FlexiFED DEFINED BY - Fedhealth

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FlexiFED DEFINED BY - Fedhealth
flexi F E D
2021
DEFINED BY
DETAIL
FlexiFED DEFINED BY - Fedhealth
DEFINED BY

     flexiFED… Attuned to the finer details of healthcare

Two years ago, Fedhealth launched the revolutionary flexiFED range, together with the MediVault
system. While this still remains a first and only for the South African medical aid market, we have now
refined the details and polished the mechanics. We have stripped away the complications and added
what was needed.

With meticulous attention to detail, we are now proud to announce that in 2021 the Fedhealth product is
not just a first and only of its kind… it’s refined like never before.

Some of flexiFED’s finer details include:

• Select your own level of day-to-day funds (flexible) or fixed
• Choose to reduce your monthly contribution by either 11% or 25%
• Plans are tailored around YOUR life stage
• Don’t pay for certain benefits until you need them with our 30-day upgrade policy
• We pay more from Risk to stretch day-to-day benefits further

When taking a closer look at Fedhealth Medical Scheme, we’re especially proud of our 84 years in
healthcare, our solvency rate of 43.43% (as at 31 December 2019), and our Global Credit Rating of AA-
retained for 14 consecutive years. Proof that we have both the experience and financial savvy to show
up for our members when they need us most.

Run by members for members, we put you first by staying on top of the latest healthcare trends and
constantly evaluating how we can give you more, whilst remaining as affordable as possible.

Choose Fedhealth to protect your precious health in a way that lets you be YOU.
FlexiFED DEFINED BY - Fedhealth
Contents   Defined by Detail                                      Trauma treatment at a casualty ward
                                                                  Female contraception
           Choose your hospital cover                             In-hospital dentistry for children under 7
                                                                  Medical Savings Account
           Customise your hospital cover
                                                                  MediVault & Wallet
           Refine your repayment structure                        Threshold benefit
                                                                  Maternity benefit
           Choose your level of day-to-day benefits               Doula benefit for labour support during
                                                                  natural childbirth
           flexiFED option range                                  Postnatal midwifery benefit
                                                                  Early childhood benefits
           Overview of the flexiFED structure                     Consultations with a paediatrician
                                                                  Infant hearing screening benefit
           Unlimited private hospital cover for peace of mind     Childhood illness specialised drug benefit
                                                                  Optometry benefits
           Day clinic/ doctors’ rooms procedures                  Dentistry benefits
           covered from the in-hospital benefit
                                                                  Threshold benefit
           In-hospital benefit
                                                                  The MediVault and Wallet
           Examining our cancer cover
           Oncology Disease Management                            A proactive stance on health:
           Independent Clinical Oncology Network (ICON)           screening benefits
           Chemotherapy and associated medicine
           Radiotherapy                                           Additional benefits
           Specialised medication                                 24-hour Fedhealth Nurse Line
           Consultations and visits                               Paed-IQ
           Pathology                                              Fedhealth Baby Programme
           Radiology                                              Emergency transport/ response
           General radiology                                      MediTaxi
           Specialised radiology                                  SOS Call Me
           PET scans                                              Upgrades within 30 days of a life-changing event
           Surgery and hospitalisation                            Child rates for financially dependent children
           Stoma therapy                                          up to the age of 27
           Terminal care and private nursing                      Only pay for three children
           Post-active treatment
                                                                    Programmes and Wellness initiatives
           Taking care of every detail during pregnancy             Corporate wellness days
           		                                                       Health Risk Assessments
           A closer look at the chronic medicine benefit			         Sisters-on-Site
           Prescribed minimum benefit conditions                    Back and Neck Rehabilitation Programme
           Chronic disease benefit                                  Mental Health Programme
           Chronic disease list                                     Weight Management Programme
           Medication for additional chronic conditions             GoSmokeFree smoking cessation programme
           The Medicine Price List                                  Aid for AIDS (HIV management)
           Chronic conditions on the Chronic Disease List (CDL)     Paed IQ
           Additional chronic conditions covered on certain options Diabetes Care
           Obtaining chronic medicine
                                                                    flexiFED contributions
           Mental health
                                                                    flexiFED rate calculations
           Network hospital list                                    Contact details

           Sanlam Gap Cover                                       @FedhealthMed at your service
                                                                  Fedhealth website
           Cover for day-to-day expenses                          Fedhealth Family Room
           Day-to-day benefits paid by Fedhealth                  LiveChat and chatbot
           Consultations with a network GP                        Fedhealth Member App
           Treatment for 30 days after discharge from hospital    Fedhealth WhatsApp Bot
           Take-home medicine                                     Network GP, specialist and hospital locator
           Specialised radiology
FlexiFED DEFINED BY - Fedhealth
STEP

                                                   01
                                                   Choose
                                                   your
                                                   hospital
                                                   cover

                                                   STEP

AFFORDABILITY
                                                   02
 FLEXIBILITY                                       Customise
                                                   your
  CONTROL                                          hospital
                                                   cover

                                                   STEP
Fedhealth’s flexiFED options allow you to create
your own option to suit your needs and budget
                 in 4 easy steps.
                                                   03
  If you are ready to build your one-of-a-kind
  medical aid solution... THEN LET’S BEGIN…
                                                   Refine
                                                   your
                                                   repayment
                                                   structure

                                                   STEP

                                                   04
                                                   Choose
                                                   your
                                                   level of
                                                   day-to-day
                                                   benefits
FlexiFED DEFINED BY - Fedhealth
STEP

                                                     01
                                                     Choose
                                                     your
                                                     hospital
                                                     cover

                                                     STEP

STEP   Choose your                                   02
01     hospital cover                                Customise
                                                     your
                                                     hospital
       Hospital cover (also called Risk cover)       cover
       is the foundation of your medical aid bene-
       fits.
                                                     STEP
       It takes care of your significant hospital
       expenses, and other costs like oncology,
       maternity and chronic medicines. Everybody
       has different needs, and it is important to
                                                     03
       choose a solid foundation that addresses
                                                     Refine
       your unique circumstances.
                                                     your
                                                     repayment
       Choose from one of the 4 flexiFED options     structure

                                                     STEP

                                                     04
                                                     Choose
                                                     your
                                                     level of
                                                     day-to-day
                                                     benefits
FlexiFED DEFINED BY - Fedhealth
STEP

                                                                                                                                                                                           01
BACK TO CONTENTS PAGE

flexiFED 1 overview
                                  STEP                                 Choose your
                                 01                                    hospital cover
flexiFED 2 Overview

flexiFED 3 Overview

flexiFED 4 Overview
                                                                                                                                                                                           Choose
Emergency and planned                                                                                                                                                                      your
procedure hospital cover
                                                                                                                                                                                           hospital
Day clinic & doctor’s rooms                                                                                                                                                                cover
procedures

Oncology                                                             Choose from one of the 4 flexiFED options below:
Maternity, infant and                                                                                                                                                                      STEP

                                                                                                                                                                                           02
children
                                         flexiFED 1                                flexiFED 2                             flexiFED 3                             flexiFED 4
Chronic                                  Young Singles                            Family Start-ups                      Young Families                        Mature Families

Mental Health
                                 Emergency and planned                     Emergency and planned                 Emergency and planned                 Emergency and planned
                                 procedure hospital cover                  procedure hospital cover              procedure hospital cover              procedure hospital cover
Full contributions table

Hospital Cover                            Oncology                                  Oncology                              Oncology                              Oncology
                                                                                                                                                                                           Customise
Screening benefits
                               Maternity, infant and children            Maternity, infant and children        Maternity, infant and children        Maternity, infant and children
                                                                                                                                                                                           your
Unique benefits                                                                                                                                                                            hospital
Additional benefits                         Chronic                                   Chronic                               Chronic                               Chronic                  cover
Wellness Initiatives                    Mental health                             Mental health                         Mental health                         Mental health

Benefit structure
                                                                                                                                                                                           STEP

                                                                                                                                                                                           03
                                 The amounts below indicate the            The amounts below indicate the        The amounts below indicate the        The amounts below indicate the
                               cost for your Hospital / Risk cover       cost for your Hospital / Risk cover   cost for your Hospital / Risk cover   cost for your Hospital / Risk cover
                                  only. As we build your perfect            only. As we build your perfect        only. As we build your perfect        only. As we build your perfect
                               Fedhealth option over the next few        Fedhealth option over the next few    Fedhealth option over the next few    Fedhealth option over the next few
                                steps, these amounts can change           steps, these amounts can change       steps, these amounts can change       steps, these amounts can change

                                             R1 788                                    R2 500                                R2 825                                R3 747

                                             R3 189                                    R4 671                                R5 374                                R7 146                  Refine
                                                                                                                                                                                           your
                                             R3 842                                    R5 413                                R6 389                                R8 299                  repayment
                                                                                                                                                                                           structure
                                             R4 495                                    R6 155                                R7 404                                R9 452

                                                                                                                                                                                           STEP

                                                                                UNIQUE TO FEDHEALTH
                                 We are the only medical aid scheme that pays for the following unique benefits like unlimited GP benefits, specialised
                               radiodology and female contraceptives from your Hospital/Risk cover – not from your day-to-day funds. This means you
                                                                                                                                                                                           04
                                                  can keep your day-to-day funds (which we’ll get to shortly) for other expenses.
   Customised interaction
                                                                      CLICK HERE TO SEE ALL OUR UNIQUE BENEFITS
                                                                                                                                                                                           Choose
   with members
                                                                                                                                                                                           your
   Contact details                                                                                                                                                                         level of
                              Remember: The great thing about Fedhealth is that you can choose the cover you need right now…
   Download brochure          not the cover you might need in future. We’re the only medical aid that allows you to upgrade your option at any                                             day-to-day
                              time of the year if a life-changing event (like pregnancy or diagnosis of serious disease) happens.                                                          benefits
FlexiFED DEFINED BY - Fedhealth
STEP

                                                      01
                                                      Choose
                                                      your
                                                      hospital
                                                      cover

                                                      STEP

STEP   Customise your                                 02
02     hospital cover                                 Customise
                                                      your
                                                      hospital
       At Fedhealth we are all about control, flex-   cover
       ibility and choice. Our flexiFED options are
       made one member at a time, and you can
                                                      STEP
       customise your Hospital / Risk cover to fit
       your budget and your needs perfectly.

