters-on-Site
SOS Call Me
Create your aid.


Alignd
Diabetes Care
Hospital at Home
MediTaxi
24-hour Nurse Line

Paed-IQ
Paed-IQ
Paed-IQ is a 24/7 telephone advisory service available to all parents
with children under the age of 14 years. This service aims to support
Sisters-on-Site
and advise parents on any healthcare related childcare issues. Call
0860 444 128 to access this great service.
SOS Call Me
Create your aid.


Alignd
Diabetes Care
Hospital at Home
MediTaxi
24-hour Nurse Line

Sisters-on-Site
Paed-IQ
Fedhealth partnered with SOS Corporate Wellness (Sisters-on-
Site) to offer a nursing Sister-on-Site at our members’ workplaces.
Sisters-on-Site
With the employer’s influence, we aim to identify and address
the organisation’s specific areas of concern. By helping members
SOS Call Me change their behaviour patterns and choose healthier lifestyles, we
aim to reduce healthcare expenditure (particularly on day-to-day
utilisation), absenteeism, turnover rates, worker’s compensation
Weight Management Programme claims and tardiness.
Create your aid.


Alignd
Diabetes Care
Hospital at Home
MediTaxi
24-hour Nurse Line

SOS Call Me
Paed-IQ
Fedhealth’s user-friendly USSD call back service is free to all
Fedhealth members and their dependants. Members can select
Sisters-on-Site
three options on the service:
1. Emergency Medical Services (EMS)
SOS Call Me 2. Nurse Line
3. MediTaxi
Create your aid.


Alignd
Diabetes Care
Hospital at Home
MediTaxi
24-hour Nurse Line Weight Management Programme

The Weight Management Programme is an intervention expertly
Paed-IQ designed for qualifying Fedhealth members with a high BMI and waist
circumference. Members participate in a 12-week, biokineticist-led
intervention plan that gives them access to a dietician and psychologist
Sisters-on-Site with the goal to lose the excess weight and lead healthier, more
rewarding lives. Once the programme is completed, ongoing advice and
monitoring is available for continued support. For more information,
SOS Call Me email [email protected]. This benefit is available
every two years.
Create your aid.

maxima PLUS Contributions

maxima PLUS (including Savings and OHEB)
Annual
Risk Savings Total Annual OHEB
Threshold*
Member 12 528 594 13 122 18 900 9 794
Adult
10 814 512 11 326 14 700 7 067
dependant
Child
3 871 183 4 054 5 100 2 171
dependant*
*Up to a maximum of three children
maxima PLUS Calculations

maxima PLUS (including Savings and OHEB)
Total Annual Self-
Annual
Risk Savings Total OHEB day-to-day Threshold payment
savings
available level gap
M 12 528 594 13 122 7 128 9 794 16 922 18 900 1 978
M + AD 23 342 1 106 24 448 13 272 16 861 30 133 33 600 3 467
M + AD + CD 27 213 1 289 28 502 15 468 19 032 34 500 38 700 4 200
M + AD + 2CD 31 084 1 472 32 556 17 664 21 203 38 867 43 800 4 933
Create your aid.

Contact details
Alignd
Ambulance Services
Chronic Medicine Management
Disease Management
Fedhealth Baby
Fedhealth Customer Service Centre
Fedhealth Oncology Programme
Fraud Hotline
Hospital Authorisation Centre
Medscheme Client Service Centres
Preferred Provider Pharmacies
Create your aid.

Contact details
AfA (HIV Management) AfA (HIV Management)
Monday to Friday 08h00 – 17h00
Tel: 0860 100 646
Email: [email protected]
Alignd
Web: www.aidforaids.co.za
SMS (call me): 083 410 9078
Ambulance Services
Disease Management
Fedhealth Baby
Fraud Hotline
Create your aid.

Contact details
Alignd
Alignd
Tel: 0860 100 572
Ambulance Services
Disease Management
Fedhealth Baby
Fraud Hotline
Create your aid.

Contact details
Alignd
Ambulance Services
Ambulance Services
Europ Assistance
Tel: 0860 333 432
Disease Management
Fedhealth Baby
Fraud Hotline
Create your aid.

Contact details
Alignd
Ambulance Services
Chronic Medicine
Management
Monday to Thursday 08h30 – 17h00
Disease Management Friday 09h00 – 17h00
Tel: 0860 002 153
Postal address: PO Box 38632, Pinelands, 7430
Fedhealth Baby
Fraud Hotline
Create your aid.

Contact details
Alignd
Ambulance Services
Disease Management
Disease Management
Tel: 0860 002 153
Fedhealth Baby
Fraud Hotline
Create your aid.

Contact details
Alignd
Ambulance Services
Disease Management
Fedhealth Baby
Fedhealth Baby
Tel: 0861 116 016
Fedhealth Customer Service Centre Web: www.babyhealth.co.za
Fraud Hotline
Create your aid.

Contact details
Alignd
Ambulance Services
Disease Management
Fedhealth Baby
Fedhealth Customer
Service Centre
Fedhealth Oncology Programme Friday 09h00 – 17h00
Tel: 0860 002 153
Claim submission: [email protected]
Fraud Hotline Web: www.fedhealth.co.za
Postal address: Private Bag X3045, Randburg, 2125
Create your aid.

Contact details
Alignd
Ambulance Services
Disease Management
Fedhealth Baby
Fedhealth Oncology
Fedhealth Oncology Programme Programme
Tel: 0860 100 572
Fraud Hotline Email: [email protected]
Postal address: P O Box 38632, Pinelands, 7430
Create your aid.

