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Fedhealth FlexiFED 4 Medical Aid Plan

Overall, the Fedhealth FlexiFED 4 Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and lower co-payments on several procedures to up to 3 Family Members. The Fedhealth FlexiFED 4 Medical Aid Plan starts from R3,805 ZAR.

👤 Main Member Contribution	R3,805 – R5,081
👥 Adult Dependent Contribution	R3,546 – R4,637
🍼 Child Dependent Contribution	R1,167 – R1,528
↪️ Gap Cover	None
📉 Annual Limit	Unlimited Hospital Cover
🏥 Hospital Cover	Unlimited
⬇️ Oncology Cover	R499,100
➡️ Maternity Benefits	☑️ Yes
💙 Medical Savings Account	☑️ Yes
🟦 Screening and Prevention	☑️ Yes

Fedhealth FlexiFED 4 Plan – 8 Key Point Quick Overview

✅ Fedhealth FlexiFED 4 Plan Overview
✅ Fedhealth FlexiFED 4 Plan Contributions, Annual Threshold, and Medical Savings
✅ Fedhealth FlexiFED 4 Plan Benefits and Cover Comprehensive Breakdown
✅ FlexiFED 4 Programs and Wellness Initiatives
✅ Fedhealth FlexiFED 4 Plan Exclusions and Waiting Periods
✅ Fedhealth FlexiFED 4 Plan vs. Similar Plans from other Medical Schemes
✅ Our Verdict on the Fedhealth FlexiFED 4 Plan
✅ Fedhealth FlexiFED 4 Plan Frequently Asked Questions

Fedhealth FlexiFED 4 Plan Overview

The Fedhealth FlexiFED 4 medical aid plan is one of 8, starting from R3,805 and includes lower co-payments on several procedures, higher limits on oncology and organ transplants, extended early childhood benefits, maternity, advanced dentistry, and more. Gap Cover is not available on the Fedhealth FlexiFED 4 Plan. However, Fedhealth offers 24/7 medical emergency assistance. According to the Trust Index, Fedhealth has a trust rating of 4.5.

Fedhealth offers 8 medical aid plans:

Fedhealth FlexiFED 4 Plan Contributions, Annual Threshold, and Medical Savings

Contributions – Supercharged Hospital Plan – Any Hospital

👤 Main Member	👥 +1 Dependent	🍼 +1 Child Dependent
R5,081	R4,637	R1,528

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Contributions and Annual Threshold – Supercharged Hospital Plan

🔎 Membership	💶 FlexiFED 4 Contribution	💵 Annual Threshold Level
👤 Main Member Only	R5,081	R18,500
👥 Main + Adult	R9,718	R33,700
🍼 Main + Adult + Child	R11,246	R38,200
👶 Main + Adult + 2 Children	R12,774	R42,700

Contributions – Supercharged Savings Plan

🔎 Member Option	💴 FlexiFED 4	💵 Annual Threshold	💶 Day-to-Day Available
👤 Main Member Only	R6,120	R18,500	R12,468
👥 Main + Adult	R11,537	R33,700	R21,828
🍼 Main + Adult + Child	R13,321	R38,200	R24,900
😊 Main + Adult + 2 Children	R15,164	R42,700	R28,680

Contributions – Supercharged Flexible Savings Plan

🔎 Member Option	💴 FlexiFED 4	💵 Annual Threshold	💶 Available Day-to-Day	💷 Total repayment to Fedhealth
👤 Main Member Only	R5,081	R16,800	R18,500	Total + Fedhealth savings used ÷ 12
👥 Main + Adult	R9,718	R30,600	R33,700	Total + Fedhealth savings used ÷ 12
🍼 Main + Adult + Child	R11,246	R34,700	R38,200	Total + Fedhealth savings used ÷ 12
💙 Main + Adult + 2 Children	R12,774	R38,800	R42,700	Total + Fedhealth savings used ÷ 12

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Fedhealth FlexiFED 4 Plan Benefits and Cover Comprehensive Breakdown

FlexiFED 4 Supercharged Hospital Plan and In-hospital benefits

All hospitalization-required treatments and procedures included in the flexiFED plans are covered under this benefit.
Unless otherwise specified, annual restrictions apply to an entire household.