       With Fedhealth, you can choose to
                                                      03
       get 11% or 25% off your monthly
                                                      Refine
       contribution!                                  your
                                                      repayment
                                                      structure

                                                      STEP

                                                      04
                                                      Choose
                                                      your
                                                      level of
                                                      day-to-day
                                                      benefits
FlexiFED DEFINED BY - Fedhealth
STEP
                            STEP   Customise your
                                                                                                                                                                                                     01
BACK TO CONTENTS PAGE

Network Hospital List

Sanlam Gap Cover

See how much you can save
on GRID and Elect           02     hospital cover
                                                                                                                                                                                                     Choose
                                                                                                                                                                                                     your
                                                                                                                                                                                                     hospital
                                                                                                                                                                                                     cover
                                           With Fedhealth, you can choose between two optional variants
                                                           to add a substantial discount.                                                                                                            STEP

                                              Full cover at
                                               all private
                                                                                                     Full cover at
                                                                                                       network
                                                                                                                                 SA
                                                                                                                                      V
                                                                                                                                          E
                                                                                                                                              11
                                                                                                                                                   %
                                                                                                                                                                    Full cover at SAV
                                                                                                                                                                     any private
                                                                                                                                                                   hospital with a
                                                                                                                                                                                      E
                                                                                                                                                                                        25
                                                                                                                                                                                           %
                                                                                                                                                                                                     02
                                                hospitals                                              hospitals                                                   co-payment for
                                                                                                                                                                  elective surgery
                                                                                                                                                                                                     Customise
                                              ANY HOSPITAL                                                   GRID                                                         Elect                      your
                                                                                                                                                                                                     hospital
                                         The standard flexiFED variant
                                        offers no additional discounts.
                                                                                             In exchange, you must use
                                                                                            Fedhealth’s Private Hospital
                                                                                                                                                                 In exchange, you will be
                                                                                                                                                                charged a fixed excess of
                                                                                                                                                                                                     cover
                                        flexiFED 1 is a network hospital                  Network for planned procedures.                                     R12 500 on all hospital admis-
                                       option, while flexiFED 2, 3, and 4                 The network includes over 100 of                                    sions, except for emergencies.
                                        covers planned procedures at                     South Africa’s best private hospi-                                     This excess however only
                                             any private hospital.                       tals and 90% of our members live                                      applies to the hospital bill;         STEP

                                                                                                                                                                                                     03
                                                                                           within a 10-kilometre radius of                                          you could still have
                                                                                         these hospitals. You can still use a                                 co-payments on out-of-net-
                                                                                         non-network hospital if you wish,                                    work specialists, a procedure
                                                                                           but you will then have to pay a                                      co-payment or shortfalls
                                                                                          R12 500 co-payment. However,                                         because benefit limits have
                                                                                         the co-payment does not apply in                                            been exceeded.
                                                                                                case of emergencies.

                                                                                                                                                                                                     Refine
                                                                                                                                                                                                     your
                                                                                                                                                                                                     repayment
                                     flexiFED 1 flexiFED 2 flexiFED 3 flexiFED 4                 flexiFED 2        flexiFED 3      flexiFED 4                     flexiFED 1 flexiFED 2 flexiFED 3 flexiFED 4
                                                                                                                                                                                                     structure

                                       !                     Avoid network restrictions with Sanlam GAP Cover.                                                                                       STEP
                                                                                                                                                                             Sanlam
                                                                                                                                                                                                     04
                                                               To avoid the network restrictions on Elect and GRID, take Sanlam Gap Cover
                                                                         from R200 p/m (individuals) and R352 p/m (families).
                                                            Even with Gap Cover, you will still pay less than the ‘any hospital’ flexiFED option
                                                                 and you won't have to worry about the co-payments mentioned above.
                                                                                                                                                                             Gap Cover
                                                                         * Please note these are 2020 rates. 2021 rates unavailable at time of printing.

   Customised interaction                                                         CLICK HERE TO FIND OUT MORE                                                                                        Choose
   with members
                                                                                                                                                                                                     your
   Contact details                                                                                                                                                                                   level of
   Download brochure                                                                                                                                                                                 day-to-day
                                                                                                                                                                                                     benefits
FlexiFED DEFINED BY - Fedhealth
STEP

                                                                                                                            01
BACK TO CONTENTS PAGE

Network Hospital List                      How much can you save with GRID and Elect?
Sanlam Gap Cover
                            The amounts below indicate your monthly contribution for your flexiFED Hospital/Risk cover.
                                 It does not include your day-to-day funding, which will be added in the next step.
                                                                                                                            Choose
                                                                                                                            your
                                                                                                                            hospital
                              flexiFED 1                             R1 788      R3 189     R2 441    R3 842        R4 495
                                                                                                                            cover
                              flexiFED 1Elect                        R1 393      R2 482    R1 900     R2 989        R3 496

                              Monthly reduction in contributions    R395        R707       R541       R853         R999     STEP

                                                                                                                            02
                              ANNUAL reduction in contributions    R4 740     R8 484     R6 492     R10 236      R11 988

                              flexiFED 2                             R2 500      R4 671    R3 242      R5 413       R6 155

                              flexiFED 2GRID                         R2 222      R4 155    R2 882      R4 815       R5 475

                              Monthly reduction in contributions    R278         R516      R360       R598         R680
                              ANNUAL reduction in contributions    R3 336      R6 192    R4 320      R7 176       R8 160
                                                                                                                            Customise
                                                                                                                            your
                              flexiFED 2Elect                         R1 871    R3 502     R2 429     R4 060        R4 618   hospital
                              Monthly reduction in contributions    R629       R1 169      R813      R1 353       R1 537    cover
                              ANNUAL reduction in contributions    R7 548     R14 028    R9 756     R16 236     R18 444

                                                                                                                            STEP

                                                                                                                            03
                              flexiFED 3                             R2 825      R5 374    R3 840     R6 389       R7 404

                              flexiFED 3GRID                          R2 511    R4 780      R3 414    R5 683        R6 586

                              Monthly reduction in contributions     R314       R594       R426       R706          R818
                              ANNUAL reduction in contributions    R3 768      R7 128     R5 112    R8 472        R9 816

                              flexiFED 3Elect                         R2 117    R4 028     R2 879     R4 790        R5 552
                                                                                                                            Refine
                              Monthly reduction in contributions    R708       R1 346      R961      R1 599       R1 852
                                                                                                                            your
                              ANNUAL reduction in contributions    R8 496     R16 152    R11 532    R19 188     R22 224     repayment
                                                                                                                            structure
                              flexiFED 4                             R3 747      R7 146    R4 900     R8 299        R9 452

                              flexiFED 4GRID                         R3 326      R6 351    R4 353      R7 378      R8 405

                              Monthly reduction in contributions     R421       R795       R547       R921       R1 047     STEP
                              ANNUAL reduction in contributions

                              flexiFED 4Elect

                              Monthly reduction in contributions
                                                                   R5 052

                                                                    R2 806

                                                                     R941
                                                                              R9 540

                                                                               R5 404

                                                                               R1 742
                                                                                         R6 564

                                                                                          R3 687

                                                                                          R1 213
                                                                                                    R11 052

                                                                                                     R6 285

                                                                                                    R2 014
                                                                                                                R12 564

                                                                                                                   R7 166

                                                                                                                 R2 286
                                                                                                                            04
   Customised interaction     ANNUAL reduction in contributions    R11 292 R20 904       R14 556    R24 168     R27 432     Choose
   with members
                                                                                                                            your
   Contact details                                                                                                          level of
   Download brochure                                                                                                        day-to-day
                                                                                                                            benefits
FlexiFED DEFINED BY - Fedhealth
STEP

                                                             01
                                                             Choose
                                                             your
                                                             hospital
                                                             cover

                                                             STEP

STEP   Refine your                                           02
03     repayment
       structure
                                                             Customise
                                                             your
                                                             hospital
                                                             cover

       Some people are happy to do a little extra admin if   STEP
       it saves them money. For others, convenience and
       simplicity is king. Whichever means more to you,
       you can choose how you want to structure
                                                             03
       your MediVault repayments.
                                                             Refine
       The choice is yours.                                  your
                                                             repayment
                                                             structure

                                                             STEP

                                                             04
                                                             Choose
                                                             your
                                                             level of
                                                             day-to-day
                                                             benefits
STEP
                            STEP   Refine your
                                                                                                                                                                 01
BACK TO CONTENTS PAGE

MediVault amounts

flexiFED contributions

Rate Calculator
                            03     repayment structure
                                                                                                                                                                 Choose
                                                                                                                                                                 your
                                                                                                                                                                 hospital
                                                                                                                                                                 cover
                                                                 The key to affordable medical aid is understanding
                                                                        what you pay for and what you get.                                                       STEP
                                      South African medical aid schemes all work the same way (or until now, at least). The total contribution you pay every
                                      month, is made up of two parts. The first part is your Hospital/Risk cover, which we explained under Step 1, and the
                                      second part is your contribution for day-to-day benefits, or savings as some call it. The savings portion may be up to
                                      25% of your total contribution.
                                                                                                                                                                 02
                                      This means that from Day 1, you pay for both your Hospital/Risk cover and your day-to-day benefits – long before
                                      you’ve used any of it. Basically, you are forced to take out a compulsory loan JUST to have day-to-day benefits you        Customise
                                      might not even plan on using! This is the main difference between Fedhealth’s flexiFED range and other medical             your
                                      schemes. We believe that younger, healthier members love the control, flexibility, and affordability we offer, and the
                                      fact that it is now their choice to manage their medical aid spend instead of a forced, compulsory loan that remains the   hospital
                                      norm for all other medical aids.                                                                                           cover
                                      How Fedhealth’s day-to-day benefits work
                                      Fedhealth uses the revolutionary MediVault to pay for day-to-day benefits. In the next step we will look at how the        STEP

                                                                                                                                                                 03
                                      MediVault system works in more detail, but for now it’s important to understand that the MediVault system makes a
                                      pre-determined amount of money available to you for your day-to-day benefits, but you only pay for the portion of
                                      your MediVault allowance that you actually use – not all of it.

