Fedhealth Medical Scheme Changes 2017

Dear Member

Fedhealth Medical Scheme launched its 2017 product offering on 10 October 2016. Here is an overview of the most important changes effective 1 January 2017.

Contribution increases for 2017

The increase for all plans will range between 12.5% and 23.6%. The weighted average headline increase is 12.7%.

Plan / Option increase / Savings %
Ultimax / 12.50% / 5.2%
Maxima Plus / 12.50% / 5.5%
Maxima Exec / 18.20% / 7.3%
Maxima Standard / 12.60% / 18.0%
Maxima Standard Elect / 12.80% / 18.0%
Maxima Advanced ( Previously Ultima 200) / 23.60% / 10.0%
Maxima Basis / 12.50% / 15.0%
Maxima Saver / 12.50% / 15.0%
Maxima EntrySaver / 12.50% / 15.0%
Maxima Core / 12.50% / N/A
Maxima EntryZone / 12.50% / N/A
Blue Door Plus / 12.60% / N/A

Benefit Changes for 2017

Maxima Plus

  • Savings level increase by 12%

Comprehensive option: Maxima Exec, Maxima Standard and Standard Elect

  • Non Fedhealth Specialists paid at 100% of Fedhealth rate in and out of hospital.
  • When in benefit, chronic medication must be obtained from DSP’s. DSP include Dis-Chem MediRite and Pharmacy Direct. Chronic formulary has changed from a comprehensive to restrictive formulary.
  • Appliances, external accessories and orthotics as well as all additional medical services will no longer accumulate to the Threshold in 2017, however they will be paid from the Threshold benefit up to a limit. Additional medical services include biokinetics, chiropractics and physiotherapy.
  • Savings increased by 18% on MaximaExec
  • Specialised radiology in and out of hospital paid from Major Medical Benefit if pre-authorisation is obtained. Co-payment of R1 900 for non- PMB MRI/CT scans
  • Specialist referral required for day to day claims. If no referral is received, no benefit.
  • A R500 co-payment is applicable to trauma treatment in a casualty ward

Saver options: Maxima Advanced, Maxima Basis, Maxima Saver, Maxima Advanced (previously known as Ultima 200) and Maxima EntrySaver

  • Non Fedhealth Specialists paid at 100% of Fedhealth rate in and out of hospital. If non Fedhealth Specialist is used, a limit of R3 500.00 on Maxima Basis and R2 000 on Maxima Saver and Maxima EntrySaver
  • Dis-Chem is included as one of the DSP’s for all chronic.
  • R10 000 co-payment introduced for elective caesarean
  • Savings level increased to 15%
  • Specialised radiology in and out of hospital paid from Major Medical Benefit if pre-authorisation is obtained. Co-payment of R1 900 for non- PMB MRI/CT scans on all options except Maxima EntrySaver where the co-payment is R2 500.
  • Specialist referral required for day to day claims. If no referral is received, no benefit.
  • A R500 co-payment is applicable to trauma treatment in a casualty ward

Hospital options: Maxima Core and Maxima EntryZone

  • Non Fedhealth Specialists paid at 100% of Fedhealth rate in and out of hospital. If non Fedhealth Specialist is used, a limit of R2 000 on Maxima EntryZone
  • Dis-Chem is included as one of the DSP’s for all chronic.
  • R10 000 co-payment introduced for elective C-section on Maxima EntryZone option
  • Specialised radiology in and out of hospital paid from Major Medical Benefit if pre-authorisation is obtained. Co-payment of R1 900 for non- PMB MRI/CT scans on all options except Maxima EntryZone where the co-payment is R2 500.
  • A R500 co-payment is applicable to trauma treatment in a casualty ward

Entry Level Primary Care Network option: BlueDoor

  • BlueDoor has introduced Netcare as their new network for hopsitalisation, and a R10 000 co-payment for voluntary use of non network (replacing the 40% in 2016) Medi Clinc hospitals will no longer be the preferred network provider.
  • R10 000 co-payment for elective C-section
  • A screening benefit has been added with a free flu vaccine per beneficiary per year as well as a free HIV/Aids test including pre-and post counselling
  • Trauma treatment at a casualty facility will be paid from risk with a R500.00 co-pay.
  • Non Fedhealth Specialists paid at 100% of Fedhealth rate in and out of hospital. If non Fedhealth Specialist is used, a limit of R2 000 applicable

Fedhealth nominated Family Practitioner (FP)

From 2017, members on Maxima Basis, Maxima Saver and Maxima EntryZone options will have to nominate a Fedhealth Network family practitioner per beneficiary to enjoy unlimited FP visits paid from Risk (once their Savings or OHEB have run out, where applicable). The use of non-nominated FP limited to two visits per beneficiary per year (referred to as out-of-area).

New Benefit Options for 2017

New Grid range applicable to Maxima Basis, Maxima Saver and Maxima Core

The Grid range of options offers a 10% discount in premiums as members would need to make use of network hospitals. Should members voluntarily make use of a non-network hospital a R10 000 co-payment will apply.