Contact details
Alignd
Ambulance Services
Disease Management
Fedhealth Baby
Fraud Hotline
Fraud Hotline
Tel: 0800 112 811
Create your aid.

Contact details
Alignd
Ambulance Services
Disease Management
Fedhealth Baby
Fraud Hotline

Friday 09h00 – 17h00
Tel: 0860 002 153
Medscheme Client Service Centres Email: [email protected]
Web: www.fedhealth.co.za
Create your aid.

Contact details
Alignd
Ambulance Services
Disease Management Medscheme Client

Service Centres
Fedhealth Baby These branches are open Monday to Thursday
07h30 – 17h00, Friday 09h00 - 17h00 and
Saturday 08h00 - 12h00
Fedhealth Customer Service Centre Bloemfontein:

Medical Suites 4 and 5, First Floor, Middestad Mall,
Corner West Burger and Charles Streets
Cape Town:
Fedhealth Oncology Programme Shop 6, 9 Long Street Cnr Long & Waterkant
Streets, Cape Town
Durban:
Ground Floor, 102 Stephen Dlamini Road,
Fraud Hotline
Musgrave, Durban
Port Elizabeth:
1st Floor, Block 6, Greenacres Office Park, 2nd
Hospital Authorisation Centre Avenue, Newton Park
Pretoria:
Nedbank Plaza, Ground Floor, Shop 17, 175 Steve
Biko Street, Arcadia
Medscheme Client Service Centres Roodepoort:
Shop 21 & 22, Flora Centre, Cnr Ontdekkers and
Conrad Roads, Florida North, Roodepoort
Vereeniging:
Preferred Provider Pharmacies 27 Grey Avenue
Create your aid.

Contact details
Alignd Preferred Provider

Pharmacies
Ambulance Services Clicks
Tel: 0860 254 257
To locate a store, go to: www.clicks.co.za and
select Store Locator
Dis-Chem
Care-Line: 0860 347 243
To locate a store, go to: www.dischem.co.za and
Disease Management select Store Locator
Medirite Pharmacy
Tel: 0800 222 617
Fedhealth Baby To locate a store, go to: www.medirite.co.za and
select Store Locator
To find an independent pharmacy near you, please

Fedhealth Customer Service Centre visit www.icpa.co.za/find-a-pharmacy/
Pharmacy Direct
Fedhealth Oncology Programme Tel: 0860 027 800
Fax: 0866 114 000/ 1/ 2/ 3/ 4
Web: www.pharmacydirect.co.za
SMS (call me): 083 690 8934
Fraud Hotline
Clicks Direct Medicines
Tel: 0861 444 405
Dis-Chem Direct Courier
Tel: 011 589 2788
Medirite Courier Pharmacy
Tel: 0800 010 701
Email: medirite.courier@shoprite
Create your aid.

#Maxima Plus Individual Option Brochure 2023

Uploaded by

Copyright:

Available Formats

#Maxima Plus Individual Option Brochure 2023

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

#Maxima Plus Individual Option Brochure 2023

Uploaded by

Copyright:

Available Formats

Create your aid.

INTERACTIVE RATES & BENEFITS GUIDE GET STARTED

Unique and additional benefits paid from Risk

maxima PLUS plan

Programmes and wellness initiatives

Contribution and benefit tables

Create your aid.

Unique benefits paid from Risk

Unlimited network doctor’s visits Female contraception

Post-hospitalisation treatment for up to 30 days after discharge

Create your aid.

Let’s take a look:

In-hospital benefit overview More info l Benefit table

Chronic benefit overview More info l Benefit table

Screening benefit overview More info l Benefit table

Cancer cover overview More info l Benefit table

Maternity and childhood benefit overview More info l Benefit table

Mental Health benefit overview More info l Benefit table

Day-to-day benefits More info l Benefit table

Create your aid.

Chronic benefit overview More info l Benefit table

This beneﬁt covers:

Cancer cover overview More info l Benefit table

Pre-authorisation must be obtained for all planned hospital admissions.

Day-to-day benefits More info l Benefit table

Create your aid.

maxima PLUS In-hospital benefit

Create your aid.

Let’s take a look:

In-hospital benefit overview More info l Benefit table

CHRONIC MEDICATION BENEFIT

Screening benefit overview More info l Benefit table

Cancer cover overview More27info l Benefit

Medicine Price List (MPL)

Day-to-day benefits More info l Benefit table

Create your aid.

Let’s take a look:

In-hospital benefit overview Chronic

Create your aid.

Let’s take a look:

In-hospital benefit overview More info l Benefit table

Chronic benefit overview More info l Benefit table

Cancer cover overview More info l Benefit table

Maternity and childhood benefit overview MoreWomen’s

Mental Health benefit overview More info l Benefit table

Day-to-day benefits More info l Benefit table

Create your aid.

Let’s take a look: Women’s Health

Mental Health benefit overview More info l Benefit tableprick test

Create your aid.

maxima PLUS ONCOLOGY BENEFIT

This beneﬁt covers:

In-hospital benefit overview More info l Benefit table

Chronic benefit overview More info l Benefit

Cancer cover overview More info l Benefit table

Maternity and childhood benefit overview More info l Benefit table

Day-to-day benefits More info l Benefit table

Create your aid.

maxima PLUS register on the Fedhealth Oncology Programme.

Create your aid.