                                      This is what makes the MediVault a game changer. With other medical aid schemes you pay for your day-to-day
                                      funds in full from the beginning of the year… as if you’ve already transferred your full MediVault from the outset.
                                      Why should you pay for something you haven’t used yet?
                                                                                                                                                                 Refine
                                                                                                                                                                 your
                                                                                                                                                                 repayment
                                                                                    The choice is yours!                                                         structure
                                    With Fedhealth, you choose whether you prefer the control and upfront savings of the MediVault system where you choose a
                                           FLEXIBLE repayment structure, or the familiarity and simplicity of the old-school FIXED repayment structure.
                                                                                                                                                                 STEP
                                           P
                                               AY
                                                  MEN
                                                                                                           P
                                                                                                               AY
                                                                                                                  M EN

                                                                                                                                                                 04
                                                         T

                                                                                                                         T
                                      RE

                                                                                                      RE

                                            E
                                     FLEXIBL FLEXIBLE MONTHLY PAYMENTS                                FIXED                      FIXED MONTHLY PAYMENTS

                                                                                                                             E
                                                             E

                                       S                                                               S

                                                                                                                         R
                                                         R

                                           T             U                                                 T             U
                                               R U C T                                                         R U C T

   Customised interaction             Some people are happy to do a little extra admin if it saves them money. For others, convenience and simplicity            Choose
   with members
                                       is key. Whichever means more to you, you can choose how you want to structure your MediVault repayments.                  your
   Contact details
                                                                             CLICK HERE TO SEE HOW THEY COMPARE                                                  level of
   Download brochure                                                                                                                                             day-to-day
                                                                                                                                                                 benefits
STEP

                                                                                                                                                                     01
BACK TO CONTENTS PAGE
                                                                                 See how they compare:
MediVault amounts                                             AY
                                                                 M E
                                                                     N                                                              AY
                                                                                                                                       M E
                                                                                                                                           N
                                                          P                                                                     P

                                                                                                                                               T
                                                                         T

                                                                                                                         E
                                                    RE
                                                         E
                                                  FLEXIBL                                                               FIXED
flexiFED contributions

                                                                                                                        R
Rate Calculator

                                                                             E

                                                                                                                                                   E
                                                      S                                                                     S

                                                                         R

                                                                                                                                               R
                                                          T              U                                                      T              U
                                                                                                                                                                     Choose
                                                              R U C T                                                               R U C T

                              What makes our MediVault system so unique, is that you can
                             choose to start paying for your day-to-day benefits when you
                                                                                                 This is medical aid as you know it currently. This option offers
                                                                                                  you simplicity and security by letting us take care of all the
                                                                                                                                                                     your
                                         need to use them – not from day one.                    admin. The Scheme will transfer a pre-determined amount to
                                                                                                   your Wallet on 1 January every year – this amount will be
                                                                                                                                                                     hospital
                            If you select the FLEXIBLE option, you simply transfer funds from              pro-rated should you join after 1 January.                cover
                                 your MediVault to your Wallet when you need to pay for
                               day-to-day medical expenses. The funds you transfer to your          This is similar to how all other medical schemes in South
                                                                                                    Africa work. You will know upfront how much day-to-day
                                    Wallet are then repaid over 12 months, interest free.
                                                                                                  funds you have available for the year and you’ll start to repay
                                                                                                 that amount every month from the beginning of the year. Both
                                                                                                                                                                     STEP

                                                                                                                                                                     02
                                                                                                   the available funds and repayments will be pro-rated if you
                                                                                                                 join Fedhealth later than January...

                                   What’s GREAT about this option?                                      What’s GREAT about this option?
                                    You don’t pay for day-to-day benefits until you use                   Simplicity – you choose once and your monthly
                                    them. This could save you thousands every month.                     repayment will never vary.

                                    You pay less without compromising on the quality of
                                    your Risk benefits.
                                                                                                         One debit order every month.                                Customise
                                    You are in full control over how much you pay for your               No admin, we’ll manage your day-to-day funds
                                                                                                                                                                     your
                                    medical aid.                                                         automatically.                                              hospital
                                    You will have one debit order each month – made up                                                                               cover
                                    of your Risk/Hospital cover contribution and your
                                    MediVault repayments.

                                    Any unused funds in your Wallet will transfer to the
                                    next year, so you won’t lose it.                                                                                                 STEP

                              !
                                   Why it’s not for everybody �
                                    Your repayments might change over time, depending
                                    on how much of your MediVault you use                           !
                                                                                                         Why it’s not for everybody�
                                                                                                         Your initial monthly reduction in contributions will be
                                                                                                         less, because you start repaying your day-to-day
                                                                                                         benefit immediately.
                                                                                                                                                                     03
                                                                                                    !    There is less flexibility. You have to repay the entire
                                                                                                         amount allocated to you, whether you use it or not.         Refine
                                                                                                         However, any unused funds will transfer to the next
                                                                                                         year, so you won’t lose it.                                 your
                            SUMMARY: The MediVault FLEXIBLE repayment structure offers           SUMMARY: The FIXED repayment structure offers you simplicity
                                                                                                                                                                     repayment
                            you full control over your repayments and could save you             and repayment security. It’s perfect for anyone who prefers         structure
                            thousands. This feature is perfect for someone who wants more        minimal admin and effort. You won’t enjoy the same flexibility and
                            control over their medical aid expenses, and doesn’t mind a little   upfront reduction in contribution, but your day-to-day benefits
                            extra admin to enjoy the perks.                                      will simply be there, ready to use whenever you need them. Your
                                                                                                 monthly repayment will be a set amount, with no surprises.
                                                                                                                                                                     STEP

                              MECHANICS: One monthly debit order

                              On the FLEXIBLE structure, your Hospital cover and
                                                                                                   MECHANICS: One monthly debit order

                                                                                                   On the FIXED structure, your Hospital cover and
                                                                                                                                                                     04
                              MediVault repayment will be combined into one                        MediVault repayment will be combined into one
   Customised interaction
                              monthly debit order which could vary depending on                    monthly debit order that will always be the same
                                                                                                                                                                     Choose
   with members
                              your MediVault usage.                                                amount for the whole year.                                        your
   Contact details                                                                                                                                                   level of
   Download brochure                                                                                                                                                 day-to-day
                                                                                                                                                                     benefits
STEP

                                                                01
                                                                Choose
                                                                your
                                                                hospital
                                                                cover

STEP   Choose your                                              STEP

04     level of
       day-to-day
                                                                02
       benefits                                                 Customise
                                                                your
                                                                hospital
                                                                cover
       Now that your hospital cover and repayment
       structure are selected, it’s time to take control
       and select your day-to-day benefits. Day-to-day
       expenses include all the frequent, everyday              STEP
       medical expenses you have that are not covered
       under the hospital or risk cover. Think of things like
       paying for medication at the pharmacy,
       specialised frames for your glasses and other
                                                                03
       similar expenses.
                                                                Refine
       With Fedhealth, affordability is in your hands.
                                                                your
       We have unlocked ample access to
                                                                repayment
       day-to-day benefits for you, and you decide
                                                                structure
       how much… or how little of it you want to use.

                                                                STEP

                                                                04
                                                                Choose
                                                                your
                                                                level of
                                                                day-to-day
                                                                benefits
STEP
                            STEP   Choose your level of
                                                                                                                                                                                                   01
BACK TO CONTENTS PAGE

Day-to-day benefits

Threshold benefits

The MediVault and Wallet

FIXED Repayment Structure
                            04     day-to-day benefits
                                                                                                                                                                                                   Choose
                                                                                                                                                                                                   your
                                                                                                                                                                                                   hospital
                                                                                                                                                                                                   cover
                                                                   FLEXIBLE repayment structure
                                                  If you select the FLEXIBLE repayment structure you choose how much
                                                      of your MediVault allowance you want to use throughout the year.                                                                             STEP

                                      M
                                       How much is in the
                                       MediVault

                                      M+1
                                      M+2
                                                                         flexiFED 1

                                                                        R9 300
                                                                        R12 900
                                                                        R14 100
                                                                                                  flexiFED 2

                                                                                                 R9 900
                                                                                                 R15 300
                                                                                                 R21 000
                                                                                                                           flexiFED 3

                                                                                                                           R11 100
                                                                                                                           R16 800
                                                                                                                           R22 200
                                                                                                                                                  flexiFED 4

                                                                                                                                                  R14 700
                                                                                                                                                  R26 700
                                                                                                                                                  R30 300
                                                                                                                                                                                                   02
                                      M + 2+                            R15 300                  R24 600                   R26 100                R33 900

                                                                                                                                                                                                   Customise
                                                                                                                                                                                                   your
                                                                                                                                                                                                   hospital
                                                                       Let’s use flexiFED 2 as an example                                                                                           cover

                                                Total Hospital/ Risk contribution          R2 500          R4 671        R3 242         R5 413            R6 155                                   STEP
                                                Total amount available for
                                                day-to-day benefits
                                                (MSA + MediVault)
                                                                                           R10 224       R15 900      R15 708        R21 684           R25 368

