Saver Options

Saver optionsChoose from:

Maxima SaverMaxima EntrySaver

Unlimited hospitalisation, plus the benefi t of Day-to-Day and Chronic cover.

Those who want all the perks associated with top-notch hospital cover, but also require a medical aid option that covers their day-to-day healthcare spending, should consider our saver options.

Single, young professionals can benefi t from both saver options, as they pro-vide quality hospital cover complemented by a Medical Savings Account that handles day-to-day healthcare expenses.

Unlimited hospitalisation at all private hospitals is available on Maxima Saver, whilst members can enjoy unlimited hospitalisation at Network Hospitals only on Maxima EntrySaver.

As an added benefi t, both options allow all benefi ciaries to visit a nominated Network GP for unlimited consultations covered from Risk and on Maxima Saver, there’s a Basic Dentistry benefi t that is also covered from Risk. These Risk benefi ts apply once Savings is depleted.

Both options also provide a Chronic Disease Benefi t that covers 25 chronic conditions at 100% of the Medicine Price List.

Max

ima

Ran

ge

Chronic Disease Benefit

Day-to-Day Benefit

Other healthcare professionals

Major Medical Benefit

Hospitalisation

Network GPs and Specialists

Non-network GPs and Specialists

maxima saver

From R1 751pm From R1 327pm

maxima entrysaver

Up to 100% of Fedhealth Rate

Up to 150% of Fedhealth Rate Up to 100% of Fedhealth Rate

Unlimited cover at cost with Fedhealth Network GPs and Specialists

No overall annual limit Network hospitals only No overall annual limit

PMB chronic conditions only from Medi-Rite pharmacies and subject to a restrictive formulary. Covers up to 100% of the

Medicine Price List

R2 160 per member p.a.R2 568 per member p.a.

Unlimited specialised radiology paid from the Major Medical Benefit if pre-authorised

Unlimited GP visits at a nominated GP on the Fedhealth GP Network

Basic dentistry

RIS

K B

ENEFITS

Savings

MajorMedicalBenefit

ChronicDiseaseBenefit

DAY-TO-D

AY B

EN

EFITS

SchemeFundedDay-to-Day

How the scheme worksMajor Medical Benefi t

All costs for hospitalisation are covered from this benefi t and must be pre-author-ised - Network Hospitals apply to Maxima EntrySaver.

Chronic Disease Benefi tMedication for approved chronic diseases is covered from this benefi t.

Day-to-Day Benefi tDay-to-day expenses are covered from Savings. Once Savings is depleted, some

Scheme Funded Benefi ts still apply.

saver options Maxima Saver & Maxima EntrySaver

FR - Fedhealth Rate ICON - Independent Clinical Oncology Network MPL - Medicine Price ListHPT - Healthcare Professional Tariff DSP - Designated Service Provider

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major medical benefit All costs for hospitalisation are covered from this benefit and must be pre-authorised - Network Hospitals apply to Maxima EntrySaver

maxima saver maxima entrysaver

BENEFIT ALL LIMITS ARE PER FAMILY PER YEAR UNLESS OTHERWISE SPECIFIED

Overall annual limit (OAL) Unlimited Unlimited at network hospitals only

Healthcare Professional Tariff (HPT)

- Fedhealth Network GPs and Specialists

- Non-Fedhealth Network GPs and Specialists

- Other Healthcare Professionals

Covered at cost

Covered at 100% of FR

Covered at 150% of FR

Covered at cost

Covered at 100% of FR

Covered at 100% of FR

Prescribed Minimum Benefits (PMBs) Unlimited in state hospitals

Hospitalisation costs Unlimited at negotiated tariff Unlimited at negotiated tariff at network hospitals only.R5 000 co-payment on voluntary use of a non-network hospital

Co-payments See details on page 2

Alternatives to hospitalisation

- Sub-acute facilities and physical rehabilitation facilities

- Nursing services, private nurse practitioners & nursing agencies

PMB level of care only

Unlimited at negotiated tariff

Ambulance services Unlimited with Europ Assistance

Appliances, external accessories, orthotics Subject to Savings

Blood, blood equivalents and blood products Unlimited

Additional medical services (dietetics, occupational therapy and speech therapy) and physical therapy (physiotherapy and biokinetics)

Unlimited (See HPT above)

Maxillo-facial surgery

- Surgical extraction of impacted wisdom teeth

Unlimited, subject to approval (See HPT above)

Co-payment applies to surgical extraction of impacted wisdom teeth

Unlimited, subject to approval (See HPT above)

