How is payment for treatment after hospital visits covered?

Who pays for the medicine members get to take home after being in hospital?

The scheme covers up to seven days of medicine that a doctor prescribes for members in hospital to take home with them (take-out medicine).
To get cover from the Major Medical Benefit, the medicine must both be dispensed by the hospital and be shown on the original hospital account. If members are given prescriptions for take-out medicine and take these prescriptions to a pharmacy, the claim will be paid from the day-to-day benefit (Savings and Out-of-Hospital Expenses Benefit) and not from the Major Medical Benefit.

How does the Post-hospitalisation Benefit work?

To protect the member’s Day-to-Day Benefit, the scheme covers certain treatments up to 30 days after discharge from hospital from the Major Medical Benefit. The day that a member is discharged counts as the first day of the 30 days of cover.
This benefit covers treatment at 100% of the Fedhealth Rate. It pays for:

  • Complications that might arise from hospitalisation
  • Physiotherapy, occupational therapy, speech therapy, ultrasounds, general radiology and pathology tests.

What special conditions apply to the 30-day post-hospitalisation benefit?

  • Only treatment as a result of a hospital event will be covered. The treatment must be related to the original diagnosis.
  • The member must get an authorisation number for this benefit in addition to the authorisation number for the hospital admission. If your employee does not get a separate authorisation number from us, the claim will be paid from the Day-to-Day Benefits and not from the Major Medical Benefit.