Why using network providers is worth your while

Ever wondered why medical schemes encourage you to use their network partners, and why you cannot visit any GP, specialist, pharmacy or hospital without incurring extra costs?

 

Here we explain the benefits of using the Fedhealth networks, how to find contracted practitioners and facilities, and the implications should you as a member choose to use non-network providers.

 

Network Pharmacies

It’s your choice to use whichever pharmacy you prefer, but Fedhealth has gone to great lengths to negotiate dispensing fees with our participating pharmacies. Pharmacies may charge up to 26% for dispensing fees, while our negotiated fees are substantially lower to save you money. Using our pharmacy partners ensures no co-payments on dispensing fees, so you save each time you hand in a prescription!

 

With 1 700 pharmacies currently belonging to our network (including all major retailers like Dis-Chem and Clicks Pharmacy and over 1 000 independent pharmacies), 89% of all Fedhealth members have access to a Network Pharmacy within a 10km radius of where they live.

 

To locate a participating pharmacy, use the Pharmacy Locator at www.fedhealth.co.za, by   selecting “Member Tools” on the home page and then clicking on the “Find a GP, Specialist or Pharmacy” button.

 

GP Network

How do unlimited GP visits paid from Risk (and not your Savings) on selected options grab you? We thought you might like it! Fact is, when you use a Network GP on our comprehensive plans Maxima Plus, Maxima Exec, Maxima Standard, Maxima StandardNet and Maxima Basis, the full cost of the consultation is paid from OHEB and never from your Savings, with full accumulation at the negotiated rate to your threshold level.

 

Once the OHEB is depleted, GP consultations will be paid in full from Risk (by the Scheme), and the benefit then also becomes UNLIMITED! You may therefore see your doctor as often as you like and never have to pay for a doctor’s consult from your own pocket again – provided you use a network doctor.

 

On both Maxima Saver and Maxima EntrySaver, consultations at a Fedhealth Network GP will be covered from your Savings. Once your Savings has been depleted, Fedhealth will cover unlimited GP visits at a nominated Fedhealth Network GP.

 

It’s totally up to you to use whichever doctor you prefer. But should you choose to use non-network GPs, the full consultation fee will be refunded from your Savings and OHEB and will accumulate to your threshold level at 100% of the Fedhealth Rate. Once your day-to-day

benefits (Savings and OHEB) are depleted and you are in your Self Payment Gap, you will have to pay for GP consultations from your own pocket. Upon reaching your threshold level, consultations with non-network GPs will be refunded up to 100% of the Fedhealth Rate, leaving you with a possible co-payment.

 

Thanks to over 4 700 doctors currently belonging to the network, 96% of all Fedhealth members have access to a Network GP within a 10km radius of their home.

 

To locate a network GP, use the Locator at www.fedhealth.co.za, by selecting “Member Tools” on the home page and then clicking on the “Find a GP, Specialist or Pharmacy” button.

 

Network Specialists

Over 3 700 specialists from all disciplines signed up to the Fedhealth network mean that our members are guaranteed easy access to a specialist in their area. Using our Specialist Partners ensures no co-payments in hospital and a fixed rate for out-of-hospital consultations, to name a few. Remember that choosing one GP as your coordinator of care, under our 360Degree Care, means benefitting from a doctor who knows your full medical history and can therefore recommend the right specialist as you need them.

 

In-hospital

Network specialists: It pays to only use specialists on the network for your in-hospital treatment for a simple reason: the specialist account is refunded in full without any shortfalls payable by yourself, so you save money when you need it most.

 

Non-network specialists: Using a non-network specialist will result in the Scheme reimbursing only up to the Fedhealth Rate, and you then having to pay any shortfalls from your own pocket. This could end up being a very costly experience.

 

Out-of-hospital

Network specialists: The Scheme has negotiated fixed tariffs with all our network specialists. This means that your account will be paid in full from your day-to-day benefits (Savings and OHEB) and will also accumulate in full to your threshold level. Once you’re in threshold, consultations with network specialists will still be covered in full from your Threshold Benefit. This part of the benefit deserves a proper mention, as we all know that good specialist care doesn’t come cheap.

 

Non-network specialists: Should you decide to use a non-network specialist for your out-of-hospital consultations, the account will be refunded from your day-to-day benefits (Savings and OHEB) up to cost and accumulate to and be refunded from the Threshold Benefit at 100% of the Fedhealth Rate only. As we have no control over the specialist’s fees, you’re opening yourself up to unnecessary additional costs.

 

Locating a contracted Fedhealth specialist is easy. Log in to the Fedhealth website at www.fedhealth.co.za, and click on the Locator button at the top left of the page. “Find a Healthcare Professional” will allow you to search for a specialist based on location.

 

Hospital Network

To complete our circle of care, we have excellent hospitals on our network. Should you be a Maxima EntryZone, Maxima EntrySaver or Maxima StandardNet member, using our Hospital Partners ensures you a lower monthly contribution, but is also compulsory.

 

Voluntary use of non-network hospitals will automatically result in a R5 000 co-payment for your hospital stay, over and above any part of the bill that may not be covered. Please refer to your option-specific brochure for a full list of participating hospitals.

 

The Fedhealth networks were established to keep contribution increases low, while still giving you the best possible care. They also ensure sustainability of the Scheme and to facilitate the support of the contracted practitioners. Using the networks means we all benefit!