No benefit for surgical extraction of impacted wisdom teeth

Emergency treatment in a casualty ward Unlimited at FR

Female health benefit: contraceptives Unlimited at MPL

Immune deficiency related to HIV infection Unlimited (See HPT above)

saver options Maxima Saver & Maxima EntrySaver

MPL - Medicine Price ListHPT - Healthcare Professional Tariff FR - Fedhealth Rate

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major medical benefit (continued)

maxima saver maxima entrysaver

BENEFIT ALL LIMITS ARE PER FAMILY PER YEAR UNLESS OTHERWISE SPECIFIED

Pathology, radiology (general) Unlimited at FR

Post-hospitalisation benefit Up to 30 days after discharge at FR

Post-natal midwifery benefit 4 consultations per pregnancy at FR

Prostheses

- Internal

- External

PMBs only

R9 430 at cost

PMBs only

PMBs only

Psychiatric services R20 300 (See HPT on page 1) PMBs only

Renal Dialysis (chronic)

- Haemodialysis and peritoneal dialysis R213 000 at FR PMBs only in state facilities

Specialised medication benefit (eg. biologicals) - oncology & non-oncology No benefit

Specialised radiology Unlimited at FR

Take-out medicines 7 days medication per hospital event at MPL

Terminal care benefit R26 500 at FR

co-paymentsmaxima saver maxima entrysaver

PROCEDURE CO-PAYMENTS (PER EVENT) APPLICABLE ON THE HOSPITAL/ FACILITY BILL ONLY

All open hernia procedures, Back & neck pain, Spinal surgery, Bunion procedures, Cataract surgery, Elective caesar-ean sections, Gastritis/ dyspepsia/ heartburn, Hysterectomy (unless for cancer), Nasal procedures, Scopes (upper GI endoscopy, colonoscopy, cystoscopy), Skin biopsy/ excision, Tonsil/ adenoid procedures, Varicose vein procedures R5 000

Dental admissions R5 000 No benefit

Surgical extraction of impacted wisdom teeth R5 000 No benefit

Arthroscopic proceduresAnkle, Knee, Shoulder R5 000

Laparoscopic proceduresDiagnostic, Nissen/ Toupey R5 000

All arthroscopic and laparoscopic procedures not listed above Only the costs for hospital/ facility, theatre fees, anaesthetist & surgeon will be covered

saver options Maxima Saver & Maxima EntrySaver[ 3

maxima entrysaver network hospitals

Please note that this list may change/ expand during the year. Please contact the Fedhealth Customer Contact Centre on 0860 002 153 or refer to the website for the latest Maxima EntrySaver Network Hospital list

