Posted on April 29, 2021 by Staff Writer
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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 plan, which happens to be the entry level option
- FlexiFed plans, the intermediate options that have comprehensive hospital benefits
- MaxiFed plans, which have executive options that comprehensively cover your hospital and Day-to-Day medical benefits
Common features of FedHealth plans
- All FedHealth options have an unlimited in-hospital benefit
- Just like most if not all medical schemes, members are supposed to obtain pre-authorisation for all planned hospital admissions
- Emergency admissions are supposed to get authorised within two working days after hospitalisation
- Some plans have Designated Service Providers in order to fully cover claims
- Using a Non-DSP (Designated Service Providers) will lead to copayments by members, the minimum copayment you can pay is R2000
- All options cover the Prescribed Minimum Benefits and compulsory chronic illnesses as set by the Medical Schemes Act.
MyFed Plan 2021
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.
MyFed In-hospital Benefits
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.
MyFed Chronic benefits
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 Day-to-Day Benefits
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.
Additional Benefits
- There is a free maternity programme called ‘MyFed Baby Programme’ accessible to all pregnant members
- There are four postnatal midwifery consultations
- Newborns get one test with an audiologist which will be covered up to the Fedhealth Rate
MyFed Contributions
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 |
FedHealth’s FlexiFED plans
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
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 In-hospital Benefits
- Members get unlimited hospital cover in the FedHealth hospital network
- There is unlimited maternity cover paid at cost when using the network GPs and specialists
- The non network specialist, GPs and other healthcare professionals are paid at 100% FedHealth rate
flexiFed 1 Chronic benefits
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
flexiFed 1 Day-to-Day Benefits
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.
flexiFed 1 Contribution rates
| Any hospital | Elect | |
| 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 Option
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.
flexiFed 2 in-hospital benefits
- There is no overall annual limit for hospitalisation
- maternity cover is unlimited when using FedHealth’s GPs and specialists networks
- Should you use a non network GP or any other medical professional, the scheme will cover you up to 100% of the Fedhealth rate
- Oncology, organ transplant and renal dialysis benefits are limited to R300 200
Chronic Disease Benefits
This is also a hospital plan and therefore only covers the chronic conditions listed by the law just as in flexiFed 1.
flexiFed 2 Day-to-Day Benefits
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:
- Pregnancy benefits; Doula benefit up to R3 000, Postnatal midwifery benefit, Infant hearing screening test
- Take-home medicine
- Female contraceptives
flexiFed 2 Contribution rates
| Any hospital | GRID | Elect | |
| 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 Option
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.
flexiFed 3 in-hospital benefits
- Get unlimited hospital cover at hospital of choice
- There is unlimited maternity cover with network GPs and specialists, upon delivery members enjoy private ward benefits
- Network GPs and Specialists are fully covered while non-network facilities and professionals are covered at 100% of FedHealth rate
- Cover for oncology, organ transplant and renal dialysis is limited to R300 200
flexiFed 3 Chronic Disease 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.
flexiFED 3 Day-to-Day Benefits
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:
Flexible MediVault repayment structure
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 | |
| M(Member) | R11 100 |
| M+1 | R16 800 |
| M+2 | R22 200 |
| M+2+ | R26 100 |
Fixed repayment structure
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 | |
| M | R7 200 |
| M+1 | R9 600 |
| M+2 | R12 600 |
| M+2+ | R15 000 |
So once you have used up your Day-to-Day benefits and reached the threshold level, FedHealth continues to cover you for:
- Unlimited GP visits at an elected facility/professional
- Basic dentistry at a contracted dentist. Benefits include x-rays, scaling and polishing, fillings, extractions and root canal.
flexiFed 3 monthly Contributions
| Any hospital | GRID | Elect | |
| 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 Option
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.
flexiFED In-hospital cover
- There are no hospitalisation annual overall limits and flexiFED 4 members have the peace of mind knowing they can even use a hospital of their choice.
- Using network GPs and specialists gets your bills covered at cost while non-network bills are covered 100% of the FedHealth rate.
- Prevention, diagnosis and treatment of cancer, together with organ transplants and renal dialysis are covered up to R480 400 per family.
- There is unlimited maternity benefits at network GPs and Specialists while delivery has a private ward cover
flexiFed 4 Chronic Disease Benefits
- On Top of the 27 chronic diseases that are listed on the Chronic Disease List (CDL), flexiFED 4 also covers additional 16 chronic conditions including eczema and acne for children
- Treatment can be obtained from either a Designated Service Provider or a provider of your choice
- Cover is limited to R6 100 per beneficiary up to R12 200 per family however conditions listed in the CDL continue to receive unlimited cover
The flexiFED 4 Day-to-Day Benefits
- Your MediVault and wallet are used to cover daily medical expenses, then a threshold benefit utilised once a predetermined threshold level is reached.