                                                Note - You don’t have to use any... or all... of the funds in your MediVault if you don’t want to and you will
                                                only repay the amount you have used. To calculate how much you have to pay to the Scheme every month,
                                                simply divide the amount you intend to use by 12 and add that to your Hospital Cover contribution.
                                                                                                                                                                                                   03
                                                                                                                                                                                                   Refine
                                          ( Transferred MediVault amount ÷ 12 )
                                                                                  +   Hospital/Risk Cover contribution
                                                                                                                          =       TOTAL MONTHLY CONTRIBUTION
                                                                                                                                                                                                   your
                                                                                                                                                                                                   repayment
                                                                                                                                                                                                   structure
                                          Example 1
                                       If you use your flexiFED option as a hospital plan with no funds for day-to-day benefits
                                       TOTAL MONTHLY REPAYMENT TO THE SCHEME                R2 500         R4 671         R3 242        R5 413           R6 155                                    STEP
                                          Example 2
                                       If you use half your available MediVault funds
                                       AMOUNT USED
                                       TOTAL MONTHLY REPAYMENT TO THE SCHEME
                                                                                            R4 950
                                                                                            R2 913
                                                                                                           R7 650
                                                                                                           R5 309
                                                                                                                          R7 650
                                                                                                                          R3 880
                                                                                                                                        R10 500
                                                                                                                                        R6 288
                                                                                                                                                         R12 300
                                                                                                                                                         R7 180
                                                                                                                                                                                                   04
   Customised interaction                                                                                                                                                                          Choose
   with members                           Example 3
                                                                                                                                                                                                   your
   Contact details                     If you use ALL your available MediVault funds
                                                                                                                                                                                                   level of
                                       AMOUNT USED                                          R9 900         R15 300       R15 300        R21 000         R24 600
   Download brochure                   TOTAL MONTHLY REPAYMENT TO THE SCHEME                R3 325         R5 946         R4 517        R7 163           R8 205    SEE FIXED REPAYMENT STRUCTURE
                                                                                                                                                                                                   day-to-day
                                                                                                                                                                                                   benefits
STEP
                                  Choose your level of
                                                                                                                                                                                       01
BACK TO CONTENTS PAGE
                           STEP

                           04
Day-to-day benefits

Threshold benefits
                                  day-to-day benefits
The MediVault and Wallet

FLEXIBLE Repayment                                                                                                                                                                     Choose
Structure                                                                                                                                                                              your
Contributions                                                                                                                                                                          hospital
                                                                  FIXED repayment structure                                                                                            cover
                                                If you select the FIXED repayment structure a pre-determined amount
                                            is transferred to your Wallet, and that is your day-to-day benefit for the year.
                                                                                                                                                                                       STEP
                                        How much is in the
                                        MediVault
                                        M
                                        M+1
                                                             flexiFED 1

                                                             R3 600
                                                             R5 400
                                                                                       flexiFED 2

                                                                                       R4 800
                                                                                       R7 200
                                                                                                              flexiFED 3

                                                                                                              R7 200
                                                                                                              R9 600
                                                                                                                                   flexiFED 4

                                                                                                                                  R12 000
                                                                                                                                  R21 000
                                                                                                                                                                                       02
                                        M+2                  R6 600                    R11 400                R12 600             R24 000
                                        M + 2+               R8 400                    R15 000                R15 000             R27 600
                                                                                                                                                                                       Customise
                                                                                                                                                                                       your
                                                                                                                                                                                       hospital
                                                                      Let’s use flexiFED 2 as an example
                                                                                                                                                                                       cover

                                                                                                                                                                                       STEP

                                                                                                                                                                                       03
                                                  RISK contribution - flexiFED 2                  R2 500   R4 671    R3 242    R5 413       R6 155

                                                  RISK contribution - flexiFED 2GRID              R2 222   R4 155    R2 882    R4 815       R5 475

                                                  RISK contribution - flexiFED 2Elect             R1 871   R3 502     R2 429   R4 060       R4 618

                                                  Fixed amount for day-to-day benefits
                                                  on ALL flexiFED 2 permutations                  R4 800   R7 200    R7 200    R11 400     R15 000
                                                                                                                                                                                       Refine
                                                                                                                                                                                       your
                                                  Total FIXED monthly contribution                                                                                                     repayment
                                                  to the Scheme for flexiFED 2                    R2 900   R5 271     R3 842   R6 363      R7 405
                                                                                                                                                                                       structure

                                                  Total FIXED monthly contribution
                                                  to the Scheme for flexiFED 2GRID                R2 622   R4 755    R3 482    R5 765      R6 725
                                                                                                                                                                                       STEP
                                                  Total FIXED monthly contribution
                                                  to the Scheme for flexiFED 2Elect               R2 271   R4 102    R3 029    R5 010       R5 868
                                                                                                                                                                                       04
                                                  Notes
 Customised interaction                                                                                                                                                                Choose
 with members                                     • You will have one deduction every month for your total repayment.
                                                  • The amount will be fixed for the entire year.
                                                                                                                                                                                       your
 Contact details                                  • You do not have to transfer funds from your MediVault to your Wallet.                                                              level of
                                                    This will be done on your behalf at the beginning of every year.
 Download brochure                                                                                                                                  SEE FLEXIBLE REPAYMENT STRUCTURE   day-to-day
                                                                                                                                                                                       benefits
flexiFED option range

With our flexiFED option range, members can stop paying for cover they don’t use. Instead, they can select cover that fits their current needs… but with the option to change when the unexpected happens. It’s cover
that grows with the member.

                                                                                                                                                                                  flexiFED 2
                                                                flexiFED 1                                                                                                         Family start-ups
                                                                Young singles

                                                                                                                                                                For young families who are just starting out.
                                    For young people who are single, in a relationship or married.

                   Access to a MediVault                                                                                             Access to a MediVault
                   for day-to-day benefits                                                                                            for day-to-day benefits
                   Most people at this life stage prefer                                                                            Many people at this life stage still prefer
                   hospital plans, but hospital plans have no                      Unlimited nominated network                      hospital plans, but hospital plans have no
                   day-to-day benefits. flexiFED 1 can be                            GP consults from Risk                            day-to-day benefits. flexiFED 2 can be
                   like a hospital plan: if you don’t use the                                                                       like a hospital plan; if you don't use the
                                                                                    after day-to-day claims have reached the
                   MediVault you don’t pay for it, but should                                                                       MediVault you don't pay for it, but should
                                                                                    Threshold level.
                   you need it you don’t have to rely on                                                                            you need it, you don’t have to rely on
                   family or your bank for a loan. You just
                                                                                                                                                                                                         Customised childhood benefits:
                                                                                                                                    family or your bank for a loan. You just
                   access your MediVault and pay it back.                                                                           access your MediVault and pay it back.                               ALL PAID FROM RISK

                                                                                                                                                                                                    Paed-IQ (telephonic parenting advice line)
                                                                                   Female contraception
                                                                                    paid from Risk.                                                                                                 Paediatric consultations without referral up to 12
                   Unlimited accident and                                                                                            Rich maternity benefits:                                        months old
                   emergency treatment                                                                                              2x 2D antenatal scans and 8 ante- or
                                                                                                                                                                                                    Infant hearing screening benefit
                                                                                                                                    postnatal consults with midwife, network
                   at any private hospital.
                                                                                                                                    GP and gynae
                                                                                   Specialised radiology                                                                                            Childhood immunisations
                                                                                    for that fall from your MTB.                    Fedhealth Baby programme
                                                                                                                                                                                                    Circumcisions

                   Basic maternity benefit                                                                                           Amniocentesis
                                                                                                                                                                                                    Trauma treatment in a casualty ward for those falls
                                                                                                                                                                                                    from the swing
                                                                                                                                    Antenatal classes to the value of R1 120

                                                                                   Basic dental benefit                              Doula benefit
                                                                                                                                                                                                    Unlimited nominated network GP consults after
                                                                                                                                                                                                    day-to-day claims have reached the Threshold level

                   Customised mental                                                                                                Postnatal midwifery benefit
                                                                                                                                                                                                    Childhood illness specialised drug benefit up to 18
                   health benefit                                                                                                    Rental of a water bath
                                                                                                                                                                                                    years old
                   for support with substance abuse and
                   eating disorders, etc.                                          Unlimited private hospital cover                 Paediatrician for the delivery room
                                                                                                                                                                                                    Only pay for up to three children, the rest are covered
                                                                                   for planned procedures                                                                                           for free

                                                                                    at network hospitals (or the smaller network    We cover natural deliveries, epidurals
                                                                                                                                                                                                    Unlimited cover (PMB level) for neonatal complica-
                                                                                    depending on your choice).                      and C-sections
                                                                                                                                                                                                    tions, infant cancers, infant injuries and fractures
                   Unlimited 30-day post
                   hospital benefit
                   (e.g. physio/ dietician/ OT/ speech).
                                                                                   PLUS
                                                                                                                                     Lifestyle benefits:
                                                                                                                                    Female contraception and vasectomies
                   Trauma treatment in a                                           HIV screening + flu vaccine                                                                                            PLUS
                   casualty ward paid from Risk                                                                                     Unlimited nominated network GP
                                                                                   Weight management programme                      consults from Risk after day-to-day
                   for sports or hazardous pursuit injuries                                                                                                                                              Fedhealth Family Room for valuable pregnancy/
                                                                                                                                    claims have reached the Threshold level
                   (co-pay applies).                                               Smoking cessation programme                                                                                           baby advice
                                                                                                                                    Upgrades within 30 days of a
                                                                                   Fedhealth Nurse Line for medical advice          life-changing event, such as pregnancy                               Fedhealth Nurse Line for medical advice
                                                                                                                                    or the diagnosis of a dread
                   Upgrades within 30 days of a                                    MediTaxi post-hospitalisation transport          disease                                                              MediTaxi post-hospitalisation transport
                   life-changing event,
                                                                                   Fedhealth Family Room rewards
                   such as pregnancy or the diagnosis of a
                   dread disease.

                                                                                                                                                                                                                                                              GO BACK
flexiFED option range

                                                      flexiFED 3                                                                                                                      flexiFED 4
                                                      Young families                                                                                                                 Mature families

                                            For young, still growing families.                                                                  For mature families looking for cover that leaves nothing to chance.

