Fedhealth Blue Door B medical aid plan: 2018

View all plans in this scheme.
Please note that these benefits are still being updated as more information is made available to us. Always consult with your broker before making final decisions regarding your healthcare cover.

COSTS and OVERVIEW:
Blue Door B
Quick Overview
Main: Adult: Child:
Total Cost pm: R1,070 R901 R516

(Pay for all)

Savings (per year):
  • No savings option on this plan
Gap (optional):
  • Varies. See below for specific recommendation for this plan.
Income band:
In brief: See full benefits below

IN HOSPITAL PROCEDURES:
Blue Door B
Scheme Benefits: Gap Benefits:
Specialists:
  • Network specialists and GPs covered in full
  • Otherwise,100% scheme rate, limited to R2,116 per person
  • You or gap cover pay the balance, if any
    • Gap tops this up to 500% scheme rate for in-hospital specialists, GPs and other medical professionals
    • Recommended for this plan: Plan Blue, R295pm per family where no member is older than 64yrs (otherwise, R435pm per family)
    Hospital Choice:
    • Network or R11,000 co-payment
    • No benefit
    Specialised Radiology:
    • Sublimit: R12,800 per person and R25,800 per family
    • Sublimit increased as necessary, subject to procedure being approved by medical aid
    Supplementary Services: (Physio, etc)
    • 100% scheme rate
    • Gap tops this up to 500% scheme rate for in-hospital specialists, GPs and other medical professionals, for non-PMB treatment
    Transplants:
    • No extra benefit available (PMB benefits are paid in full by medical aid)
    Co-payments:
    • N/A
    • N/A
    Alternatives to hospitals:
    • PMBs only, excludes hospice
    • No benefit
    Casualty:
    • Paid by scheme at 100% scheme rate
    • li>R550 co-payment if not PMB
    • Pays up to R20,000 per person per year for emergency medical treatment not paid for by medical aid
    Other:
    • No benefit
    • No benefit
    Note:
    • Gap cover is an add-on to your medical aid, not a stand alone product
    • Gap cover has a maximum benefit payout of R150,000 per person per year for all gap benefits (except dread disease and premium waiver benefits which do not count towards the R150,000 limit)
    • Gap only supplements payment for procedures approved or authorised by your medical aid, and does not cover “penalties” (such as if, for example, you choose a non-DSP doctor for your procedure when the plan required a DSP doctor)

    No phone calls!
    Our quote will include the right gap cover for this plan

    All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme.
    The gap benefits listed are for AskAdam gaps, unless otherwise stated. Actual benefits depend on gap choice option.

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    OUT OF HOSPITAL BENEFITS (non-PMB):
    Blue Door B
    Scheme Benefits Gap benefits
    Main: Adult: Child:
    Savings /yr: No savings option on this plan
    General info:
    • Our recommended gap cover does not pay out-of-hospital claims, unless it is for cancer treatment, dialysis, or MRI/CT scans
    GP consultations:
    • Nominated network GPs: Unlimited
    • Non-nominated network GPs: 2 consults
    • Non-network Gps: no benefit
    • No benefit
    Childcare:
    • Hearing test for newborns up to 8 weeks
    • No extra benefit available
    Specialists consultations:
    • Network specialists: 2 consults per family
    • Non-network specialists: No benefit
    • No benefit
    Pathology:
    • Unlimited subject to referral and basic protocols
    • No benefit
    General radiology:
    • Unlimited subject to referral and basic protocols
    • No benefit
    Specialised radiology:
    • No benefit, unless PMB
    • No benefit
    Supplementary Services: (Physio, etc)
    • No benefit, unless PMB
    • No benefit

    No phone calls!
    Our quote will include the right gap cover for this plan

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    MATERNITY BENEFITS:
    Blue Door B
    Scheme Benefits Gap benefits
    Hospital stay:
    • PMB level of care
    • Elective Caesarean: R11,000 co-payment
    • Co-payments paid
    Consultations:
    • 4 postnatal consultations with midwife
    • No benefit
    Scans:
    • Some scans paid for out of radiology benefit
    • No benefit

    No phone calls!
    Our quote will include the right gap cover for this plan

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    CANCER (ONCOLOGY):
    Blue Door B
    Scheme Benefits Gap benefits
    Overall coverage (in and out of hospital):
    • PMBs only
    • No benefit

