fedhealth Fedhealth Medical Cover | Sanlam Health Solutions

• Unlimited network doctors’ visits – members can see their GP as often as they need on most options, by either visiting any network GP or a nominated network GP (depending on the option)
• Child rates for financially dependent children up to 27 years of age
• Upgrades to higher options any time of the year due to a life-changing event, like a pregnancy or on diagnosis of a dread disease

• Post-hospitalisation treatment for up to 30 days after discharge from hospital (for example, physiotherapy, x-rays, pathology). Excludes follow-up consultations with GPs or specialists, and is not applicable to myFED.
• Take-home medication – we pay for seven days of take-home medication when the member is discharged from hospital. The medication must be dispensed by the hospital and must reflect on the original hospital account.
• Specialised radiology like MRI and CT scans – whether performed in- or out-of-hospital. Co-payment applies to non-PMB MRI/CT scans on all options except maxima PLUS. myFED does not have an out-of-hospital benefit for specialised radiology.
• Trauma treatment at a casualty ward – emergency treatment, like stitches, at a casualty ward is covered. Whether the member is admitted to hospital or not, authorisation must be obtained within 48 hours and a co-payment of R600 per visit for non-PMBs applies to all options except maxima PLUS.
• Female contraception is covered, including oral, patches, certain injectables, contraceptive rings as well as IUDs that include the Mirena®. It must, however, be prescribed by a GP or gynaecologist and is not applicable to pills prescribed for acne. On myFED, only oral and injectable contraceptives are covered.
• In-hospital dentistry for children under 7 – We pay for dentistry performed in-hospital for children up to the age of seven. The hospital account and anaesthetist costs are paid from the in-hospital benefit while the dentist’s account comes from day-to-day benefits. Not applicable to flexiFED 1 or myFED.

• With this philosophy we encourage you to see the same general practitioner (GP) every time, who then becomes the coordinator of your care. The doctor builds a valuable relationship with you, and gets to know your health history.
• When you need a specialist, your GP can refer you to the appropriate specialist type, avoiding fragmented care, costly duplications of tests and treatments, and even the prescription of conflicting medication.
• Coordinated care protects you, gives you better quality of care, and it also helps ensure the financial sustainability of the scheme.
• A referral from the general practitioner is necessary on all options where the specialist consultation is paid from a Risk benefit, for example the Out-of-Hospital Expenses Benefit (OHEB) on maxima PLUS, and the Threshold Benefit.
• Members on certain options have to nominate a Fedhealth Network GP to enjoy unlimited GP visits paid from Risk.

GP nomination and referral management through the nominated GPs helps Fedhealth to ensure that all members get quality care and better value for money.

• 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 Programme provides qualifying members on certain options who have mental health or substance abuse issues with access to the best quality primary mental healthcare.
• Conservative Back and Neck Rehabilitation Programme helps qualifying members address their back and neck issues to avoid spinal surgery. Over six weeks, members benefit from a multidisciplinary approach including a GP, physio and biokineticist to assess and treat their condition.
• Smoking Cessation Programme – all members on all options can sign up for the GoSmokeFree service at 200 pharmacies countrywide to help them kick the habit for good. This programme will be paid from Risk.
• Weight Management Programme provides a 12-week programme designed for qualifying Fedhealth members with a high BMI and waist circumference. Led by a biokineticist, members have access to a dietician and behavioural psychologist with the goal to lose the excess weight and lead healthier, more rewarding lives.
• MediTaxi provides a free transport service to take members with hospital authorisations to follow-up medical appointments.
• SOS Call Me is our user-friendly call-back service for members and dependants.

We partner with healthcare professionals with the same passion for healthcare.

• Negotiated dispensing fees with Clicks, MediRite, Dis-Chem and Pharmacy Direct, as well as plenty of smaller pharmacies, providing price certainty, regardless of where you live in South Africa.
• Over 6 168 General Practitioners currently contracted to the Fedhealth GP Network. 98% of principal members have access to a Network Doctor within a 10 km radius of where they live.
• More than 81% of claiming beneficiaries on various options are already using Network Doctors.
• Access to unlimited GP visits on most options.
• Over 5,058 specialists from all disciplines contracted to the Fedhealth Specialist Network. Using a Fedhealth Network Specialist means no co-payments and truly unlimited benefits at cost for members in-hospital and price certainty out-of-hospital.
• Partnerships with excellent hospitals across the country, providing members with financial peace, while allowing the Scheme to provide sound benefits at affordable rates.