                                                                                                                                      Access to a MediVault
                                                                                 Customised childhood benefits:                        for day-to-day benefits
      Access to a MediVault
      for day-to-day benefits
                                                                                                                                     Many people prefer hospital plans because                         Rich maternity benefits
                                                                                 ALL PAID FROM RISK                                  they are simple and affordable, but
      Many people prefer hospital plans                                                                                              hospital plans have no day-to-day benefits.
      because they are simple and affordable,                                                                                        flexiFED 4 can be like a hospital plan; if you
                                                                          Paed-IQ (telephonic parenting advice line) up to 14
      but hospital plans have no day-to-day                                                                                          don’t use the MediVault you don’t pay for
      benefits. flexiFED 3 can be like a hospital                                                                                      it, but should you need it, you don’t have                        Child rates up to the age of 27
                                                                          Fedhealth Nurse Line for advice
      plan; if you don’t use the MediVault you                                                                                       to rely on your bank for a loan. You just
      don’t pay for it, but should you need it,                           Paediatric consultations without referral up to 24         access your MediVault and pay it back.
      you don’t have to rely on your bank for a                           months old
      loan. You just access your MediVault and
                                                                          Infant hearing screening benefit
                                                                                                                                                                                                       Screening benefit for breast
      pay it back.                                                                                                                  Unlimited network GP                                               cancer
                                                                          Infant/ childhood immunisations (DoH recommended)         consults from R1                                                   (> age 45), cervical cancer (ages 21-65),
                                                                          Trauma treatment in a casualty ward (co-pay applies)                                                                         cholesterol, colorectal, HIV, PSA (ages 45 – 69)
      Rich maternity benefits:
                                                                          for accidental injuries like fractures, burns, near       Cover for mental health
      2x 2D antenatal scans and 12 ante- and                              drowning.                                                 disorders:
      postnatal consults with midwife, network                            Unlimited nominated network GP consults after
      GP and gynae                                                                                                                  anxiety and panic disorders, ADHD,
                                                                          day-to-day claims have reached the Threshold level.       eating disorders, OCD                                              Health risk assessments
      Fedhealth Baby programme                                            Tonsillectomy under age 12
      Doula benefit                                                        In-hospital dentistry up to age 7                         Advanced and basic dental
      Postnatal midwifery benefit                                          Nasal procedures
                                                                                                                                    benefits                                                            Optical benefits
      Private ward cover                                                                                                            e.g. extraction of impacted wisdom teeth
                                                                          Childhood illness specialised drug benefit up to 18
      Amniocentesis                                                       years old.

      Antenatal classes to the value of R1 120                            Specialised medicine like Synagis, Botox and growth                                                                          Non-PMB chronic benefits
                                                                          hormones for children up to age 10
                                                                                                                                    Unlimited accident and
      Support for post-partum depression                                                                                            emergency treatment at
                                                                          Additional chronic benefit for children up to the age of
                                                                          18 with asthma, eczema and acne up to the age of 21.
                                                                                                                                    any private hospital
                                                                                                                                    (co-pays apply)                                                    Terminal care benefit
                                                                          Cover for the following conditions:
      Lifestyle benefits:                                                  - Childhood diabetes
                                                                          - Childhood epilepsy                                      Varicose vein procedures
      Female contraception and vasectomies                                - Haemophilia
                                                                          - Heart rhythm disorders in children                                                                                         Bunion procedures
      Mammograms                                                          - Juvenile rheumatoid arthritis
      Screening benefit covering cholesterol                                                                                         Diabetes managed care
                                                                          Unlimited cover for childhood cancers, leukaemia and
      Health Risk Assessments                                             tumors                                                    programme
                                                                                                                                                                                                       Customised mental health
      Conservative Back and Neck Rehabilita-                              Only pay for up to three children, the rest are covered                                                                      support programmes
      tion Programme                                                      for free                                                  Conservative Back and
      Customised mental health support                                                                                              Neck Rehabilitation
      programmes
                                                                                                                                                                                                       Acne benefit up to age 21
      Unlimited nominated network GP                                             PLUS                                               Oncology benefits
      consults from Risk after day-to-day
      claims have reached the Threshold level.                                   Flu vaccine                                                                                                           PLUS
      Child rates up to 27 for financially                                                                                           Unlimited specialised
                                                                                 Fedhealth Family Room                                                                                                 Flu vaccine
      dependent children.                                                                                                           radiology (co-pays apply)
      Upgrades within 30 days of a                                               Weight management programme                                                                                           Fedhealth Family Room
      life-changing event, such as pregnancy
      or the diagnosis of a dread disease.                                       Fedhealth Nurse Line for medical advice
                                                                                                                                    Upgrades within 30 days of                                         Weight management programme
                                                                                                                                    a life-changing event,                                             Smoking cessation programme
      Optometry benefit                                                           MediTaxi post-hospitalisation transport            such as pregnancy or the diagnosis
      Basic dentistry benefit                                                                                                                                                                           Fedhealth Nurse Line for medical advice
                                                                                                                                    of a dread disease.
                                                                                 Predictive modelling of claims to identify and                                                                        MediTaxi post-hospitalisation transport
      Terminal care benefit
                                                                                 intervene early to manage emerging health risks
      Oncology benefits                                                                                                                                                                                 Predictive modelling of claims to identify and
                                                                                                                                    Post-hospitalisation benefit                                        intervene early to manage emerging health risks

                                                                                                                                    Threshold benefit

                                                                                                                                                                                                                                                          GO BACK
Overview of the                                                                                                  BENEFIT STRUCTURE

flexiFED structure

Our flexiFED 1, 2, 3 and 4 options free members from one-size-fits-all
plans by giving them more control over how they structure their own
cover, and how much they pay.

Members start by choosing one of four options, flexiFED 1, 2, 3 or 4,
to provide them with in-hospital benefits, chronic benefits, screening
benefits, day-to-day benefits and additional benefits.

The next step is having the option to pay lower
contributions by choosing between two discounts.

Next, the member also enjoys the advantage of the MediVault - an
amount available for their day-to-day medical expenses. They can
either choose a FLEXIBLE or FIXED repayment structure for the
MediVault - depending on whether they prefer flexibility and afforda-     On flexiFED, members enjoy the following benefits:
bility of only paying for what they use, OR the predictability of a set
amount allocated at the beginning of the year.                            • In-hospital benefit –Members have no overall annual limit for hospitalisation.

Last but not least, after the member’s day-to-day claims have             • Chronic disease benefit – This benefit covers chronic conditions on the CDL. It’s covered in full up to the Medicine Price
                                                                            List if members use medicine on the formulary and obtain it from either one of our Preferred Providers or designated ser-
accumulated to the Threshold level, members on flexiFED 1, 2 and 3          vice providers depending on the option. Additional conditions are covered on flexiFED 3 and flexiFED 4.
still have certain benefits covered from the Threshold benefit, like
unlimited network GP visits and dentistry benefits. Members on            • Day-to-day benefits – Day-to-day expenses on the flexiFED option range are first funded from any available Savings the
flexiFED 4 have a comprehensive Threshold benefit. Please see the           member might have. Once their Savings is depleted, day-to-day expenses can be paid from the Wallet once the member
                                                                            has activated their MediVault and transferred funds to their Wallet, on a FLEXIBLE repayment structure, or from the funds
following pages for more details on the flexiFED Risk benefits and          allocated to them on 1 January (FIXED repayment structure).
what they offer members.
                                                                           Each of the flexiFED options has a Nominal Savings contribution. This allows members to transfer/retain any accumulated
                                                                           Savings from a previous option/ scheme when joining a flexiFED option. Any member on a flexiFED option can also top
                                                                           up this Savings Account at any time up to a maximum annual amount of 25% of their gross contribution. Any claim sub-
                                                                           mitted which is not payable from Risk will be funded from the member’s Savings Account first.

                                                                          •Threshold benefit
                                                                           On flexiFED 1, 2 and 3, the Threshold benefit pays for limited day-to-day expenses once claims have accumulated to the
  Control, customisation                                                   Threshold level.
                                                                           On flexiFED 4 the Threshold benefit pays for comprehensive day-to-day expenses once claims have accumulated to the
     and choice like                                                       Threshold level.

      never before!                                                       • Day-to-day benefits paid by the Scheme – We pride ourselves on paying more from Risk so the members’ day-to-day
                                                                            benefit lasts longer.

                                                                          • Screening benefit – Preventative screenings and assessments like lifestyle screenings, wellness screenings (includes finger
                                                                            prick glucose and total cholesterol, blood pressure, waist circumference and body mass index (BMI) and physical screenings
                                                                            are covered from this benefit.

                                                                          • Savings – The funds in the member’s Medical Savings Account (MSA) will be used first when he or she has day-to-day
                                                                            medical expenses.

                                                                                                                                                                                              GO BACK
Unlimited private
   hospital cover
   for peace of mind

                                                                                                                                                                                                                        We pay for unlimited
                                                                                                                                                                                                                        private hospitalisation!
All Fedhealth options have an unlimited in-hospital benefit. Mem-        By law, all medical schemes are required to cover the treatment of     If referral is not obtained, there will be a co-payment on specialist
bers must obtain pre-authorisation for all planned hospital admis-       270 hospital-based conditions and 27 chronic conditions, i.e. the      claims paid from the Risk benefit. The co-payment depends on
sions and in the case of an emergency admission, they must obtain        Chronic                                                                your option.
authorisation within two working days after going to hospital.           Disease List (CDL), in full without co-payment or deductibles, as
                                                                         well as any emergency treatment and certain out-of-hospital treat-     Please note: Qualification for reimbursement as a PMB is not
On certain options, members must use a hospital on the Fedhealth         ment.                                                                  based solely on the diagnosis (condition), but also on the treat-
Hospital Network. If they use any other hospital, they will have to                                                                             ment provided (level of care). This means that although a mem-
pay a co-payment on the hospital account.                                This means that all schemes must provide PMB level of care at cost     ber’s condition may be a PMB condition, the Scheme would only
                                                                         for these conditions. The Medical Schemes Act 131 of 1998 allows       be obliged to fund it in full if the treatment provided was deemed
The in-hospital benefit covers hospital costs as well as the accounts    schemes to require members to make use of Designated Service           to be PMB level of care.
from doctors, specialists e.g. the anaesthetist and other healthcare     Providers (DSPs) in order for a member to be entitled to funding in
providers like the x-ray department.                                     full. Schemes may also apply formularies – a list of medicines which   Co-payments on certain procedures
                                                                         should be used to treat PMBs, and managed care protocols – based       For some treatments and procedures, members must pay an
This benefit also covers selected procedures performed in day            on evidence-based medicine and cost-effectiveness principles to        amount out of their own pocket. This is called a co-payment.
wards, day clinics and doctor’s rooms. On certain options, members       manage this                                                            Co-payments apply to the hospital account and/or certain proce-
must use day clinics on the Fedhealth Day Clinic Network.                benefit.                                                               dures, depending on the option.

