FedHealth medical scheme is one of the fast growing open medical schemes in South Africa. As from 1 August 2019, the Council for Medical Schemes approved its amalgamation with Topmed leaving FedHealth with some of Topmed’s members.
Gathering from the reviews on Hello Peter, FedHealth has managed to retain Topmed’s former members, providing them with satisfactory cover and honoring their claims. This successful amalgamation has earned FedHealth a good reputation and set the scheme for even more growth in terms of membership subscriptions.
In this review, we look at the 2021 plans offered by FedHealth, takin a closer look on their benefits, contributions and the general procedures of the scheme. FedHealth has three plan categories on offer, that is:
MyFed is FedHealth’s entry level plan that accommodates low income members who have never had a medical plan before. The main objective of this plan is to give you peace of mind that comes with knowing that your major hospital expenses are covered and you only have to cater for your daily medical needs.
Hospital benefits are paid in full when you use the hospital that is listed in the MyFed list of network hospitals. Using network hospitals and getting authorization for hospitalisation is advisable because this will avoid you having to do copayments and you will also allow you to have unlimited overall annual limits.
There is unlimited maternity cover provided at the PMB (Prescribed Minimum Benefits) level, however you can make a R12 500 copayment for elective C-sections maternity benefit.
Network GPs and specialists are fully covered while non network healthcare professionals are covered upto 100% of the FedHealth rate and the cover is limited to R2 400 per beneficiary.
Oncology cover is determined by the PMB level, fully covered at a Designated Service Provider (DSP), and it will be subject to the Level 1 treatment protocols. There is a 40% co-payment payable if you don’t use a DSP.
As obligated by the Medical Schemes Act, MyFed covers all the Prescribed Minimum Benefits (PMB) Chronic Diseases List (CDL) which includes a wide range of close to 300 conditions and 27 chronic conditions.
These conditions and diseases’ medicines are fully covered, provided that you use the DSPs. The FedHealth’s list of DSPs for medicines include Clicks, Dis-Chem, MediRite, Clicks Direct Medicines, Dis-Chem Direct and Pharmacy Direct.
MyFed is primarily meant for covering the basic hospital benefits, the plan doesn’t cater much for your daily medical expenses since you are expected to pay them from your own pocket.
However among other benefits, members get to enjoy unlimited visits at contracted DSP General Practitioners (GPs) and 2 specialist consultations per year, up to R1 900 per family.. The consultation must have been referred by the contracted GP.
As mentioned earlier, the MyFed plan option is designed mainly to accommodate low income earners, hence the contributions are set with much consideration of your income.
|Income per month (R)||member||Adult Dependant||Child Dependant|
|1 – 6 251||R1 128||R985||R543|
|6 252 – 10 219||R1 430||R1 242||R699|
|10 220 – 12 622||R2 005||R1 750||R769|
|12 623 – 14 426||R2 547||R2 100||R996|
|> 14 427+||R3 455||R3 147||R1 317|
To come up with customised plans that are tailor made by members, FedHealth had to modify their flexiFED range of plans. The plans in the flexiFED category allow you to determine the structure of your medical aid cover and even set your monthly contribution.
There are four plans in this category and it also happens that they are the most popular of all the FedHealth plans. There is flexiFED 1, flexiFED 2, flexiFED 3 and flexiFED 4.
flexiFED 1 is an ideal option if you are a young and healthy person who is single or just married without a big family. The plan allows you to use non elected private hospitals, obviously with a slightly higher contribution than when you are using an elected hospital.
flexiFed 1 is also a hospital benefit, it doesn’t really cover any special chronic conditions other than those listed in the Chronic Disease List (CDL) and mandated by the law.
For benefits covered, members are supposed to use the following Designated service provider: Clicks, Dis-Chem, MediRite and the courier pharmacies include: Pharmacy Direct, Clicks Direct Medicines and Dis-Chem Direct
The plan has a separate account named MediVault which works together with a provided wallet. So, your MediVault is credited with funds that you transfer to the wallet as when you need to use them. The amount you spend on your Day-to-Day medical bills is then payable back to the scheme over a period of 12 months without interest charged.
