flexiFED 2 Member Guide 01 - fedhealth.co.za

1 We let you be YOU. 2019. flexiFED 2. Contents 1 Overview of benefits 5 Procedures performed in day wards, day clinics and doctor's rooms 18. Examples of what each benefit covers 6 Doctor appointments with network GPs when your Savings has run out 18. Risk and Savings benefits 8 Female contraception 18. Some important words 9 Some treatment after a hospital visit 19. About healthcare providers 9 Medicine you get while in hospital to take at home 19. About medicines and payment for medicines 9 Treatment in the 30 days after your hospital visit (post-hospitalisation benefit) 19.

2 About limits to what we pay 9 Prosthesis benefit table 19. About treatment and payment for treatment 9 External prosthesis 19. 360 Care: Let the healing begin (with your GP) 10 Internal prosthesis 19. Prescribed Minimum Benefits (basic level of cover for a defined set of conditions) 10 flexiFED 2 GRID network hospitals 21 2 Emergencies 11 flexiFED 2 GRID network day clinics 23. You are covered for emergency medical expenses 11 flexiFED 2 Elect network hospitals 25. Emergency medical services: call 0860 333 432 11 4 To have hospital or other treatment covered by the Core Benefit Bundle 26.

3 You must contact us within two working days if it was an emergency 11 You must have authorisation 26. Contact us within two working days if you needed trauma treatment 12 Contact us at least 48 hours before the hospital stay or the procedure 26. 3 Hospital visits and treatment paid from the Core Benefit Bundle 13 When you contact us, have this information ready 26. About limits and co-payments for hospital stays 13 5 Screening and immunisation benefits 27. No overall yearly limit 13 Screening benefit 27. There are limits and restrictions for specific treatments and conditions 13 Active Disease Risk Management programmes 28.

4 Where a co-payment will apply for not using a network hospital 13 Immunisation benefit for children 28. Different cover for different types of hospital treatments 13 6 Chronic medicine (covered by Chronic Disease Benefit) 29. Hospital costs we cover in full 13 What is chronic medicine? 29. Medicine you receive in hospital 13 Limits 29. Doctor visits while you're in hospital 14 To claim under this benefit 29. Blood and pathology services while you're in hospital 15 List of chronic conditions 29. Maternity benefit 15 Conditions that are on the CDL 29.

5 Spinal surgery 15 If your condition is on the Prescribed Minimum Benefit chronic conditions list 30. Oncology (cancer) 16 Cover for treatment for HIV/Aids 31. Full cover for services through ICON 16 How to apply for the Chronic Disease Benefit 31. If you have reached your limit for the Oncology benefit 16 Step 1: Collect the information needed to apply 31. Limits for specific treatments 16 Step 2: Apply 31. Oncology Disease Management Programme (ODM) 16 Step 3: We will give you a response right away 31. Specialised radiology (for example, MRI or CT scans) 16 Step 4: You get your medicine access card 31.

6 Other treatments or procedures that you receive in hospital 17 We will give you treatment guidelines 32. 01 Some treatment and procedures done out of hospital 18 If there is a co-payment on your medicine 32 02. Services like physical rehab and treatment in sub-acute facilities 18 We will approve a chronic condition, not individual chronic medications 32. Nursing instead of hospitalisation 18 Chronic medication delivered to your door 32. Contents 7 Paying for day-to-day expenses (Day-to-Day Benefits) 33 Who can be registered as a dependant 49.

7 The basics of the savings account for day-to-day medical expenses 33 Criteria for children 49. The Savings Account 33 Adding a newborn baby 49. You must pay when the Savings Account runs out 33 You must give us these documents for registering dependants 49. The MediVault and Wallet 33 Membership cards 50. How do you activate your MediVault and transfer funds into your Wallet? 33 Removing a dependant from your membership 50. MediVault transfers to Wallet 33 How we communicate with you 50. When will funds be available in my Wallet? 33 We email and SMS your claim status 50.

8 How is the instalment paid back? 34 Make sure we have your correct email address and cell number 50. What will happen if there is membership movement? 34 You can find your claim and benefit information on our website 50. My MediVault 34 You can message Fedhealth free of charge with the FedChat Mobile App 51. Benefit Maximiser 34 Fedhealth Family Room 51. Cover for doctors, specialists and medicines 35 Microsite 51. GPs in the Fedhealth network 35 flexiFED 2, flexiFED 2 GRID. and flexiFED 2 contributions table Elect 52. How to nominate a GP 35 Option changes 53.

9 GPs not in the Fedhealth network 35 You can upgrade to a higher option 53. Specialists in the Fedhealth network 35 Paying for your medical aid 53. Specialists not in the Fedhealth network 35 You must pay by the third of each month 53. Prescribed medicine 35 Our bank details 53. Dispensing fees for prescribed medicine 35 Leaving the scheme 54. over -the-counter medicine 36 Three months of notice to leave 54. Female contraception 36 Last contribution 54. Optometry 36 Amount in Savings Account if you spent less than you paid in 54. Pregnancy 36 Amount in Savings Account if you spent more than you paid in 54.

10 Specialised radiology (for example, MRI or CT scans) 36 Whistle-blowing on fraud 54. Basic Dentistry 36 10 Extra services 55. All cover in day-to-day benefits 39 24-hour Nurse Line on 0860 333 432 55. Dental Codes 41 MediTaxi 55. 8 How to claim 47 SOS call me 55. If the healthcare professional or the hospital claims on your behalf 47 Fedhealth Baby 56. If you need a refund because you paid the medical expense 47 Paed-IQ 56. You must claim within four months of the date of the treatment 47 11 Service centres and contact details 57. Send your claims to 47 Medscheme Client Service Centres 57.