Cover for hospital admissions                                            Fedhealth has appointed network specialists, network GPs, net-         Treatment for emergencies
We cover the hospital account from the                                   work hospitals and DSP pharmacies, Clicks, Dis-Chem and MediRite       To qualify as an emergency, the condition must be unexpected
in-hospital benefit. Specialists and GPs who are on the Fedhealth        as well as Pharmacy Direct, Clicks Direct Medicines and Dis-Chem       and require immediate treatment. This means that if there is no
network are covered in full. Specialists and GPs who are not on the      Direct, courier pharmacies, for the provision of PMBs. If a DSP is     immediate treatment, the condition might result in lasting dam-
Fedhealth network, are covered up to the Fedhealth Rate.                 required on your option, a 40% co-payment will apply if you don’t      age to organs, limbs or other body parts, or even in death. If the
                                                                         use a DSP. Members must use a Fedhealth Network Specialist and a       member is on a network hospital option, treatment of an emer-
Referral by a medical practitioner and                                   nominated network GP in order for the cost to be refunded in full.     gency medical condition may take place at any hospital, but once
pre-authorisation is required for physical therapy (physiotherapists),                                                                          their condition has stabilised and they can be safely transferred
which is covered up to the Fedhealth Rate.                               Should you not use these DSPs for the treatment of a PMB condi-        to a network hospital, the co-payment will apply if they opt not to
                                                                         tion, the Scheme will reimburse treatment at the non-network rate.     be transferred.
How Prescribed Minimum Benefits are covered                              Co-payments are applicable to the voluntary use of non-DSPs. Re-
Prescribed Minimum Benefits or PMBs refer to a basic level of cover      ferral must be obtained from a Fedhealth Network GP for
for a defined set of conditions.                                         consultations with Fedhealth Network Specialists.

                                                                                                                                                                                                                                           GO BACK
We cover certain
Day clinic/ doctor’s room                                                                                                                                                                                      procedures unlimited
                                                                                                                                                                                                             from the hospital benefit
procedures covered from                                                                                                                                                                                        if done in a day ward,
                                                                                                                                                                                                                    day clinic or
the in-hospital benefit                                                                                                                                                                                            doctor’s rooms!