The amount allocated to your MediVault ranges from R9 300 to R15 300 depending on the beneficiary structure in your plan.
The other way is that FedHealth credits your wallet with a predetermined amount every 1st of January and you get to use it from there and pay it back interest free over a period of 12 months.
The fixed amount credited to your wallet also varies depending on the number of dependants listed in your plan. The range starts from R3 600 for the member only to R8 400 when there are more than two beneficiaries.
|member||R1 788||R1 393|
|M + Adult Dependant||R3 189||R2 482|
|M + AD + Child Dependant||R3 842||R2 989|
|M + AD + 2 CDs||R4 495||R3 496|
flexiFed 2 is an ideal option for a young family which is looking forward to growing their healthy family with the peace of mind knowing that hospital and other Day-to-Day benefits are covered.
This is also a hospital plan and therefore only covers the chronic conditions listed by the law just as in flexiFed 1.
Similar to flexiFed 1, the scheme transfers an amount to your MediVault and the funds transferred will be the ones you use for your daily medical bills. The amount allocated for your daily medical expenses is determined by your dependants structure and whether you want to pay it back in fixed sums or flexible.
For fixed repayment structure, your MediVault is credited with R9 900 to R24 600 depending on the number of dependents in the plan.
For a fixed repayment structure, FedHealth transfers R4 800 to R15 000 to your wallet, depending on the number of beneficiaries.
Some of the flexiFed 2 Day-to-Day benefits are:
|member||R2 500||R2 222||R1 871|
|M + Adult Dependant||R4 671||R4 155||R3 502|
|M + AD + Child Dependant||R5 413||R4 815||R4 060|
|M + AD + 2 CDs||R6 155||R5 475||R4 618|
flexiFED 3 is a great plan for young and growing families who have young kids and can use the maternity benefits flexiFED offers. Members enjoy unlimited cover with network GPs and specialists including maternity cover benefits.
On flexiFED 3, members are covered from all 27 chronic diseases as listed on the Chronic Disease List (CDL) plus an additional 3 popular chronic conditions: eczema, acne and allergic rhinitis for children.
flexiFED members can choose to use the DSPs or a service provider of their choice. The flexiFED 3 preferred service providers are Clicks, Dis-Chem, MediRite and the courier pharmacies include Clicks Direct Medicines, Dis-Chem Direct and Pharmacy Direct.
Daily medical bills are also paid using the MediVault and wallet system. When the predetermined Day-to-Day benefits are depleted, flexiFED 3 members still benefit from the threshold benefits which include basic dentistry and unlimited GPs visits.
There are two options of utilising the MediVault and wallet system:
In this structure FedHealth allocates your annual benefit funds to your MediVault. Then, whenever the need arises, you transfer the needed amount to your wallet at that particular time. You’ll then pay back what you use over 12 months, interest-free.
Flexible repayment structure:
|Amount allocated to MediVault|
On this payment option, FedHealth transfers predetermined annual Day-to-Day benefit funds to your wallet. The funds are transferred every 1st of January in the beginning of the year, however, for those joining the plan during the course of the year, funds will still be pro-rated and transferred to your wallet.
