Managed Care Programmes
We offer the following comprehensive Managed Care Programmes for members with specific healthcare needs:
Aid for AIDS (AfA)
HIV, although serious, is a manageable chronic disease just like any other chronic condition. There have been major advances in the understanding of the disease as well as developments in its treatment and management. An HIV positive diagnosis is no longer a death sentence.
Fedhealth’s Aid for AIDS programme helps members who are HIV-positive manage the condition.
The benefits of AfA (over and above the payment of the necessary medicine and pathology claims), include clinical and emotional support on how to manage the condition. Members are routinely called by counsellors to check how they are doing, and receive reminders when they are due for blood tests.
Fedhealth provides cover for an HIV test (which includes pre- and post-test counselling) on all its options, and we encourage employers to ensure that their staff is tested and know their status so that they can get the appropriate assistance early.
Research has shown that patients who take their medicine correctly improve their body’s defence mechanism and will have reduced incidence of opportunistic infections (infections due to a weakened immune system).
Contact us: Call the HIV Disease Manager on 0860 100 646 or email firstname.lastname@example.org for a confidential conversation.
Oncology Disease Management
Our Oncology Disease Management Programme is specifically designed to support you as a member if you’ve been diagnosed with cancer.
Our Oncology Disease Management team are a group of highly skilled healthcare professionals who work in conjunction with your doctor to ensure that the treatment you receive is both clinically appropriate and cost-effective. Our team is also supported by a number of oncologists and haematologists from the private, public and academic sectors.
What does the programme include?
Our Oncology Disease Management Programme gives you the following benefits:
- Access to the Independent Clinical Oncology Network (ICON): We’ve contracted with ICON, an organisation that includes 75% of all practicing oncologists in South Africa in order to provide your oncology treatment. For more details of the ICON Network, visit www.cancernet.co.za or call your Oncology Case Manager on 0860 100 572.
- Coverage for chemotherapy, radiotherapy & associated medicine: We’ll pay for chemotherapy and medicine directly associated with the treatment of cancer, provided a valid authorisation has been obtained. Treatment for conditions not directly related to the treatment of the cancer (e.g. depression) as well as treatment for the long-term conditions that may develop as the result of chemotherapy or radiotherapy will be funded from an alternative benefit (e.g. the Chronic Disease Benefit, the Savings Account or OHEB, if you r option has an OHEB).
- Consultations & visits: These will be covered while you have either an active chemotherapy or radiotherapy authorisation. Prior to starting treatment and once treatment has been concluded, consultations are paid from the Savings Account or OHEB, if your option has an OHEB.
- Pathology: We’ll cover oncology-related pathology claims while you’re receiving either chemotherapy or radiotherapy and for 12 months post treatment.
- Radiology: We’ll cover general oncology-related radiology claims while you’re receiving either chemotherapy or radiotherapy treatment, and for 12 months post treatment.
- Specialised radiology (e.g. CT scans, MRIs, angiography, radio-isotopes): These procedures require a separate pre-authorisation, and will be paid from the Major Medical Benefit.
- PET scans: You can have up to two PET scans per family per year, restricted to staging of malignant tumours.
- Surgery & hospitalisation: These claims will be paid from the Major Medical Benefit, subject to you obtaining a valid authorisation from the Authorisation Centre.
- Stoma therapy: This will be paid from the OHEB first (if your option has an OHEB) and once depleted, from the Major Medical Benefit. Pre-authorisation is not required.
- Terminal care & private nursing: As part of our Oncology Benefit, the Terminal Care Benefit will cover accommodation in a hospice or terminal care facility for the care of patients in terminal stages of life (subject to a limit). You’ll need to get pre-authorisation from the Hospital Authorisation Centre. Private nursing will be paid from the Alternatives to Hospitalisation benefit, where this is available.
How to access this benefit
If you’re a Fedhealth member and want to access the oncology benefit, you’ll need to get pre-authorisation. This process uses a set of cancer guidelines and protocols that are continually updated as new products are launched and new treatment protocols are established.
Need More Information?
Want to know more? Read more about Fedhealth’s oncology benefit here
Mental Health Programme
Mental health can be seen as the centre of all health, characterised by integral relationships with a person’s physical, social, workplace and financial wellbeing.
Mental illness has direct consequences on behaviour, quality of life and productivity. The presence of mental illness increases the risk of disability and premature mortality from other diseases such as cardiovascular disease, diabetes and HIV/AIDS. While patient activation and empowerment is becoming an important focus area in the management of other chronic diseases, this may be a particularly difficult achievement in the patient with a mental disorder.
Fedhealth’s Mental Health Programme uses innovative solutions for member empowerment, and relies on social, family and workplace support.
- Greater reduction in mental health symptoms
- Greater rates of care for mental health
- Improvement in quality of life
- Less functional impairment
- Better patient satisfaction
- Better provider satisfaction
- Lower total health care costs in the medium and long term
Adherence to and active participation in treatment is required from patients to achieve desired clinical outcomes. Patient activation and support for self-care are other key components of the model. This is achieved through education of patients and their families, behavioural activation via Care Managers, integration with workplace wellness initiatives, and accessing community support groups.
Contact us: The share call number is 0860 002 153 – follow the prompts to the Disease Management Programme and select the Mental Health Programme, or send an email to email@example.com for more information and to see whether you qualify.
Conservative Back and Neck Rehabilitation Programme
Back pain is a common cause of morbidity and incapacity, and has a significant social and economic impact. It’s second only to headaches when it comes to painful disorders that affect humans.
Studies conducted at the Escola Paulista de Medicin in Brazil have shown that occupational lower back pain is the largest single health problem related to work and absenteeism, and the most common cause of incapacity among people younger than 45. Occupational back pain affects the economically active segment of the population and is related to work incapacity. It causes suffering to patients, and has implications in terms of quality of life, productivity loss and escalating medical expenses.
Fedhealth has an established programme intervention for qualifying members suffering from back and neck problems. It’s built on the principle of active muscle reconditioning, supported by scientific clinical studies showing that exercise reduces pain and can normalise function in many instances.
The programme requires 30 hours of treatment and tangible benefits for the member include an increased quality of life, and the assurance that their employer, through Fedhealth, is providing them with the care that they specifically require.
The share call number is 0860 002 153 – follow the prompts to the Disease Management Programme and select the Conservative Back and Neck Rehabilitation Programme, or send an email to firstname.lastname@example.org for more information and to see whether you qualify for participation in this programme.