Fedhealth Blue Door C medical aid plan: 2017 vs 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 C
2018 costs In brief:
What’s new in 2018?
Main: Adult: Child:
Cost 2018: R1,500 R1,269 R568
Cost 2017: (R1,380) (R1,145) (R522)
Gap (optional): KaeloXelus: R350 per family
(R600 per family if anyone is 60yrs+)
Overal Limit: Unlimited
PMBs: Day-to-day expenses for PMBs (eg. cancer) are always paid for by the scheme, according to protocols. Find out more
Savings: No savings option on this plan
Children: Pay for all children
Income band: This plan is only available to households with income in R9,096-R11,235pm band.
View other income bands
    In 2018, with this plan:
  • Scheme pays for newborn hearing test
  • Maternity at PMB level of care, and co-payment for elective caesarean
  • Specialised radiology limit increased
See below for other changes
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Avoid bills! Get up to: 800% scheme rate;  R12,800 per ER visit; unlimited cancer cover;  

co-payments paid and cash payout for hospital stay. R350pm per family


IN HOSPITAL PROCEDURES:
Blue Door C
2017 v 2018 benefits Gap benefits Notes
Payout Rate for Specialists:
  • Network specialists and GPs covered in full
  • Otherwise,100% scheme rate, limited to R2,116 per person
  • Fusion Gap:
    • Up to 600% scheme rate for specialists and other providers
    • In case of admission related to accident:
      -R300 per day, for days 1-13
      -R600 per day for days 14-20
      -R1,200 per day for days 21-30
    • R350pm per family. More Info or download application below.

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    Hospital Choice:
    • Network
    • or R11,000 co-payment
    Fusion Gap:
    • R12,800 per person per year for use of a non-network hospital
    Specialised Radiology:
    • Co-payment: none
    • Sublimit: R12,800 per person and R25,800 per family
    • Rate: 100% scheme rate
    Supplementary Services: (Physio, etc)
    • 100% scheme rate
    Fusion Gap:
    • Up to 600% scheme rate for specialists and other providers
    Transplants:
    • PMBs only
    Co-payments:
    • N/A
    • N/A
    Alternatives to hospitals:
    • PMBs only, excludes hospice
    Casualty:
    • Paid by scheme at 100% scheme rate
    • li>R550 co-payment if not PMB
    • Casualty costs not covered by medical aid, in case of emergency treatment: R12,800 per incident. Cover also applies to costs covered by savings account.
    Other: 2018 benefits are coming soon!
    • N/A
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    OUT OF HOSPITAL BENEFITS:
    Blue Door C
    2017 v 2018 benefits Gap benefits Notes
    GP consultations:
    • Nominated network GPs: Unlimited
    • Non-nominated network GPs: 2 consults
    • Non-network Gps: no benefit
    • No benefit


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    Childcare:
    • Hearing test for newborns up to 8 weeks
    • No benefit
    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
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    MATERNITY BENEFITS:
    Blue Door C
    2017 v 2018 benefits Gap benefits Notes
    Hospital stay:
    • PMB level of care
    • Elective Caesarean: R11,000 co-payment
    • Premature birth, more than 6 weeks:R12,000 lump payment
    • In case of admission related to premature birth:
      • R300 per day, for days 1-13
      • R600 per day for days 14-20
      • R1,200 per day for days 21-30

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    Consultations:
    • 4 postnatal consultations with midwife
    • No benefit
    Scans:
    • Some scans paid for out of radiology benefit
    • No benefit
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    CANCER (ONCOLOGY):
    Blue Door C
    2017 v 2018 benefits Gap benefits Notes
    Overall coverage (in and out of hospital):
    • PMBs only
    • No benefit
    All oncology benefits are assessed on a case-by-case basis, and are subject to protocols, preferred providers and scheme rules. Benefit covers out-of-hospital treatment too, like chemotherapy.
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    DENTISTRY:
    Blue Door C
    2017 v 2018 benefits Gap benefits Notes
    Dentistry:
    • Standard dentistry: paid by scheme
    • Plastic dentures: 1 set per person every two years
    • Dental reconstruction due to due to trauma or oncology treatment: R40,000 per event
    • Full cover for in-hospital co-payments

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    Orthodontics:
    • No benefit
    • No benefit
    Maxillo Facial Surgery: 2018 benefits are coming soon!
    • Dental reconstruction as result of trauma or oncology: R40,000 per event

    Avoid bills! Get up to: 800% scheme rate;  R12,800 per ER visit; unlimited cancer cover;  

    co-payments paid and cash payout for hospital stay. R350pm per family

    MEDICATION:
    Blue Door C
    2017 v 2018 benefits Gap benefits Notes
    Chronic:
    • No. of chronic conditions covered: 27
    • Co-payment if out of formulary: 40% co-payment
    • No benefit

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    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
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    OPTOMETRY:
    Blue Door C
    2017 v 2018 benefits Gap benefits Notes
    Optometry:
    • One test, frame and lenses per person every 2 years, subject to sub limits
    • No benefit

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    MENTAL HEALTH:
    Blue Door C
    2017 v 2018 benefits Gap benefits Notes
    In-hospital:
    • R8,400

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    Out-of-hospital:
    • 2 psychiatric consults per family
    Trauma:
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    OTHER BENEFITS:
    Blue Door C
    2017 v 2018 benefits Gap benefits Notes
    General Appliances:
    • PMBs only
    • No benefit

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    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:
    • No benefit
    International Insurance: 2018 benefits are coming soon!
    • No benefit
    Other: 2018 benefits are coming soon!
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    WELLNESS/PREVENTATIVE BENEFITS:
    Blue Door C
    2017 v 2018 benefits Gap benefits Notes
    Flu vaccination:
    • Covered
    • No benefit

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    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

    Avoid bills! Get up to: 800% scheme rate;  R12,800 per ER visit; unlimited cancer cover;  

    co-payments paid and cash payout for hospital stay. R350pm per family

    2017 v 2018 benefits Gap benefits Notes
    Overal Limit:
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    Sub-limits:
    • External: PMBs only
    • Internal: PMBs only
    • An additional R40,000 per sublimit, per event

      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