Fedhealth Ultimax 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:
Ultimax
Quick Overview
Main: Adult: Child:
Total Cost pm: R10,306 R8,761 R3,150
Savings: R6,432 R5,460 R1,968
Self Payment:
(per year, if you use up all your savings)
R8,143 R5,629 R1,728
Above Threshold: Once your savings are depleted, and you have paid the self payment gap, scheme will cover most out of hospital expenses at scheme rate, with sublimits for some benefits.
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
Children: Pay for maximum 3 children
See full benefits below

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IN HOSPITAL PROCEDURES:
Ultimax
Benefits Gap benefits
Payout Rate for Specialists:
  • 300% scheme rate
  • Network specialists and GPs covered in full
Fusion Gap:
  • Up to 800% 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.
Hospital Choice:
  • Unlimited
  • N/A
Specialised Radiology: 2018 benefits are coming soon!
Supplementary Services: (Physio, etc) 2018 benefits are coming soon! Fusion Gap:
  • Up to 800% scheme rate for specialists and other providers
Transplants: 2018 benefits are coming soon!
Co-payments:
  • N/A
  • N/A
Alternatives to hospitals: 2018 benefits are coming soon!
Casualty: 2018 benefits are coming soon!
  • 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!
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OUT OF HOSPITAL BENEFITS:
Ultimax
Benefits Gap benefits
GP consultations: 2018 benefits are coming soon!
  • No benefit
Childcare:
  • No benefit
Specialists consultations: 2018 benefits are coming soon!
  • No benefit
Pathology: 2018 benefits are coming soon!
  • No benefit
General radiology: 2018 benefits are coming soon!
  • No benefit
Specialised radiology: 2018 benefits are coming soon!
  • No benefit
Supplementary Services: (Physio, etc) 2018 benefits are coming soon!
  • No benefit
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MATERNITY BENEFITS:
Ultimax
Benefits Gap benefits
Hospital stay: 2018 benefits are coming soon!
  • 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
Consultations: 2018 benefits are coming soon!
  • No benefit
Scans: 2018 benefits are coming soon!
  • No benefit
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CANCER (ONCOLOGY):
Ultimax
Benefits Gap benefits
Overall coverage (in and out of hospital): 2018 benefits are coming soon!
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DENTISTRY:
Ultimax
Benefits Gap benefits
Dentistry: 2018 benefits are coming soon!
  • Dental reconstruction due to due to trauma or oncology treatment: R40,000 per event
  • Full cover for in-hospital co-payments
Orthodontics: 2018 benefits are coming soon!
  • No benefit
Maxillo Facial Surgery: 2018 benefits are coming soon!
  • Dental reconstruction as result of trauma or oncology: R40,000 per event
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MEDICATION:
Ultimax
Benefits Gap benefits
Chronic: 2018 benefits are coming soon!
  • No benefit
Acute (presrcibed) medication:
  • No benefit
Over-the-counter:
  • No benefit
Birth Control:
On Discharge:
  • No benefit
Biological:
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OPTOMETRY:
Ultimax
Benefits Gap benefits
Optometry: 2018 benefits are coming soon!
  • No benefit
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MENTAL HEALTH:
Ultimax
Benefits Gap benefits
In-hospital: 2018 benefits are coming soon!
Out-of-hospital: 2018 benefits are coming soon!
Trauma:
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OTHER BENEFITS:
Ultimax
Benefits Gap benefits
General Appliances: 2018 benefits are coming soon!
  • No benefit
1.1. Hearing Aids: 2018 benefits are coming soon!
  • No benefit
1.2. Wheelchairs: 2018 benefits are coming soon!
  • No benefit
Dialysis: 2018 benefits are coming soon!
HIV: 2018 benefits are coming soon!
  • 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:
Ultimax
Benefits Gap benefits
Flu vaccination:
  • Covered
  • No benefit
Pneumonia vaccines: 2018 benefits are coming soon!
  • 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
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PROSTHETICS:
Ultimax
Benefits Gap benefits
Overal Limit:
Sub-limits:
  • 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