FedHealth Medical Scheme Review 2021

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: 

Common features of FedHealth plans

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

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

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

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:

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

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:

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

flexiFed 4 Chronic Disease Benefits

The flexiFED 4 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

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.

	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

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.

	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.