HOSPITAL PROVINCE SUBURB

Life Beacon Bay Hospital Eastern Cape East London

Life Mercantile Hospital Eastern Cape Korsten

Life St George’s Hospital Eastern Cape Centrahill

Life St James Hospital Eastern Cape Southernwood

Life St Mary's Private Hospital Eastern Cape Umtata

Horizon Eye Care Centre Free State Bloemfontein

Mediclinic Hoogland Free State Bethlehem

Life Pasteur Hospital Free State Bloemfontein

Life Rosepark Hospital Free State Bloemfontein

Netcare Bougainville Hospital Gauteng Hercules

Life Brenthurst Clinic Gauteng Johannesburg

Life Carstenhof Clinic Gauteng Midrand

Cormed Clinic Gauteng Vanderbijlpark

Life Dalview Clinic Gauteng Brakpan

Life Flora Clinic Gauteng Roodepoort

HOSPITAL PROVINCE SUBURB

Life Fourways Hospital Gauteng Fourways Gardens

Life The Glynnwood Gauteng Benoni

Louis Pasteur Hospital Gauteng Pretoria Central

Midvaal Private Hospital Gauteng Three Rivers

Life Robinson Private Hospital Gauteng Randfontein

Life Roseacres Clinic Gauteng Primrose

Life Chatsmed Garden Hospital Kwa-Zulu Natal Chatsworth

Durdoc Clinic Kwa-Zulu Natal Durban Central

Life Entabeni Hospital Kwa-Zulu Natal Durban

Maxwell Clinic Kwa-Zulu Natal Qualbert

Life Mount Edgecombe Hospital Kwa-Zulu Natal Mount Edgecombe

Life Westville Hospital Kwa-Zulu Natal Westville

Zoutpansberg Private Hospital Limpopo Polokwane

Life Cosmos Hospital Mpumalanga Witbank

HOSPITAL PROVINCE SUBURB

Life Peglerae Hospital North West Rustenburg

Mediclinic Kimberley Northern Cape Kimberley

Life Bay View Private Hospital Western Cape Mossel Bay

Netcare Blaauwberg Hospital Western Cape Bloubergrant

Mediclinic Cape Gate Western Cape Cape Gate

Mediclinic Cape Town Western Cape Mill Street

Ceres Private Hospital Western Cape Ceres

Life Claremont Hospital Western Cape Claremont

Life Kingsbury Hospital Western Cape Claremont

Mediclinic Geneva Western Cape George

Mediclinic George Western Cape George

Melomed Mitchells Plain Medical Centre

Western Cape Cape Town

Life West Coast Private Hospital Western Cape Vredenburg

saver options Maxima Saver & Maxima EntrySaver[ 4

EPI - Expanded Programme on Immunisation

screening benefitThis benefit provides access to a number of screening and preventative programmes aimed at improving members’ health

maxima saver maxima entrysaver

BENEFIT CRITERIA ALL LIMITS ARE PER BENEFICIARY

Women’s HealthBreast cancer screening with mammographyCervical cancer screening (PAP smear - test only) Liquid based Cytology will be reimbursed up to the rate for a standard PAP smear

Women; ages 50 to 74Women; ages 21 to 65

1 every 3 years1 every 3 years

Children’s HealthImmunisation Programme As per State EPI As per State EPI

Cardiac HealthCholesterol screening (full lipogram) All lives; aged 20 and older 1 every 5 years

GeneralFlu vaccination All lives 1 every year

chronic disease benefitMedication for approved chronic diseases is covered from this benefit

maxima saver maxima entrysaver

Limit Unlimited

Conditions covered 25 Chronic Conditions below

Formulary Restrictive formulary

Designated Service Provider (DSP) Medi-Rite pharmacy

HIV/ AIDS MEDICINE BENEFIT INCLUDING TREATMENT FOR MOTHER-TO-CHILD TRANSMISSION, RAPE & POST-EXPOSURE PROPHYLAXIS

Limit Unlimited

Non-compliance with DSP and/ or formulary requirements will attract a co-payment of 40%. All medicine claims are subject to the Medicine Price List (MPL), a generic reference price list, and the maximum negotiated dispensing fee. Where the dispensing fee has not been negoti-ated, a maximum dispensing fee of 26% / R26 will apply.

25 CHRONIC CONDITIONS

Addison’s Disease, Asthma, Bipolar Mood Disorder, Bronchiectasis, Cardiac Failure, Cardiomyopathy, COPD/ Emphysema/ Chronic Bronchitis, Chronic Renal Disease,

Coronary Artery Disease, Crohn’s Disease, Diabetes Insipidus, Diabetes Mellitus type 1 & 2, Dysrhythmias, Epilepsy, Glaucoma, Haemophilia, Hyperlipidaemia, Hypertension,

Hypothyroidism, Multiple Sclerosis, Parkinson’s Disease, Rheumatoid Arthritis, Schizophrenia, Systemic Lupus Erythematosus, Ulcerative Colitis

saver options Maxima Saver & Maxima EntrySaver[ 5

day-to-day benefitDay-to-day expenses are covered directly from available funds in Savings - with no Threshold benefit available. However, once Savings is depleted, various Scheme Funded Benefits still apply to each option.

benefit maxima saver maxima entrysaver

Appliances, external accessories and orthotics Subject to Savings Subject to Savings

Alternative healthcare

Accupuncture, homeopathy, naturopathy, osteopathy and phytotherapy (including prescribed medication) Subject to Savings Subject to Savings

Additional medical services

Audiology, dietetics, occupational therapy, orthoptics, podiatry, psychologists, social workers and speech therapy Subject to Savings Subject to Savings

Dentistry (Advanced)

Including oral surgery, osseo-integrated implants, orthognathic surgery and orthodontic treatment Subject to Savings Subject to Savings

Dentistry (Basic)

Removal of teeth and roots and suturing of traumatic wounds. Oral medical procedures: diagnosis and treatment of oral and associated conditions, plastic dentures and dental technician fees for all such dentistry

Subject to Savings. Once Savings is depleted the following benefits will be paid from Risk:2 Annual consultations per beneficiary including scaling and polishing. Subject to a contracted list of dentists and limited to a list of approved proce-dures, dental tariff codes and protocols. Plastic dentures limited to one set per beneficiary every two years

Subject to Savings

Optometry

Frames, single vision, bifocal, multifocal or special lenses, lens add-ons, contact lenses, readers and optometric examinations

Subject to Savings Subject to Savings

Biokinetics, Chiropractics, Radiology (General), Pathology and PhysiotherapySubject to Savings Subject to Savings

