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.

Ultimax
2018 Costs:
Total Cost pm:

Main member:

R10,306

Adult:

R8,761

Child: (Pay only for first 3)

R3,150
Savings Account (yr): R6,432 R5,460 R1,968
Self Payment Gap:
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.
2019 Costs:
Total Cost pm:

Main member:

R
(%)

Adult:

R

Child: (Pay only for first 3)

R
Self Payment Gap:
R R R
In brief (2018): See full benefits below

IN HOSPITAL PROCEDURES:
Ultimax
Scheme Benefits: Gap Benefits:
Specialists:
  • 100% scheme rate
  • Network specialists covered in full
  • 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:
  • Choose any hospital
  • No benefit
Specialised Radiology: 2018 benefits are coming soon!
Supplementary Services: (Physio, etc) 2018 benefits are coming soon! .
Transplants: 2018 benefits are coming soon!
Co-payments:
  • N/A
  • N/A
Alternatives to hospitals: 2018 benefits are coming soon!
  • No benefit
Casualty: 2018 benefits are coming soon!
  • Pays up to R20,000 per person per year for emergency medical treatment not paid for by medical aid
Other: 2018 benefits are coming soon!
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):
Ultimax
Scheme Benefits Gap benefits
Main: Adult: Child:
Savings /yr: 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.
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: 2018 benefits are coming soon!
  • No benefit
Childcare:
  • No extra benefit available
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

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

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MATERNITY BENEFITS:
Ultimax
Scheme Benefits Gap benefits
Hospital stay: 2018 benefits are coming soon!
  • Pays up to 500% scheme rate for specialists, GPs and other medical professionals, in-hospital only
Consultations: 2018 benefits are coming soon!
  • No benefit
Scans: 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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CANCER (ONCOLOGY):
Ultimax
Scheme Benefits Gap benefits
Overall coverage (in and out of hospital): 2018 benefits are coming soon!
  • Once you or the medical scheme have spent R200,000 per oncology treatment cycle from a private hospital, your sublimits increase as necessary. More info

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

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DENTISTRY:
Ultimax
Scheme Benefits Gap benefits
Dentistry: 2018 benefits are coming soon!
  • Pays shortfalls and co-payments for in-hospital dentistry treatment approved by scheme
Orthodontics: 2018 benefits are coming soon!
  • 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:
Ultimax
Scheme 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:

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

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OPTOMETRY:
Ultimax
Scheme Benefits Gap benefits
Optometry: 2018 benefits are coming soon!
  • 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:
Ultimax
Scheme Benefits Gap benefits
In-hospital: 2018 benefits are coming soon!
  • No benefit
Out-of-hospital: 2018 benefits are coming soon!
  • 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:
Ultimax
Scheme 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: 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:
Ultimax
Scheme 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

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

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PROSTHETICS:
Ultimax
Scheme Benefits Gap benefits
Overal Limit:
  • 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