How We Run Things

Holding your family in safe hands

Our philosophy

Our Fedhealth family has been growing from strength to strength since 1936, and includes our members, business partners and service provider networks.

Thanks to our proud heritage and thorough understanding of healthcare, we continue to look after South African families with quality, value for money medical aid. Our consistently high Global Credit Rating of AA- (retained for 11 years in a row) and reserves well over the required 25%, ensure that our family is financially sound and rated as one of the top medical aid schemes in South Africa.

Sustainability is at the heart of everything we do, and we are always developing initiatives that benefit our members, partners and providers – our extended family – alike. Run by members for members, and with complete transparency, our member-elected Board of Trustees operates with one objective only, namely to put the interests of our members first.

Today, our extensive option range and unique benefits, where we pay more from Risk than other schemes to ensure that members’ day-to-day benefits go further, prove that we’re in it with families for the long run.

Join the family that will always lend a helping hand to yours. For life.

360 Care: Let the healing begin (with your FP)

Our 360 Care philosophy is one in which we wholeheartedly believe. In encourages our members to see the same family practitioner every time, who then becomes the coordinator of your care. In this way, the doctor builds a valuable relationship with you, and gets to know your health history. So when you need a specialist, your FP can refer you to the appropriate specialist type, avoiding fragmented care, costly duplications of tests and treatments, and even the prescription of conflicting medication.

Coordinated care protects our members and gives you better quality of care, and it also helps ensure the financial sustainability of the Scheme. A referral from your family practitioner is necessary on all options where the specialist consultation is paid from a risk benefit, for example the Out-of-Hospital Expenses Benefit (OHEB) and the Threshold Benefit.

Members on certain options have to nominate a Fedhealth Network family practitioner to enjoy UNLIMITED FP visits paid from Risk (once your Savings or OHEB have run out where applicable). Don’t you agree that access to unlimited FP visits is a very valuable benefit indeed?

FP nomination and referral management through the nominated FP helps your Fedhealth family to ensure that all members get quality care and better value for money!

Joining Fedhealth is about more than receiving quality healthcare, great benefits and sound support. It’s about belonging to a family. For life.

Cover for every stage of your family’s life

We offer an extensive product range featuring two hospital plans, three saver options and four comprehensive options. So whether it’s basic hospital cover through plans like Maxima EntryZone, or high-end options offering generous amounts of day-to-day cover like Maxima Plus for members who don’t want to leave anything to chance, we provide cover for every individual. We even cater for the needs of previously uncovered employees with our low cost, entry-level medical aid product called Blue Door Plus.

There’s nothing we wouldn’t do for our family

We protect Fedhealth family members’ pockets with a range of value-added benefits.

Unique to Fedhealth

  • Unlimited Network doctor’s visits – Members can see their family practitioner (FP) as often as they need on most options, by either visiting any network FP or a nominated network FP (depending on the option)
  • Child rates for financially dependent children up to 27 years of age
  • Upgrades to higher options any time of the year on diagnosis of a dread disease or life-changing event, like a pregnancy

We pay more from Risk than other schemes

  • Post-hospitalisation treatment for up to 30 days after discharge from hospital (e.g. physiotherapy, x-rays, pathology)
  • 7 days of take-home medication
  • Specialised radiology like MRI and CT scans – whether admitted to hospital or not. Co-payment may apply depending on the option
  • Trauma treatment at a casualty ward – whether admitted to hospital or not. Co-payment may apply depending on the option
  • Monthly prescriptions for female contraception, including oral, patches, certain injectables, contraceptive rings as well as IUDs that include Mirena®, on all comprehensive and saver options. On Maxima Core, Maxima EntryZone and Blue Door Plus, oral and injectable contraceptives only are covered from an approved list
  • In-hospital dentistry for children under 7 – The hospital and anaethetist costs are covered from the Major Medical Benefit, while the dentist is covered by the Day-to-day Benefit. Not applicable to Maxima EntrySaver, Maxima Dynamic Saver, Maxima EntryZone and Blue Door Plus