The following procedures will be paid from the             Gynaecology                                 hydrocoele                      repair                            Ophthalmology                            be paid from the in-hospital benefit
in-hospital benefit if done in a day clinic, day ward or   Bartholin cyst - drainage/excision/mar-     Meatotomy for meatal ste-       Gastroscopy/oesophagogas-         Cataract surgery                         if performed in a doctor’s room or
                                                           supialisation                               nosis                           troduodenoscopy                   Foreign body removal                     suitably equipped procedure room,
an outpatient section of a hospital. Some may incur a      Cauterization of warts                      Orchidopexy for undescend-      Haemorrhoidectomy                 Intra ocular injection e.g. Avas-        at up to 100% of the Fedhealth Rate.
procedure co-payment. Overnight admissions will not        Cervical cerclage                           ed testis                       Inguinal hernia repair            tin, including Glaucoma                  Pre-authorisation must be obtained and
be covered except for Prescribed Minimum Benefits.         Colposcopy                                  Urethrocystoscopy for uri-      Lymph node/muscle/skin/bone       Laser Surgery                            should no pre-authorisation take place,
                                                           Fine needle aspiration - cytology           nary incontinence               and breast biopsy                 Posterior and Anterior Vitrec-           reimbursement will be restricted to the
                                                           LETZ of cervix                                                              Proctoscopy and removal of        tomy                                     member’s available day-to-day benefit
These procedures must be pre-authorised. If the            Dilatation and Curettage                    Orthopaedics                    polyps                            Probing & repair of tear ducts           or self-funded by the member. This will
procedure is performed without pre-authorisation,          Endometrial ablation                        Arthrocentesis                  Resection/debridement of mul-     Pterygium (conjunctiva)                  not accumulate to the Threshold Level:
                                                           Hysteroscopy                                Arthrodesis of hand/elbow/      tiple nails (6 plus)              Removal of pterygium
the full amount will be paid from day-to-day               Insertion of IUD (Intra-uterine Device)     foot                            Sigmoidoscopy                     Strabismus repair                        Gastroscopy (no general
benefits or self-funded by the member and will not         Labiaplasty                                 Arthroscopy                     Umbilical hernia repair                                                    anaesthetic will be paid for)
accumulate towards the Threshold level.                                                                Arthrotomy of finger/hand/      Wound debridement (skin/sub-      Oral and Maxillofacial Sur-              Colonoscopy (no general
                                                           Urology                                     elbow/knee/hip/toe              cutaneous tissue)                 gery                                     anaesthetic will be paid for)
                                                           Adults                                      Aspiration/intra-articular                                        Apisectomy                               Flexible sigmoidoscopy
If authorisation is requested after the procedure has      Bilateral total orchidectomy for prostate   injection of joints             ENT Surgery                       Frenectomies                             Indirect laryngoscopy
taken place, a R1 000 penalty will apply which will be     cancer                                      Bunionectomy                    Adenoidectomy                     Gingival Graft                           Removal of impacted wisdom
                                                           Bladder biopsy (cancer and other            Carpal Tunnel release           Antrostomy                        Implantology                             teeth
paid from day-to-day benefits or self-funded by the        conditions)                                 Cast/application removal        Diathermy to nose and pharynx     Orthodontic Attachment                   Intravenous administration of
member, without accumulating to the Threshold level.       Bouginage for urethral stricture            Ganglionectomy                  (under LA)                        Pulpotomy and fillings                   bolus injections for medicines
                                                           Circumcision                                Injection of tendon/ligament/   DPP (Diagnostic Proof Punc-       Wisdom or Impacted Teeth                 that include antimicrobials and
                                                           Cystoscopy & ureteral dilation              trigger points/ganglion cyst    ture)                             removal                                  Immunoglobulins (payment of
Members on the following options flexiFED 1,               DJ stent removal post pyeloplasty           Injection therapeutic carpal    ENT Endoscopy                     Extractions                              immunoglobulins is subject to the
flexiFED2GRID, flexiFED 3GRID and flexiFED 4GRID will      Hydrocelectomy for vaginal hydrocoele       tunnel                          Middle ear procedures (mas-                                                Specialised Medication Benefit)
incur a R2 000 co-payment on the voluntary use of          Inguinal hernia repair                      Insertion or removal of K       toidectomy, tympanoplasty/        Plastic and Reconstructive               Fine needle aspiration biopsy
                                                           Open cystolithotomy for bladder stone       wires or other internal fixa-   stapedectomy)                     Surgery                                  Excision of nailbed
non-network day clinics.                                   Prostate biopsy (cancer and other con-      tives                           Myringotomy (including as-        Repair wound with layers                 Drainage of abscess or cyst
                                                           ditions)                                    Radical nail bed removal        piration and incision) and/or     (scalp/axillae/trunk/limbs               Injection of varicose veins
                                                           Renal calculus removal & stent insertion                                    grommets                          Repair wound lesions (scalp/             Excision of superficial benign
                                                           Scope and pyelogram                         General Surgery                 Nasal bleeds (control)            hands/neck/feet/face)                    tumours
                                                           Second stage urethroplasty post stage 1     Anal dilatation/Anoscopies/     Reduction of nose fracture        Excision of benign lesions               Superficial foreign body removal
                                                           Testicular biopsy for infertility           fissures and fistula repair     Rhinoplasty                       (scalp/neck/hands/feet/trunk/            Nasal plugging for epistaxis
                                                           Urethrocystoscopy for bladder outlet        Breast biopsy/ removal lump     Septoplasty                       limbs)                                   Cauterisation of warts
                                                           obstruction                                 Colonoscopy                     Sinus related surgery (ethmoid-   Excision of malignant lesions (+         Bartholin cyst excision
                                                           Varicocelectomy for varicocele              Drainage of abscesses/hae-      ectomy/sinusotomy and             flap if required)
                                                           Vasectomy                                   matomas/cysts (subcutane-       lavage)
                                                           Vasostomy                                   ous/submucosal)                 Tonsillectomy                     Procedures performed in a
                                                           Paediatrics                                 Excision lipoma/cysts/tu-       Turbinectomy                      doctor’s room or suitably
                                                           Circumcision for intact prepuce             mours                           Tympanoplasty                     equipped procedure room
                                                           Glandulo-cavernous shunt for priapism       Excision of sweat glands                                          The following procedures will
                                                           Hydrocelectomy for congenital               (axilla/inguinal) and simple
                                                                                                                                                                                                                                           GO BACK
flexiFED in-hospital benefit
      flexiFED in-hospital benefit
                       flexiFED 1             flexiFED 2      flexiFED 3       flexiFED 4                               flexiFED 1       flexiFED 2        flexiFED 3   flexiFED 4                                flexiFED 1             flexiFED 2           flexiFED 3      flexiFED 4
Overall annual limit Unlimited at net-       Unlimited at negotiated tariff.                    Alternatives to hospitalisation:                                                         Oncology: oncologist     Unlimited at cost at R300 200 at designated service         R480 400 at
(OAL)                work hospitals only.                                                                                                                                                consultations, visits,   PMB level of care at provider* and paid from Level 1        designated
                     R7 000 co-pay-          On flexiFED 2GRID, flexiFED 3GRID and flex-        Nursing services,       Unlimited at negotiated tariff
                                                                                                                                                                                         treatment and            designated service   treatment protocols.                   service provider*
                     ment on voluntary       iFED 4GRID members must use network                private nurse
                                                                                                                                                                                         materials for            provider* and paid                                          and
                     use of non-network hospitals and network day clinics. There is a           practitioners &                                                                          chemotherapy and         from Level 1                                                paid from
                     hospital.               R12 500 co-payment on use of non-network           nursing agencies                                                                         radiotherapy,            treatment protocols.                                        Level 1 treatment
                     R2 000 co-pay-          hospitals and a R2 000 co-payment on use           Sub-acute facilities,   Unlimited at cost up to PMB level of care                        approved medication,                                                                 protocols.
                     ment on voluntary       of non-network day clinics.                        physical                                                                                 radiology and
                     use of non-network                                                                                                                                                                           A 40% co-payment applies where a DSP is not used
                                                                                                rehabilitation                                                                           pathology
                     day facility.           On flexiFED 2Elect, flexiFED 3Elect and flex-
                     On flexiFED 1Elect,     iFED 4Elect there is a R12 500 excess on           facilities
                     there is a R12 500      all hospital admissions except emergency           Appliances,             Paid from Savings/ Wallet or self-funded.       Paid from        Organ transplant in-     Unlimited at cost at   R300 200 (See HPT)                   R480 400 (See
                     excess on all hos-      admissions.                                        external accesso-       Accumulates at cost to Threshold level          Savings/         cluding immunosup-       PMB level of care                                           HPT)
                     pital admissions                                                           ries and orthotics                                                      Wallet or        pression medication
                     except emergency                                                                                                                                   self-funded.     Corneal graft            No benefit                                                  R35 000 per
                     admissions.                                                                                                                                        Does not                                                                                              beneficiary
Healthcare Professional Tariff in hospital (HPT)                                                                                                                        accumulate       Pathology, radiology     Unlimited at Fedhealth Rate
Fedhealth Network Covered unlimited. Paid in full.                                                                                                                      to threshold.    (general)
GPs and Specialists                                                                                                                                                     Paid from
                                                                                                                                                                                         Physiotherapy            Subject to referral by a medical practitioner, pre-authorisation and treat-
Non-network GPs      Paid up to Fedhealth Rate                                                                                                                          threshold up
                                                                                                                                                                                                                  ment
Non-network          Paid up to Fedhealth Rate                                                                                                                          to                                        protocols
Specialists                                                                                                                                                             R12 500 per
                                                                                                                                                                        family per       Psychiatric services:    Unlimited at cost at   R25 500 (see         R27 000 (see HPT)
Other Healthcare     Paid up to Fedhealth Rate                                                                                                                                           accommodation in         PMB level of care      HPT)
Professionals                                                                                                                                                           year. (R4
                                                                                                                                                                        680 sub-limit    a general ward,
Prescribed Min-      To have the treatment for PMB conditions covered in full, you will                                                                                                  procedures, ECT,
                                                                                                                                                                        per benefi-
imum Benefits        have                                                                                                                                                                materials and
                                                                                                                                                                        ciary for foot   hospital equipment,
(PMB): Treatment     to use Fedhealth Network GPs, Specialists, Hospitals and DSPs
                                                                                                                                                                        orthotics)       consultations and
for PMB conditions where
can be funded in     applicable.                                                                Blood, blood            Unlimited                                                        visits, medicines and
two ways:                                                                                       equivalents and                                                                          injection material
                     Should you choose not to make use of network providers, the                blood products                                                                           Renal dialysis (chron-   Unlimited at cost at   R300 200 up to the Fedhealth         R480 400 up to
                     Scheme                                                                     Immune deficiency       Unlimited (see HPT)                                              ic): consultations,      PMB level of care at   Rate at Designated Service Pro-      the Fedhealth
                     will only refund treatment up to the Fedhealth Rate and you will           related to HIV                                                                           visits, all services,    Designated Service     vider (DSP).                         Rate at Desig-
                     have a co-payment should the healthcare professional charge                                                                                                         materials and            Provider (DSP).                                             nated Service
                                                                                                infection
                     more                                                                                                                                                                medicines associated                                                                 Provider (DSP).
                                                                                                Maternity - Healthcare Professional Tariff in-hospital (HPT)                             with the cost of renal
Hospitalisation      Unlimited at            Unlimited at     Unlimited at     Unlimited at                                                                                                                       A 40% co-payment applies where a DSP is not used
                                                                                                Fedhealth Network       Covered unlimited. Paid in full.                                 dialysis
costs:               negotiated tariff at negotiated          negotiated       negotiated
accommodation        network                 tariff           tariff. Private tariff. Private   GPs and Specialists                                                                      Childhood illness        No benefit             Childhood illness specialised drug benefit for chil-
                                                                                                (e.g. Gynaecolo-                                                                         specialised drug                                dren up to the age of 18
in a general ward,   hospitals only.                          ward             ward
                                                                                                gists & Paediatri-                                                                       benefit (up to the
high care ward and                                            cover for        cover for
                                                                                                cians)                                                                                   age of 18)
intensive care unit,                                          maternity        maternity
theatre fees,                                                 admissions       admissions       Non-network GPs         Paid up to Fedhealth Rate                                        Specialised radiology Unlimited at              Unlimited at Fedhealth Rate. First R2 380 for non-
medicine, material                                                                                                                                                                                             Fedhealth Rate.           PMB MRI/ CT scans for the member’s account
                                                                                                Non-network             Paid up to Fedhealth Rate                                                              First
and hospital                                                                                    Specialists                                                                                                    R3 310 for
apparatus
                                                                                                Other Healthcare        Paid up to Fedhealth Rate                                                              non-PMB MRI/ CT
Additional medical Paid from Savings/ Wallet or self-funded. Accu-             In and                                                                                                                          scans for the
                                                                                                Professionals
services (dietetics, mulates at cost to Threshold level                        out-of-hospi-                                                                                                                   member’s account
occupational                                                                   tal: Paid from   Dentistry
                                                                                                                                                                                         Spinal surgery           No benefit unless Conservative Back & Neck                  No benefit unless
therapy and speech                                                             Savings/         Maxillo-facial          Unlimited, subject to approval (see HPT)                                                  Rehabilitation Programme has been completed. Mem-           Conservative
therapy)                                                                       Wallet or        surgery                                                                                                           ber pays a co-payment of R8 000 on the hospital bill        Back & Neck
                                                                               self-funded.                                                                                                                                                                                   Rehabilitation
                                                                               Does not         Surgical extraction     You pay a co-payment of R4 600 on the hospital bill
                                                                                                of impacted wis-                                                                                                                                                              Programme has
                                                                               accumulate                                                                                                                                                                                     been completed.
                                                                               to Threshold.    dom teeth
                                                                                                                                                                                                                                                                              Member pays a
                                                                               Paid from        In-hospital den-        No benefit       We cover the hospital and anaesthetist                                                                                               co-payment of
                                                                               Threshold up     tistry benefit for                       costs from the in-hospital benefit. The                                                                                              R6 000 on the
                                                                               to R12 500                                                                                                                                                                                     hospital bill
                                                                                                children under 7                         dentist account will be paid from Savings/
                                                                               per family per                                            Wallet or self-funded                           Terminal care benefit    R33 300 at Fedhealth Rate
                                                                               year
                                                                                                                                                                                                                                                                               GO BACK
flexiFED co-payments & prosthesis benefit
     flexiFED in-hospital benefit
Co-payments                                                                                                                                                                                                                          Prosthesis benefit
Co-payments may apply on certain in-hospital procedures, which will be for the member’s account.                                                                                                                                     Under this benefit, we cover internal prosthesis like pacemakers and spinal plates.

