Major benefit changes for 2019

NEW Paed-IQ BabyLine

Fedhealth is proud to bring parents the Paed-IQ BabyLine: a 24-hour children’s health advice line that’s manned by paediatric-trained registered nurses for parents with babies, toddlers and children. These professionals are on the other side of the phone to assist with any parental concerns, or health-related issues, 24/7, 365 days of the year.

 

Not only will this provide great peace of mind to parents, it can also help members’ benefits last longer by possibly limiting doctor’s or ER visits, or, on the other hand, help parents seek immediate and appropriate treatment when a condition is urgent.

 

NEW Childhood Illness Benefit (specialised medication)

Traditionally, only Fedhealth’s more comprehensive options offered specialised medication for children. In line with our drive to attract younger members, Fedhealth will now offer certain specialised medications for children on our more affordable family options flexiFED 2, flexiFED 3 and flexiFED 4.

 

The medications are Palivizumab (Synagis®) for the prevention of serious lower respiratory tract diseases; growth hormone products (Humatrope®, Norditropin Nordilet®, and Genotropin®) for the treatment of short stature in the presence of open epiphyses to stimulate normal growth development; and Botulinum toxin (Botox® and Dysport®) for the treatment of a variety of conditions.

 

Enhancements to the Weight Management Programme

When we launched our Weight Management Programme in 2018, it was met with great enthusiasm from members, brokers and employer groups. This 12-week biokineticist-led programme was intended to help put qualifying members with a high BMI and waist circumference on the road to healthy weight-loss by giving them the support of a dietician and behavioural psychologist.

 

CHANGES FOR 2019: We’ve now bumped up the programme to include two dietician consultations (currently only one) and 12 one-on-one or group biokineticist sessions (currently only three).

 

 

Increased reimbursement of obstetricians

Many South African obstetricians are abandoning the profession because malpractice insurance premiums are simply too high and affect the financial viability of their practices. This trend is concerning, as it could result in South Africa losing precious talent in the near future.

 

To attract and retain obstetricians onto the Fedhealth specialist network, we investigated increasing the rate of payment for both C-sections and normal vaginal deliveries. And although Fedhealth reimbursement rates compared well with other open medical schemes on most options, we did identify the need to increase our reimbursement rates on certain options.

 

CHANGES FOR 2019: On our flexiFED 1 core benefit bundle, we have increased the reimbursement rate for obstetricians from 100% to 165%.

 

Removal of the co-payment on elective C-sections

To curb the year-on-year increase of elective Caesarean sections, Fedhealth introduced co-payments of either R5 600 or R11 000 on these procedures on some of our options.

 

CHANGES FOR 2019: The Scheme has decided to remove co-payments on elective C-sections on all options to bring Fedhealth’s maternity benefit more in line with other open medical schemes.

 

PREVENTATIVE CARE BENEFIT

 

Breast Cancer Screening (Mammography)

In 2019, the Scheme will allow a mammogram once every three years for all members aged 45 and older without any upper age cut-off. The myFED option is still excluded.

 

Colorectal Cancer Screening: Faecal Occult Screening

In 2019, Fedhealth will cover one test every year for all members aged 50 to 75 years per beneficiary on all options. Our myFED option is excluded.

 

Osteoporosis Screening: Bone Mineral Density

In 2019, Fedhealth will cover one per beneficiary every two years for women aged 65 and older, and for men aged 70 and older on Maxima PLUS and Maxima EXEC.

 

Pneumococcal Vaccine

Fedhealth will now cover one per lifetime for all

 

members aged 65 and older on all options, except for myFED.

 

Prostate Specific Antigen (PSA)

From 2019, Fedhealth will cover one per year for male members aged between 45 and 69 on all options.

 

Review of hysterectomy co-payments

Currently, the Scheme charges a co-payment on both laparascopic and open hysterectomies on some of our options. We do however pay in full (co-payment is waived) for open hysterectomies on the diagnosis of cancer, as well as where PMB level of care is met; other reasons for open hysterectomies still attract the applicable co-payments.

 

CHANGES FOR 2019: The Scheme is reducing the co-payment on open hysterectomies to R3 600 on our flexiFED 1, flexiFED 2 and flexiFED 3 core benefit bundles. This is to bring our offering more on par with competitor schemes, and because an open hysterectomy is usually a last resort for the member and not a procedure that’s likely to be over-utilised.

 

Review of laparascopic varicocelectomy co-payments

At present, Fedhealth charges no co-payments on laparascopic varicocelectomies, which means it is not in line with how the Scheme covers other laparascopic procedures.

 

CHANGES FOR 2019: Fedhealth is introducing a R6 200 co-payment on laparascopic varicocelectomies on flexiFED 1, flexiFED 2 and flexiFED 3 core benefit bundles. On myFED, only open varicocelectomies will be allowed (PMB level of care).

 

Changing the Maxima EXEC formulary from restrictive to comprehensive

To better serve our members suffering from chronic conditions on the Maxima EXEC option, we are changing the chronic medicine formulary from restrictive to comprehensive.

 

Removal of OHEB benefit on Maxima EXEC

Savings levels will be proportionally increased.

 

The Scheme is confident that these changes and introductions will assist us in taking even better care of our members in 2019 and beyond!