Fedhealth DynamicSaver A 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:
Maxima Dynamic Saver A
Quick Overview
Main: Adult: Child:
Total Cost pm: R1,133 R1,041 R381

(Pay only for first 3)

Savings: R2,100 R1,932 R708
Gap (optional):
  • Varies. See below for specific recommendation for this plan.
In brief: See full benefits below

IN HOSPITAL PROCEDURES:
Maxima Dynamic Saver A
Scheme Benefits: Gap Benefits:
Specialists:
  • Covered in full for specialists and GPs in Fedhealth network
  • Otherwise, from day-to-day benefit
  • 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:
  • You or your gap pay R2,800 co-payment
  • Gap cover pays co-payments for procedures approved by medical aid
Supplementary Services: (Physio, etc)
  • Physio: subject to protocols
  • Dietetics, occupational therapy and speech therapy: from day-to-day benefit
  • Otherwise, 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:
  • PMBs only
  • Corneal graft: no benefit
  • No extra benefit available (PMB benefits are paid in full by medical aid)
Co-payments:
  • Adenoidectomy
  • back and neck procedures
  • bunion procedures
  • diagnostic cystoscopy
  • dental admissions
  • elective caesarean
  • gastritis, dyspepsia, heartburn
  • hysterectomy (unless for cancer)
  • laparoscopic hernia repairs, laparoscopic procedures
  • spinal surgery
  • nasal procedures
  • skin biopsy/excision
  • tonsil/adenoid procedures (over 12yrs old)
  • varicose vein procedures
  • R5,900 co-payment paid by you or by your gap cover
  • Colonoscopy, upper GI endoscopy
  • open hernia repairs
  • gastritis, dyspepsia, heartburn
  • surgical removal of wisdom teeth
  • R4,000 co-payment paid by you or by your gap cover
  • Arthroscopic procedures: R7,500 co-payment paid by you or by your gap cover
  • Gap cover pays co-payments for procedures approved by medical aid
Alternatives to hospitals:
  • Terminal care: R29,500 per family
  • Physical rehabilitation, sub-acute facilities: PMBs only
  • Nursing services, private nurse practitioners, nursing agencies: Unlimited, at negotiated rate
  • 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:
  • Post hospitalization treatment for up to 30 days after discharge, paid for by scheme. Includes physio, occupational therapy, speech therapy, ultrasounds, standard radiology and pathology
    Excluded unless PMB:
  • Adenoidectomy
  • all open hernia repairs
  • arthroscopic procedures
  • back and neck procedures
  • bunion procedures
  • cataract surgery
  • colonoscopy
  • upper GI endoscopy, diagnostic cystoscopy
  • gastritis, dyspepsia, heartburn
  • hysterectomy
  • joint replacements
  • laparoscopic hernia repairs, laparoscopic procedures
  • spinal surgery
  • nasal procedures
  • skin biopsy/excision
  • tonsil procedures
  • varicose vein procedures
  • No benefit for exclusions
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):
Maxima Dynamic Saver A
Scheme Benefits Gap benefits
Main: Adult: Child:
Savings /yr: R2,100 R1,932 R708
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:
  • From day-to-day benefit
  • No benefit
Childcare:
  • Hearing test for newborns up to 8 weeks
  • No extra benefit available
Specialists consultations:
  • Paid from day-to-day benefit, unless PMB
  • If no referral is obtained from network GP, there is a 40% co-payment
  • No benefit
Pathology:
  • Paid from day-to-day benefit, unless PMB
  • No benefit
General radiology:
  • Paid from day-to-day benefit, unless PMB
  • No benefit
Specialised radiology:
  • Unlimited, paid by scheme. R2,800 co-payment, unless PMB
  • Co-payment paid for authorised out of hospital MRI and CT Scans
Supplementary Services: (Physio, etc)
  • Paid from day-to-day 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:
Maxima Dynamic Saver A
Scheme Benefits Gap benefits
Hospital stay:
  • Specialists from network, covered at full cost. Otherwise, 100% scheme rate
  • Elective caesarean: R11,000 co-payment
  • Doula benefit: R1,270 per delivery
  • Pays up to 500% scheme rate for specialists, GPs and other medical professionals, in-hospital only
  • In-hospital sublimits increased as necessary
Consultations:
  • 4 postnatal consultations with midwife
  • Otherwise, paid from day-to-day benefit
  • No benefit
Scans:
  • Paid from day-to-day benefit
  • No benefit

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

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CANCER (ONCOLOGY):
Maxima Dynamic Saver A
Scheme Benefits Gap benefits
Overall coverage (in and out of hospital):
  • PMBs only at DSP
  • No benefit

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

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DENTISTRY:
Maxima Dynamic Saver A
Scheme Benefits Gap benefits
Dentistry:
  • From day-to-day benefit
  • Pays shortfalls and co-payments for in-hospital dentistry treatment approved by scheme
Orthodontics:
  • Paid from day-to-day benefit
  • No extra benefit available
Maxillo Facial Surgery:
  • Unlimited, subject to approval
  • 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:
Maxima Dynamic Saver A
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:
  • Paid from day-to-day benefit
  • No benefit
Over-the-counter:
  • Paid from day-to-day 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:
Maxima Dynamic Saver A
Scheme Benefits Gap benefits
Optometry:
  • Paid from day-to-day benefit
  • 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:
Maxima Dynamic Saver A
Scheme Benefits Gap benefits
In-hospital:
  • No benefit, unless PMB
  • No benefit
Out-of-hospital:
  • 2 consults paid from day-to-day benefit
  • 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:
Maxima Dynamic Saver A
Scheme Benefits Gap benefits
General Appliances:
  • Paid from day-to-day benefit, both in and out of hospital
  • No benefit
1.1. Hearing Aids:
  • Paid from day-to-day benefit
  • No benefit
1.2. Wheelchairs:
  • Paid from day-to-day benefit
  • No benefit
Dialysis:
  • PMBs only
HIV:
  • Treatment includes rape- and post-exposure prophylaxis
  • No benefit
Emergency Transport: Europ Assistance
  • No benefit
International Insurance:
  • No benefit
Other:
  • No benefit

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

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WELLNESS/PREVENTATIVE BENEFITS:
Maxima Dynamic Saver A
Scheme Benefits Gap benefits
Flu vaccination:
  • Covered
  • No benefit
Pneumonia vaccines:
  • No benefit
  • No benefit
Back Rehabilitation Programme:
  • Covered
  • No benefit
Biometric Screening:
  • Covered
  • No benefit
Child Immunisation:
  • Covered
  • No benefit
Pap Smear:
  • Covered, 21-65yrs, every 3 years
  • No benefit
Mammogram:
  • Covered, 45-74yrs, every 3 years
  • No benefit
PAS Test: 2018 benefits are coming soon!
  • 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:
Maxima Dynamic Saver A
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