Fedhealth Ultimax 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:
Ultimax
2018 costs In brief:
What’s new in 2018?
Main: Adult: Child:
Cost 2018: R10,306 R8,761 R3,150
Cost 2017: (R9,215) (R7,829) (R2,765)
Gap (optional): KaeloXelus: R350 per family
(R600 per family if anyone is 60yrs+)
Overal Limit: Unlimited overall, with sub-limits
PMBs: Day-to-day expenses for PMBs (eg. cancer) are always paid for by the scheme, according to protocols. Find out more
Savings: R6,432 R5,460 R1,968
Self Payment: R8,143 R5,629 R1,728
Above Threshold: Unlimited overall, with sublimits for some benefits. Find out more
Children: Pay for maximum 3 children

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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:
Ultimax
2017 v 2018 benefits Gap benefits Notes
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.

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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
2017 v 2018 benefits Gap benefits Notes
GP consultations: 2018 benefits are coming soon!
  • No benefit


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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
2017 v 2018 benefits Gap benefits Notes
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

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Consultations: 2018 benefits are coming soon!
  • No benefit
Scans: 2018 benefits are coming soon!
  • No benefit
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CANCER (ONCOLOGY):
Ultimax
2017 v 2018 benefits Gap benefits Notes
Overall coverage (in and out of hospital): 2018 benefits are coming soon! 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:
Ultimax
2017 v 2018 benefits Gap benefits Notes
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

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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

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:
Ultimax
2017 v 2018 benefits Gap benefits Notes
Chronic: 2018 benefits are coming soon!
  • No benefit

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Acute (presrcibed) medication:
  • No benefit
Over-the-counter:
  • No benefit
Birth Control:
On Discharge:
  • No benefit
Biological:
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OPTOMETRY:
Ultimax
2017 v 2018 benefits Gap benefits Notes
Optometry: 2018 benefits are coming soon!
  • No benefit

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MENTAL HEALTH:
Ultimax
2017 v 2018 benefits Gap benefits Notes
In-hospital: 2018 benefits are coming soon!
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Out-of-hospital: 2018 benefits are coming soon!
Trauma:
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OTHER BENEFITS:
Ultimax
2017 v 2018 benefits Gap benefits Notes
General Appliances: 2018 benefits are coming soon!
  • No benefit

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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
2017 v 2018 benefits Gap benefits Notes
Flu vaccination:
  • Covered
  • No benefit

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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

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:
  • 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