From our family, with love to you

  • The Fedhealth Family Room (personalised online member portal)
  • The Fedhealth Baby Programme
  • 24-Hour Fedhealth Nurse Line
  • 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
  • Oncology Disease Management supports cancer sufferers with comprehensive care including cover for chemotherapy, radiotherapy, approved medication, related consultations, pathology and general radiology.
  • Mental Health Programme provides qualifying members who have mental health or substance-abuse issues with access to the best quality primary mental healthcare.
  • Conservative Back and Neck Rehabilitation Programme helps qualifying members address their back and neck issues to avoid spinal surgery. Over six weeks, members benefit from a multidisciplinary approach including an FP, physio and biokineticist to assess and treat their condition.
  • Smoking Cessation Programme – All members on all options can sign up for the GoSmokeFree service at 200 pharmacies countrywide to help them kick the habit for good. This programme will be paid from Risk.
  • Weight Management Programme is a new 12-week programme designed for qualifying Fedhealth members with a high BMI and waist circumference. Led by a biokineticist, members have access to a dietician and behavioural psycologist with the goal to lose the excess weight and lead healthier, more rewarding lives.

The support you deserve

Administration by Medscheme, a level 2 BBBEE Company and South Africa’s largest managed care services provider and third largest medical scheme administrator, offers:

  • An average claim turn-around time of 5 days
  • An efficient and highly-rated ISO 9001:2008 certified Customer Contact Centre offers 90% one-call query resolution, with an average 8-second waiting time on calls
  • Real-time electronic communication.

Family always keeps in touch

Constant engagement and communication with members by way of:

  • The Fedchat Mobile App – FREE Instant Messenger channel for Apple, Android, Blackberry and Windows Phone users
  • The Fedhealth website – the definitive online portal for everything Fedhealth-related. Fun, functional and informative, the site brings the Fedhealth member experience to life online. It has a section devoted to Living Fedhealthy, where visitors to the site get to experience just what Fedhealth has to offer. Once in the Member Section of the site, members are able to update personal information, obtain hospital pre-authorisation, conduct benefit enquiries, locate Network FPs and Specialists, as well as successfully track their claim submissions and payments due to them. All brochure-ware, option selection forms and related Fedhealth documentation is also available as easy-to-access PDF downloads or e-books.
  • The Fedhealth Family Room – our new personalised online member platform enables members to manage their membership, connect with communities based on their interests and life stages, and earn rewards


Something for our corporate family members

For corporate organisations joining the Scheme we offer various initiatives to meet company-specific demands:

  • Group implementation and training ensures a smooth transition from previous schemes to Fedhealth
  • A dedicated Account Executive (AE) for each organisation with 25 or more staff members – regular visits take place and the AE is always available to solve queries online
  • A dedicated credit controller per organisation
  • Tailor-made solutions with option mapping to cater directly to the organisation’s staff
  • Update – an electronic newsletter aimed directly at HR/Finance departments delivers scheme-related news to employers

Our network family

When it comes to giving our members quality healthcare they can trust, we partner with healthcare professionals with the same passion for healthcare. After all, only the best will do for our family!

Over 1 700 pharmacies nationwide currently belong to the Fedhealth Pharmacy Network (including all major retailers like Dis-Chem, Medi-Rite and Clicks Pharmacy and over 1 000 independent pharmacies). This means that 90% of our principal members have access to a network pharmacy within a 10km radius of where they reside.

We have over 4 600 Family Practitioners currently contracted to the Fedhealth FP Network. As such 97% of our principal members have access to a Network Doctor within a 10km radius of where they live. And more than 81% of claiming beneficiaries on all comprehensive and saver options are already using Network Doctors. On most options, members have access to unlimited FP visits.

We have over 3 600 specialists from all disciplines contracted to the Fedhealth Specialist Network. Using a Fedhealth Network Specialist means no co-payments and truly unlimited benefits at cost for members in-hospital and price certainty out-of-hospital.

We’ve also established partnerships with hospitals across the country. Our Hospital Network ensures that Blue Door Plus, Maxima EntryZone, Maxima EntrySaver, Maxima Basis GRID, Maxima Saver GRID and Maxima Saver GRID members have access to unlimited hospitalisation – provided they make use of network facilities. This partnership provides immense financial peace of mind for members and allows the Scheme to provide comprehensive benefits at affordable rates.