- There is a 20% co-payment for claims paid from the threshold benefit, however claims for network specialists are fully paid
- The doula benefit is covered up to R3 000 per delivery
- There is post hospital treatments, Fedhealth Baby Programme, trauma treatments among other day-to-day benefits
| Amount allocated to MediVault | |
| M | R14 700 |
| M+1 | R26 700 |
| M+2 | R30 300 |
| M+2+ | R33 900 |
| Amount allocated to MediVault | |
| M | R12 000 |
| M+1 | R21 000 |
| M+2 | R24 000 |
| M+2+ | R27 600 |
Contribution Rates
The following are the monthly contributions for the flexiFED 4 members:
| Any hospital | GRID | Elect | |
| 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 |
MAXIFED Medical Options
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.
maxima EXEC option
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.
Maxima EXEC In-hospital benefits
- There is no overall annual limit for hospitalisation
- Network GPs and specialists are covered at cost while non-network GPs are covered up to 100% of the Fedhealth Rate and non-network specialists at 200% of the scheme rate
- The oncology benefits are covered up toR600 600
- There is Prostate Specific Antigen (PSA) cover per year covering men aged 45 to 69
- Unlimited maxillo-facial surgery that is subject to approval
- Immune deficiency related to HIV infection benefits are unlimited
- Corneal grafting is covered up to R35 000 per beneficiary
- Psychiatric services covered up to R34 500
Chronic benefits
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.
Day-to-Day medical benefits
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.
- follow-up treatment is covered for 30 days after being discharged from hospital, benefits like physio, x-rays and pathology
- There is unlimited specialised radiology paid by the scheme provided you get authorisation. However, the first R2 380 for non-PMB MRI/CT scans are from your own pocket
- When your medical savings have been depleted, Fedhealth continues to give you unlimited cover for all network GP visits.
| 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 |
maxima PLUS Option
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.
In-hospital Benefits
- Unlimited benefits for surgical extraction of impacted wisdom teeth
- Unlimited cover for oncology medical benefits
- Organ transplants including immunosuppression medication are also unlimited
- Psychiatric services are covered up to R43 500
- Specialised radiology is unlimited and covered at FedHealth rate
- There is unlimited cover at cost for network GPs and specialists while non network GPs are covered at 100% of the FedHealth rate, and specialists at 200% of the FedHealth rate
- All other healthcare professionals are covered up to 300% of the Fedhealth Rate
Chronic 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.
Maxima PLUS Day-to-Day benefits
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.
- Fedhealth Network GP visits have unlimited cover and are paid from the scheme risk
- There is unlimited specialised radiology cover for the likes of MRI and CT scans
- Seven days’ medicine after discharge from hospital is covered at 100% of the Medicine Price List
- trauma treatment at a casualty ward has unlimited cover at 100% of the Fedhealth Rate
| 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 |
Competitive advantages of FedHealth medical scheme
- The scheme provides a variety of plans that accommodate everyone and upgrading your plan can take you 30 days without hassle
- MyFed plan is salary bended giving you the opportunity to get a plan you can afford based on your income
- The flexiFED plans are designed in such a way that you can get a customised cover that will cover what you need the most at that particular time
- Claims are in the click of your fingertips using the Fedhealth Family Room and usually you should not even worry about making a claim since a healthcare professional can do that on your behalf, the scheme has a good reputation of honoring claims
- From flexiFED 4 going up the tier, there is a threshold benefit allowing you to continue receiving cover on some day-to-day medical benefits even after your day-to-day limits are depleted
- All FedHealth plans have incredible additional benefits you can rely on
- Maxima PLUS has Out-of-Hospital Expenses Benefit to cover many of your day-to-day expenses
- Some day-to-day benefits in the maxima PLUS are covered from the scheme risk, easing pressure on your savings
Competitive disadvantages of FedHealth medical scheme
- Even though the maxima PLUS plan has the Out-of-Hospital Expenses Benefit to cover some day-to-day expenses, the scheme does not really make more room for day-to-day benefits because the savings in the maxima PLUS are less than in the maxima EXEC.
- The scheme does not have Spinal surgery cover, even the maxima PLUS which is meant to be the most comprehensive only steps in when Conservative Back & Neck Rehabilitation Programme has been completed
Conclusion
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.