FedHealth South Africa

Fedhealth is a well-established medical aid registered in 1969, it covers close to 150,000 lives and has one of the highest Global Credit Ratings, currently at AA-.

All benefits are pro-rated depending on when in the year one joins the scheme.

This medical aid has a unique benefit in that it allows members to upgrade their option in the event of a change of health status e.g. the onset of a chronic condition.

FedHealth Maxima Core

Has unlimited hospital cover paid out at 100% of Fedhealth rate to non-Fedhealth specialist partners and cost for Fedhealth specialist partners. There is also cover for Chronic Medication and Emergency Evacuation Cover i.e. Ambulance and Helicopter. (irrespective of who pays them)

FedHealth Maxima Basis

Has unlimited hospital cover paid out at 100% of Fedhealth rate to non-Fedhealth specialist partners and cost for Fedhealth specialist partners. There is also cover for Chronic Medication and Emergency Evacuation Cover i.e. Ambulance and Helicopter. This plan has a Threshold benefit for day-to-day claims that kicks in at a specified Rand amount. There is a gap between the savings limit and the Threshold benefit kicking in, called the self-payment gap, during which expenses must be paid by the member but the bills must still be submitted to the medical aid. Once all your accumulated day-to-day expenses (irrespective of who pays them) reach the Threshold Excess, it will pay all day-to-day expenses until the end of the year, subject to sub-limits. In addition this option also includes a limited fund (OHEB) for day-to-day expenses e.g. doctor’s consultations, medicines, etc. The gap between the accumulated day-to-day benefit and the Threshold Excess would be for the member’s account (self-payment gap) but the bills must still be submitted to the medical aid for them to be accumulated so that the Threshold benefit can be activated. In self payment Gap - Fedhealth GP Partners - subject to OHEB and unlimited from Risk.

FedHealth Maxima Standard

Has unlimited hospital cover paid out at 100% of Fedhealth rate to non-Fedhealth specialist partners and cost for Fedhealth specialist partners. There is also cover for Chronic Medication and Emergency Evacuation Cover i.e. Ambulance and Helicopter. A threshold benefit for day-to-day claims that kicks in at a specified Rand amount. There is a gap between the savings limit and the Threshold benefit kicking in, called the self-payment gap, during which expenses must be paid by the member but the bills must still be submitted to the medical aid. Once all your accumulated day-to-day expenses (irrespective of who pays them) reach the Threshold Excess, it will pay all day-to-day expenses until the end of the year, subject to sub-limits. In addition this option includes a fund (OHEB) as well as a savings account for day-to-day expenses e.g. doctor’s consultations, medicines, etc. Claims submitted to the medical aid would first be paid out of OHEB until that is exhausted and then from the savings account. Any portion of the savings not used would be carried forward to the following year. The gap between the accumulated day-to-day benefit and the Threshold Excess would be for the member’s account (self- payment gap) but the bills must still be submitted to the medical aid for them to be accumulated so that the Threshold benefit can be activated. In self payment Gap - Fedhealth GP Partners - subject to OHEB and unlimited from Risk.

Fedhealth’s Unique Benefits

  • Dependants stay at Child Rates until age 27.
  • Grown up dependants can transfer to their own membership with no underwriting.
  • Members can upgrade to a higher option at any time of the year, subject to approval – not only effective 1st January.
  • Members can get certain oral contraception on selected plans paid for by the scheme.
  • All professional and extreme sports are covered.
  • Members are covered for 30 days post hospitalisation treatment paid for by the scheme.
  • Take home medicine following hospitalisation is paid for by the scheme.
  • MRI and CT scans are paid for by the scheme.
  • In-hospital dentistry for children under 8 is paid for by the scheme.
  • Emergency treatment in a casualty ward that does not result in hospitalisation is paid for by the scheme.
Quick facts:

Click here to view a comparative summary of the Fedhealth medical aid plans