General Practitioners

- Fedhealth Network GPs

- Non-Fedhealth Network GPs

Subject to Savings. Unlimited GP visits at nominated Fedhealth Network GP once Savings is depleted

Subject to Savings

Subject to Savings. Unlimited GP visits at nominated Fedhealth Network GP once Savings is depleted

Subject to Savings

Maternity Subject to Savings Subject to Savings

Over-the-counter medication Subject to Savings Subject to Savings

Prescribed medication Subject to Savings Subject to Savings

Radiology (Specialised) Paid from the Major Medical Benefit if pre-authorised Paid from the Major Medical Benefit if pre-authorised

Specialists

- Fedhealth Network Specialists

- Non-Fedhealth Network Specialists

Subject to Savings

Subject to Savings

Subject to Savings

Subject to Savings

Benefits that set us apartWhat sets us apart is that together with our first-rate medical aid options, we offer unique value-added benefits. With some of these tangible benefits we pay more from Risk than other schemes to ensure that members’ day-to-day medical spending not only goes further, but also works harder when they really need it.

Benefits unique to Fedhealth:• Unlimited visits to a nominated Network GP – paid from Risk once Savings is depleted on both Saver

options• Child rates for financially dependent children up to 27 years of age – so student dependants pay rates

applicable to children, provided they’re unmarried and not earning more than the maximum social pension• Upgrades to higher options any time of the year within 30 days of diagnosis of a dread disease, or in the

case of a life changing event – which means the member’s never locked into an option, and can upgrade should something dramatic happen that changes their circumstances during the year. *New contributions will apply

Where we pay more from Risk than other schemes:• Post-hospitalisation treatment for up to 30 days after discharge from hospital (physiotherapy, pathology,

occupational therapy, speech therapy and general radiology) – that means most follow-up treatment for a full 30-day period paid directly from Risk not to deplete the member’s day-to-day benefit

• 7 days of take-home medication - after discharge from hospital paid for – provided the medication is dispensed by the hospital and reflects on the original hospital account

• Specialised radiology like MRI and CT scans - paid from Risk and never from Savings – no matter what option the member’s on, whether performed in or out-of-hospital

• Trauma treatment at a casualty ward - whether admitted to hospital or not, emergency treatment, like stitches, is always paid from Risk and never from the member’s day-to-day benefit

• Cover for female contraception - including oral, patches, certain injectables as well as IUDs that include Mirena®, contraceptive rings and implants on all comprehensive and saver options. *Must be prescribed by a GP or gynaecologist and not applicable to pills prescribed for acne

• The Screening Benefit - health screenings for women and children, cardiac screenings as well as an annual flu vaccine funded from Risk and not from the member’s day-to-day benefit.

How we add value:• The Fedhealth Baby Programme• 24-Hour Fedhealth Nurseline• FREE trauma counselling for practical and emotional support• Emergency transport/ response through Europ Assistance• Comprehensive managed care programmes: Aid for AIDS (AfA) for those living with HIV/AIDS, AsthmaCare ensures that asthma patients still lead a normal life, DiabeticCare assists diabetics in managing their blood sugar, CardioCare to prevent heart attacks in Coronary Heart Disease sufferers, and Oncology Disease Management that supports cancer sufferers with comprehensive care including cover for chemotherapy, radiotherapy, approved medication, related consultations, pathology and general radiology.

And then members still get:• Professional and extreme sports cover - injuries sustained during sporting activities are covered within the

benefits and rules of the Scheme, provided the treatment is received within the borders of South Africa• In-hospital dentistry for children under 8 - we cover the hospital and anaesthetist costs from the Major

Medical Benefit while the dentist’s account comes from day-to-day benefits. *The Authorisation Centre must be contacted at least 48 hours before the procedure. Authorisation will be granted provided no dental authorisation was granted for the same child within at least six months of the required admission date. This benefit does not apply to Maxima EntrySaver

• Easy membership for child dependants - who are at an age and status to afford their own medical aid, meaning no underwriting required for child dependants moving from their parent’s medical aid onto their own at Fedhealth.

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contributionsmaxima saver

Risk Savings TOTAL Annual Savings

Member 1 571 180 1 751 M 2 160

Adult Dependant 1 279 147 1 426 M + AD 3 924

Child Dependant 452 52 504 M + AD + CD 4 548

maxima entrysaverRisk Savings TOTAL Annual Savings

Member 1 113 214 1 327 M 2 568

Adult Dependant 753 145 898 M + AD 4 308

Child Dependant 338 65 403 M + AD + CD 5 088

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