Fixed repayment structure
|Amount allocated to MediVault|
So once you have used up your Day-to-Day benefits and reached the threshold level, FedHealth continues to cover you for:
|member||R2 825||R2 511||R2 117|
|M + Adult Dependant||R5 374||R4 780||R4 028|
|M + AD + Child Dependant||R6 389||R5 683||R4 790|
|M + AD + 2 CDs||R7 404||R6 586||R5 552|
flexiFED 4 is an ideal option for a well matured family looking for comprehensive hospital cover at any hospital and get to also benefit from reliable Day-to-Day cover. In their Day-to-Day cover FedHealth has the MediVault and Wallet offer coupled with a threshold benefit once prescribed daily limits are reached.
|Amount allocated to MediVault|
|Amount allocated to MediVault|
The following are the monthly contributions for the flexiFED 4 members:
|member||R3 747||R3 326||R2 806|
|M + Adult Dependant||R7 146||R6 351||R5 404|
|M + AD + Child Dependant||R8 299||R7 378||R6 285|
|M + AD + 2 CDs||R9 452||R8 405||R7 166|
The maxiFED range is designed to offer mature couples, families and individuaIs with comprehensive medical benefits that will ease their life especially in old age. In both of the MAXIFED plans, there are very generous Day-to-Day benefits with a threshold benefit set up for determined levels.
The maxima EXEC plan has a fabulous all-round coverage that includes in-hospital, chronic medicine, screening benefits, and a wide range of added benefits to give you ultimate peace of mind when it comes to medical cover.
In this plan, there are 56 chronic diseases covered and are subject to the comprehensive formulary. Subscribers Under get R7 600 per beneficiary each year, the benefits capped at R14 000 per family per year.
The plan’s preferred providers include MediRite, Clicks, Dis-Chem and Pharmacy Direct.
For your daily medical expenses like GP or dentist visits, maxima EXEC provides funds as follows: Member R10 560, Adult Dependent R9 168, Child Dependent (up to a maximum of 3 children) R3 348.
Should your Day-to-Day funds be exhausted FedHealth continues to cover some of your Day-to-Day benefits, and most importantly, there is a threshold benefit leveled as follows:
Principal member R14 800, adult R11 400 and child (up to a maximum of 3 children) R3 800.
|risk||savings||contribution||Available day-to-day||Threshold level||S-payment gap|
|M||R5 936||R880||R6 816||R10 560||R4 800||R4 240|
|M+AD||R11 089||R1 644||R12 733||R19 728||R26 200||R6 472|
|M+AD+CD||R12 978||R1 923||R14 901||R23 076||R30 000||R6 924|
|M+AD+2CD||R14 867||R2 202||R17 069||R26 424||R33 800||R7 376|
For an extensive medical cover that will comprehensively cover all aspects of your health needs, FedHealth has the maxima PLUS plan to offer. Apart from the day-to-day savings portion and the threshold benefits, maxima PLUS cover, this plan has an OHEB (Out-of-Hospital Expenses Benefit) to cover daily medical benefits.
Maxima PLUS covers 70 chronic illnesses and each beneficiary has a limit of R16 100 per year while the whole family is limited to R30 200 per year.
In this option, members enjoy the comprehensive cover on their daily medical benefits. The plan has set up two pools to cover Day-to-Day medical benefits; the savings account and the OHEB when the savings account has been depleted.
Once claims reach the predetermined threshold level, the scheme continues to cover some of members’ day-to-day benefits up to the following limits; Member R17 100 Adult Dependant R13 200 Child Dependant (up to a maximum of 3 children) R4 600.
|risk||Annual savings||OHEB||contribution||Available day-to-day||Threshold level||S-payment gap|
|M||10 229||6 516||9 426||10 772||15 942||17 100||1 158|
|M+AD||19 059||12 132||16 228||20 070||28 360||30 300||1 940|
|M+AD+CD||22 313||14 196||18 318||23 496||32 514||34 900||2 386|
|M+AD+2CD||25 567||16 260||20 408||26 922||36 668||39 500||2 832|
Getting a medical aid plan is an essential decision you must do for yourself and loved ones. You surely need a reputable healthcare scheme like FedHealth to get started since the scheme has stood the test of time, showing its strength in growth and has moreover received lots of positive reviews in its efficiency when it comes to honouring claims. FedHealth also stands out among its competitors such as Bestmed on diversity in their plan options which allows almost every breadwinner to afford a medical plan.