    No phone calls!
    Our quote will include the right gap cover for this plan

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    DENTISTRY:
    Blue Door B
    Scheme Benefits Gap benefits
    Dentistry:
    • Standard dentistry: paid by scheme
    • Plastic dentures: 1 set per person every two years
    • Pays shortfalls and co-payments for in-hospital dentistry treatment approved by scheme
    Orthodontics:
    • You pay this out of pocket
    • No extra benefit available
    Maxillo Facial Surgery: 2018 benefits are coming soon!
    • Pays shortfalls and co-payments for any non-PMB in-hospital dentistry treatment approved by scheme. (PMB are paid in full by scheme if you use DSP)

    No phone calls!
    Our quote will include the right gap cover for this plan

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    MEDICATION:
    Blue Door B
    Scheme Benefits Gap benefits
    Chronic:
    • No. of chronic conditions covered: 27
    • Co-payment if out of formulary: 40% co-payment
    • No benefit
    Acute (presrcibed) medication:
    • Unlimited if dispensed by network GP, otherwise subject to formulary
    • No benefit
    Over-the-counter:
    • No benefit
    • No benefit
    Birth Control:
    • Oral and injectible contraceptives only, subject to formulary
    On Discharge:
    • 7 days supply
    • No benefit
    Biological:
    • No benefit
    • No benefit

    No phone calls!
    Our quote will include the right gap cover for this plan

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    OPTOMETRY:
    Blue Door B
    Scheme Benefits Gap benefits
    Optometry:
    • One test, frame and lenses per person every 2 years, subject to sub limits
    • Pays shortfalls and co-payments for any non-PMB in-hospital treatment approved by scheme. (PMBs are paid in full by scheme if you use DSP)

    No phone calls!
    Our quote will include the right gap cover for this plan

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    MENTAL HEALTH:
    Blue Door B
    Scheme Benefits Gap benefits
    In-hospital:
    • R8,400
    • No benefit
    Out-of-hospital:
    • 2 psychiatric consults per family
    • No benefit
    Trauma:
    • No benefit

    No phone calls!
    Our quote will include the right gap cover for this plan

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    OTHER BENEFITS:
    Blue Door B
    Scheme Benefits Gap benefits
    General Appliances:
    • PMBs only
    • No benefit
    1.1. Hearing Aids:
    • No benefit
    • No benefit
    1.2. Wheelchairs:
    • No benefit
    • No benefit
    Dialysis:
    • PMBs only
    HIV:
    • Treatment includes rape- and post-exposure prophylaxis
    • No benefit
    Emergency Transport: Europ Assistance
    • No benefit
    International Insurance: 2018 benefits are coming soon!
    • No benefit
    Other: 2018 benefits are coming soon!
    • No benefit

    No phone calls!
    Our quote will include the right gap cover for this plan

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    WELLNESS/PREVENTATIVE BENEFITS:
    Blue Door B
    Scheme Benefits Gap benefits
    Flu vaccination:
    • Covered
    • No benefit
    Pneumonia vaccines:
    • No benefit
    • No benefit
    Back Rehabilitation Programme:
    • No benefit
    • No benefit
    Biometric Screening:
    • Covered
    • No benefit
    Child Immunisation:
    • No benefit
    • No benefit
    Pap Smear:
    • No benefit
    • No benefit
    Mammogram:
    • No benefit
    • No benefit
    PAS Test:
    • No benefit
    • No benefit
    HIV Test:
    • Covered
    • No benefit
    Other:
    • No benefit

    No phone calls!
    Our quote will include the right gap cover for this plan

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    PROSTHETICS:
    Blue Door B
    Scheme Benefits Gap benefits
    Overal Limit:
    • External: PMBs only
    • Internal: PMBs only
    • Sublimit increased by up to R150,000 per person
    • No benefit for procedures excluded by medical aid
    Sub-limits:
    • Sublimit increased by up to R150,000 per person
    • No benefit for procedures excluded by medical aid

    No phone calls!
    Our quote will include the right gap cover for this plan


      Important!
    • Unless specified, assume that all benefits are paid are paid at 100% scheme rate
    • No limits or co-payments can apply to treatment of PMBs, which is always unlimited, although subject to strict protocols and scheme rules.
    • “Unlimited” benefits are still subject to authorisation, protocols and sublimits
    • Assume that all benefits need to be pre-authorised