What sets us apart as a scheme is that together with our first-rate medical aid options, we offer unique value-added benefits. With some of these tangible benefits we pay more from Risk than other schemes to ensure that your day-to-day medical spending not only goes further, but also works harder for you. Please remember that all benefits paid from Risk must be pre-authorised with the Authorisation Centre.
Benefits unique to us:
- Unlimited FP visits to Network FPs paid from Risk and never from Savings on all comprehensive options
- Child rates for financially dependent children up to 27 years of age – yes, student dependants pay rates applicable to children, provided they’re unmarried and not earning more than the maximum social pension
- Upgrades to higher options any time of the year within 30 days of diagnosis of a dread disease or life changing event – which means you’re never locked into an option should something dramatic happen that changes your circumstances.
*New premiums will apply
Where we pay more from Risk than other schemes:
- Post-hospitalisation treatment for up to 30 days after discharge from hospital (physiotherapy, pathology, etc) – that means follow-up treatment for a full 30 period paid directly from Risk not to deplete your day-to-day benefit. Requires pre-authorisation 48 hours before treatment
- 7 days of paid for take-home medication after discharge from hospital – provided the medication is dispensed by the hospital and reflects on the original hospital account
- Specialised radiology like MRI and CT scans – paid from Risk and never from Savings, whether performed in or out-of-hospital. Other schemes will only offer a limited combined benefit for specialised radiology performed either in or out-of-hospital. Requires pre-authorisation 48 hours before the procedure. ** This benefit does not apply to the Blue Door Plus option
- Trauma treatment at a casualty ward – whether admitted to hospital or not, emergency treatment, like stitches, is always paid from Risk and never from your Savings (meaning we don’t deplete your day-to-day benefits). Other schemes cover these costs directly from the member’s day-to-day benefit, or will only provide cover from Risk should the member be admitted to hospital immediately after treatment in the emergency ward is received. Please call the Authorisation Centre within 48 hours of treatment
- Cover for monthly prescriptions for female contraception – including oral, patches, contraceptive rings, certain injectables as well as IUDs that include Mirena®, on all comprehensive options. * Must be prescribed by a FP or gynaecologist and not applicable to pills prescribed for acne.
This benefit only covers oral contraception on our two hospital plans, Maxima Core and Maxima EntryZone as well as Blue Door Plus
How we add REAL value:
- The Fedhealth Baby Programme
- 24-Hour Fedhealth Nurseline
- FREE trauma counselling for practical and emotional support
- Emergency transport/ response through Europ Assistance
- Comprehensive managed care programmes:
Aid for AIDS (AfA) for those living with HIV/AIDS,
AsthmaCare ensures that asthma patients still lead a normal life,
DiabeticCare assists diabetics in managing their blood sugar,
CardioCare to prevent heart attacks in Coronary Heart Disease sufferers, and
Oncology Disease Management thatsupports cancer sufferers with comprehensive care including cover for chemotherapy, radiotherapy, approved medication, related consultations, pathology and general radiology.
And then you also still get:
- Professional and extreme sports cover – injuries sustained during sporting activities are covered within the benefits and rules of the Scheme, provided the treatment is received within the borders of South Africa
- In-hospital dentistry for children under 8 – we cover the hospital and anaesthetist costs from the In-Hospital Benefit while the dentist’s account comes from day-to-day benefits (Savings and OHEB).
* The Authorisation Centre must be contacted at least 48 hours before the procedure. Authorisation will be granted provided no dental authorisation was granted for the same child within at least six months of the required admission date
This benefit does not apply to Maxima EntrySaver and Maxima EntryZone
- Easy membership for former child dependants – meaning no underwriting required for child dependants moving from their parent’s medical aid onto their own with Fedhealth.