Corporate Wellness

Fedhealth will embark on targeted interventions to ensure effective healthcare, which improves employee quality of life and thus enhances their professional output. The corporate wellness program consists of:

- Conservative Back and Neck Rehabilitation Programme

- Mental Health Programme

- Oncology Disease Management

- Aid for AIDS (HIV Disease Management)

- Fedhealth Baby/High Risk Maternity/

- Contraceptive benefit

- Health Risk Assessments

- Screening benefits

- Trauma/Casualty benefit

- Children’s Health

- Sisters on Site – 100 or more Fedhealth members on site

- MyHealth Portal

- Chronic Medicine Management

- Hospital Benefit Management

- Chronic Disease Self-management Programme

- Corporate Wellness Days

- Free Trauma Counselling

Foundation Benefit

The foundation benefits will cover all Fedhealth members for a rich benefit package which includes screening benefits, birth and baby care, with extended care according to the benefit options.

  • Screening benefit, which includes women’s, children’s, cardiac, over 50s, and general health risk assessments and screenings from Risk depending on option.
  • Birth and baby care including the Fedhealth baby program and post-natal midwifery benefit
  • Extended care which includes;

- Unlimited Network Family Practitioner according to your option

- 24 hour Fedhealth nurse line to advice on issues including emergencies, symptoms, medication side-effects, stress management and teenage support

- Trauma counselling – free trauma management assistance, support and care allowing members to speak to a registered psychologist or trauma counsellor 24/7.

- Emergency transport/response through Europ Assist

- Comprehensive managed care programmes

  • Aid for AIDS (AfA) for those living with HIV/AIDS,
  • Oncology Disease Management supports cancer sufferers with comprehensive care including cover for chemotherapy, radiotherapy, approved medication, related consultations, pathology and general radiology,
  • Mental Health Program provides members with mental health or substance-abuse issues, as well as their FP, with access to the best quality primary mental healthcare,
  • Conservative Back & Neck Rehabilitation Programme helps members address their back and neck issues to avoid spinal surgery. Over six weeks, members benefit from a multidisciplinary approach including an FP, physio and biokineticist to assess and treat their condition.

Threshold Levels

Threshold levels have increased between 6.00% and 12.00% across Maxima Plus, Exec, Standard and Standard Elect.

Plan / Principal member / Adult / Child
Maxima Plus / R13 038 / R10 028 / R3 477
Maxima Exec / R11 200 / R8 600 / R2 880
Maxima Standard / R11 200 / R8 600 / R2 880
Maxima Standard Elect / R11 200 / R8 600 / R2 880

BlueDoor

The income band structure of BlueDoor option has been adjusted for 2017:

2016 / 2017 / Increase
Income bands / R0 - R5000 / R0 - R5 200 / 4.0%
R5 001 - R8 200 / R5 201 - R8 500 / 3.7%
R8 201 - R10 000 / R8 501 - R10 500 / 5.0%
R10 001 - R11 760 / R10 001 - R11 760 / 2.0%
R 11 761 / R 11 761 / 2.0%

Sanlam Reality Program

Sanlam Reality is a lifestyle, wellness, rewards and financial education programme available to all Fedhealth medical aid members. All Fedhealth members not on Reality Health will be registered for free as Reality Access members and enjoy free International Travel Insurance.

The Reality Health option has been specifically tailored to help Fedhealth medical aid members save money on wellness, travel, entertainment and day-to-day expenses, and to learn more about achieving financial fitness.

More than 20 benefits to help save time and money:

- Family membership options, enabling all immediate family members to join the program.

- A Bronze, Silver and Gold tiering structure that allows members to earn more discounts.

- A day-to-day transactional shopping card called Money Saver, which pays out a quarterly or annual cash-back bonus.

- An online platform called Wealth Sense, with free access to money calculators, tools, tips, digital magazines and more…

- Reality Health has been specifically tailored to the Fedhealth market.

- All Fedhealth members not on Reality Health will automatically be registered free of charge as Reality Access members and enjoy free International Travel Insurance. Fedhealth members have the option to opt out

Stay in touch with Fedhealth

Fedhealth has 4 ways to keep in touch, these options include:

  • Fedhealth member mobile app – free for Apple and Android users
  • Fedchat mobile app – free instant messager channel for Apple, Android Blackberry and Windows phone users
  • Fedhealth website – visit Fedhealth.co.za for scheme information, member tools and lifestyle articles
  • Fedhealthy – monthly digital newsletter customised for member’s unique profile

Yours in health

Alexander Forbes Health

Follow us on Twitter #AF_Health

Disclaimer: While all reasonable care has been taken in compiling this communication, we have relied upon the accuracy and completeness of the information made available to us by Fedhealth Medical Scheme at their Corporate Broker Launch. Consequently we cannot accept any liability for any errors or omissions that may arise as a result of the reliance on such information. Further please note that the medical scheme changes are still subject to approval by the Council for Medical Schemes. Alexander Forbes Health will keep you informed as to further information or changes that we may become aware of.
Alexander Forbes Health is a licensed financial services provider. (FSP 33471)
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