                             flexiFED 1             flexiFED 2          flexiFED 3               flexiFED 4                                                     flexiFED 1         flexiFED 2       flexiFED 3       flexiFED 4                               flexiFED 1      flexiFED 2 flexiFED 3           flexiFED 4
 Co-payments per event applicable on the hospital/ facility bill only                                                     Laparoscopic hernia repairs           R6 800                                               R4 600          External                 Unlimited at    R11 780 at   R12 500 at cost
                                                                                                                          (bilateral inguinal, repeated in-                                                                                                   cost at PMB     cost
 Adenoidectomy,        R6 800                                           No co-payment
                                                                                                                          guinal hernias & Nissen/ Toupet                                                                                                     level of care
 bunion procedures,
 diagnostic                                                                                                               hernia repairs only), laparo-                                                                              Internal
 cystoscopy,                                                                                                              scopic procedures                                                                                          Aorta Stent Grafts     Unlimited at cost at PMB       R63 100
 gastritis/ dyspepsia/                                                                                                                                                                                                               Bone lengthening       level of care                  See combined benefit limit for
                                                                                                                          Laparoscopic varicocelectomy          R6 800                                               No co-payment
 heartburn, nasal                                                                                                                                                                                                                    devices, carotid                                      all
 procedures, skin                                                                                                         Rhizotomies and facet pain            No benefit                                           R4 600          stents, embolic                                       unlisted internal prosthesis*
 biopsy/ excision                                                                                                         blocks (limited to 1 of either                                                                             protection devices,
                                                                                                                          procedure per beneficiary                                                                                  other
 All open hernia             R6 800                 R4 600                                       No co-payment
                                                                                                                          per year)                                                                                                  approved spinal
 surgery
                                                                                                                                                                                                                                     implantable
 Arthroscopic                R8 500                                                              R2 600                   Spinal surgery**                      R8 000                                               R6 000
                                                                                                                                                                                                                                     devices and in-
 procedures - knee,                                                                                                       Surgical extraction of                R4 600                                                               tervertebral discs,
 shoulder, ankle and                                                                                                      impacted wisdom teeth                                                                                      peripheral arterial
 other                                                                                                                                                                                                                               stent grafts, spinal
                                                                                                                          Varicose vein procedures              R6 800                              R4 600           No
 Arthroscopic                No benefit             R8 500                                       R2 600                                                                                                                              plates and
                                                                                                                                                                                                                     co-payment
 procedures: hip                                                                                                                                                                                                                     screws
                                                                                                                          Tonsillectomy                                                                                              Cardiac pacemakers,                                   Unlimited at       R29 900
 Arthroscopic                Unlimited at cost R8 500                                            R2 600
 procedures: wrist           at PMB level of                                                                              Under the age of 12                   No co-payment                                                        cardiac stents, cardi-                                cost at PMB
                             care                                                                                                                                                                                                    ac valves                                             level of care
                                                                                                                          12 and over                           R6 800                              No co-payment                    Detachable platinum                                   R54 600
 Back & neck                 R6 800                                     R4 500                   R2 500                                                                                                                              coils
                                                                                                                        ** No benefit unless Conservative Back & Neck Rehabilitation Programme has been completed.
 procedures
                                                                                                                                                                                                                                     Elbow, hip, knee and                                  See combined       R29 900
 Cataract surgery            Unlimited at cost at PMB level of care                                                                                                                                                                  shoulder replace-                                     benefit limit
 with CP**                                                                                                                                                                                                                           ment                                                  for all unlisted
 Colonoscopy, upper          R6 800                 R4 600                                       R2 600                                                                                                                                                                                    internal pros-
 GI endoscopy                                                                                                                                                                                                                                                                              thesis*
                                                                                                                                                                                                                                     Total ankle replace-     No benefit                                      See com-
 Dental admissions           No benefit             R6 800              No co-payment
                                                                                                                                                                                                                                     ment                                                                     bined benefit
 Hysterectomy                R4 000                                                              No co-payment                                                                                                                                                                                                limit for all
 (unless for cancer)                                                                                                                                                                                                                                                                                          unlisted inter-
 Inguinal hernia             R6 800                 R4 600                                       No co-payment                                                                                                                                                                                                nal prosthe-
 sugery                                                                                                                                                                                                                                                                                                       sis*
                                                                                                                                                                                                                                     Intraocular lenses       Unlimited at cost at PMB     R3 400
 Joint replacements
                                                                                                                                                                                                                                     (per lens)               level of care
 Single hip and knee         Unlimited at cost at PMB level of          No co-payment                                                                                                                                                * Combined benefit                                    R26 900
 replacements with           care                                                                                                                                                                                                    limit for all unlisted
 CP*                                                                                                                                                                                                                                 internal prosthesis
 Single hip and knee         Unlimited at cost at PMB level of          R28 400
 replacements-               care
 voluntary non-use
 of CP*
 Other joint                 Unlimited at cost at PMB level of          R6 800                   R4 600
 replacements and            care
 involuntary non-use
 of CP* for single
 hip and knee
 replacements
* Contracted Provider: Must use ICPS Hip and Knee network or JointCare for single non-PMB hip and knee joint replacements.
   Non-use of Contracted Provider (CP) will result in co-payment.
** Contracted Provider: Must use ICPS Cataract network for cataract surgery. Non-use of Contracted Provider (CP) will result in
   co-payment of R6 000.

                                                                                                                                                                                                                                                                                                              GO BACK
Examining our             Oncology Disease Management
                          Fedhealth supports cancer patients in their time of need, and
                          diagnosed members are encouraged to register on the Fed-
                                                                                             provided a valid authorisation has been obtained. The treating
                                                                                             doctor must submit a treatment plan to Oncology Disease Manage-
                                                                                             ment, cancerinfo@fedhealth.co.za. Once treatment has been au-
                                                                                                                                                                      Specialised radiology
                                                                                                                                                                      Specialised radiology (e.g. CT scans, MRIs, angiography, radioiso-
                                                                                                                                                                      topes) requires a separate pre-authorisation. These pre-authorisa-

cancer cover              health Oncology Programme by calling 0860 100 572. The
                          Scheme offers all members the opportunity to change to a
                          higher option within 30 days of a life-changing event or diag-
                                                                                             thorised, the member and doctor will receive an authorisation letter.
                                                                                             Treatment for conditions not directly related to the treatment of
                                                                                             the cancer (e.g. depression) as well as treatment for the long-term
                                                                                                                                                                      tions must be obtained from the Authorisation Centre. Specialised
                                                                                                                                                                      radiology is paid from Risk. A co-payment for non-PMB MRI/CT
                                                                                                                                                                      scans will apply on all options.
                          nosis. This ensures that those with cancer can get access to       conditions that may develop as the result of chemotherapy or radi-
                          medication that will help them to remain economically active,      otherapy, will be funded from an alternative benefit (i.e. the Chronic   PET scans
                          with all the support they need to deal with this stressful diag-   Disease Benefit or the Savings Account/ Wallet).                         PET scans are limited to two per family per annum restricted to
                          nosis.                                                                                                                                      staging of malignant tumours. PET scans are paid from the oncolo-
                                                                                             On flexiFED 1, flexiFED2GRID and all Elect options: Chemotherapy,        gy benefit. flexiFED 1 does not have a PET scan benefit.
                          We require a clinical summary of each member’s case: this          as well as medicine and consumables directly associated with the
                          must include the history, ICD–10 codes, the clinical findings of   treatment of cancer, should be obtained from the Oncology Phar-          Surgery and hospitalisation
                          the doctor, as well as the test results confirming the cancer      macy Network and in accordance to the oncology Preferred Prod-           Claims for surgery and hospitalisation will be paid from the in-hospi-
                          and the specific type of cancer. The proposed treatment plan       uct List (PPL) – non-use of these will result in a 25% co-payment.       tal benefit, provided that the member obtains a valid authorisation
                          must be submitted so that the oncology team can approve the                                                                                 from the Authorisation Centre.
                          appropriate therapy. Our                                           Radiotherapy
                          caring agents will guide the member through the process.           Radiotherapy will be paid from the oncology benefit, provided a          Stoma therapy
                                                                                             valid authorisation has been                                             Stoma therapy will be paid from Risk. Pre-authorisation is not re-
                          Members can access the oncology benefit by obtaining               obtained. The treating doctor must submit a treatment plan to On-        quired.
                          pre-authorisation from the Oncology Disease Management             cology Disease Management. Once treatment has been authorised,
                          team. The team comprises highly skilled healthcare profession-     the member and doctor will be sent an authorisation letter.              Terminal care and private nursing
                          als who work in conjunction with the treating doctor to ensure                                                                              Accommodation in a hospice or terminal care facility for the care of
                          that treatment provided is both clinically appropriate and         Specialised medication                                                   patients in terminal stage of life will be covered from the Terminal
                          cost-effective. A set of cancer guidelines and protocols are       Specialised medication is medication that is focused on a defined        Care Benefit covered up to R33 300 per family per year. Pre-au-
                          used during the pre-authorisation process. These guidelines        group of patients, diseases, skills, or philosophy e.g. biologicals –    thorisation must be obtained from the Hospital Authorisation Cen-
                          are continually updated as new products are launched and           oncology and non-oncology. Specialised medication is covered on          tre. Private nursing will be paid from the Alternatives to Hospitalisa-
                          new treatment protocols are established. In addition, our team     our maxiFED options only.                                                tion benefit, where this is available.
                          is supported by a number of oncologists and haematologists
                          from the private, public and academic sectors.                     Consultations and visits                                                 Post-active treatment
                                                                                             Oncologist consultations and hospital visits are paid from the oncol-    Post-active refers to the time when the member actually had last
                          On flexiFED 1, oncology is covered unlimited at PMB level of       ogy benefit while the member has either an active chemotherapy or        active treatment (e.g., hormone therapy, chemotherapy or radio-
                          care at the designated service provider, ICON, subject to Level    radiotherapy authorisation. Hospital visits are pre-authorised at the    therapy). “For life” means that the member will remain on the oncol-
                          1 treatment protocols. A 40% co-payment applies where a DSP        same time as the authorisation for chemotherapy or radiation treat-      ogy programme as long as the cancer is in remission. Whilst in re-
                          is not used.                                                       ment. You will receive an authorisation letter detailing the number      mission, a list of appropriate consultation, radiology and pathology
                                                                                             of visits authorised and the period for which these visits are author-   codes has been defined and claims for these services are automat-
                          On flexiFED 2 and flexiFED 3, oncology is covered up to R300       ised.                                                                    ically paid for life from the oncology benefit. Should the condition
                          200 per family per year at the designated service provider,                                                                                 regress, the active treatment benefit will be reinstated upon
                          ICON, subject to Level 1 treatment protocols. A 40% co-pay-        Pathology                                                                submission of a new treatment plan.
                          ment applies where a DSP is not used.                              Oncology-related pathology claims are paid from the oncology
                                                                                             benefit while the member is receiving treatment (either chemother-
                          On flexiFED 4, oncology is covered up to                           apy or radiotherapy), provided that the member has a valid author-
                          R480 400 per family per year at the designated service pro-        isation. A list of appropriate pathology codes has been defined and
                          vider, ICON, subject to Level 1 treatment protocols. A 40%         claims for these services are automatically paid from the oncology
                          co-payment applies where a DSP is not used.                        benefit (a separate pre-authorisation is therefore not required).
 At Fedhealth you can     Independent Clinical Oncology Network (ICON)                       Radiology
 upgrade your option      ICON provides Fedhealth’s active oncology treatment. ICON
                          is a network of oncologists that includes 75% of all practicing
                                                                                             General radiology
                                                                                             General oncology-related radiology claims are paid from the oncol-
any time of the year on   oncologists in South Africa. To find an ICON network special-
                          ist, you can call 0860 002 153.
                                                                                             ogy benefit while the member is receiving treatment (either chemo-
                                                                                             therapy or radiotherapy), provided that the member has a valid
 diagnosis of cancer.     Chemotherapy and associated medicine
                                                                                             authorisation. A list of appropriate radiology codes has been de-
                                                                                             fined and claims for these services are automatically paid from the
                          Chemotherapy and medicine directly associated with the             oncology benefit (i.e. a separate pre-authorisation is not required).
                          treatment of cancer will be paid from the oncology benefit,

                                                                                                                                                                                                                                      GO BACK
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