🟥 Overall Annual Limit (OAL)	Unlimited cover at the negotiated tariff. FlexiFED 4 covers admissions to any private hospital except for the following: Zuid-Afrikaans Hospital (Tshwane) Arwyp Medical Centre (Ekurhuleni) Busamed Modderfontein Private Hospital (Johannesburg) Hibiscus Hospital (Ugu) Mooimed Private Hospital (Dr. Kenneth Kaunda) St Helena Private Hospital (Lejweleputswa) Capital Hospital (Durban) Furthermore, emergency care is free, but elective procedures incur a co-payment of R7,800.
☑️ Healthcare Professional Tariff in-hospital (HPT)	–
🟧 Fedhealth Network GPs and Specialists	Unlimited cover. Accounts will be paid in full.
🟨 Non-network GPs	Covered up to the Fedhealth Rate.
🟩 Non-Network Specialists	Covered up to the Fedhealth Rate.
🟦 Other healthcare professionals	Covered up to the Fedhealth Rate.
🟪 PMBs treatment	You must use Fedhealth Network Doctors and specialists to receive complete coverage for PMB conditions. If you choose not to use network providers, the Scheme will only reimburse you for treatment up to the Fedhealth Rate for non-network GPs and specialists. If the healthcare practitioner charges extra, you will have a shortfall.
🟥 Hospitalization Costs	Unlimited cover at the negotiated tariff. A private ward will be covered for maternity admissions if available at the negotiated tariff.
🟧 Additional medical services	Paid from Fedhealth savings or must be self-funded. The benefit will accumulate at cost towards the Threshold level.
☑️ Hospitalisation Alternatives	–
🟨 Nursing services Private nurse practitioners Nursing agencies	Unlimited according to the negotiated tariff.
🟩 Sub-acute facilities Physical Rehabilitation facilities	Unlimited according to PMB level of care.
🟦 Appliances, external accessories, and orthotics	The threshold covers up to R12,900 per family per year. The benefit is subject to the R4,860 sub-limit for foot orthotics per beneficiary. Paid from Fedhealth savings or must be self-funded. The benefit will not accumulate at cost toward the Threshold level.
🟪 Blood, Blood Equivalents, and Blood Products	Unlimited cover.
🟥 Immune Deficiency relating to HIV	Unlimited cover.
☑️ Maternity	–
🟧 Fedhealth Network GPs and Specialists	Unlimited and fully covered.
🟨 Non-network GPs and Specialists	Covered up to the Fedhealth Rate.
🟩 Other healthcare professionals	Covered up to the Fedhealth Rate.
☑️ Dentistry	–
🟦 Maxillo-Facial Surgery	Unlimited cover. Subject to approval.
🟪 Surgical extraction of impacted wisdom teeth	A co-payment of R5,100 is required.
🟥 In-hospital dentistry benefits for child beneficiaries <7	Fedhealth covers the hospital and anesthetist costs from the in-hospital benefit. The Fedhealth savings cover the dentist account, or the member must fund it.
🟧 Oncology	Limited to R499,100 at a designated service provider under the Essential protocol. Non-DSP users must pay a 25% co-payment.
🟨 Corneal Grafts	Limited to R36,300 per beneficiary.
🟩 Organ Transplants	Limited to R499,100.
🟦 Pathology and Radiology (Basic)	Unlimited up to the Fedhealth Rate.
🟪 Physiotherapy	Pre-authorization and treatment regimens apply. Subject to referral by a medical practitioner.
🟥 Psychiatric Services For Example: Accommodation in a general ward Procedures ECT Materials	Limited to R28,000 per year.
🟧 Renal Dialysis Consultations Visits All services, materials, and medicine associated with the cost of renal dialysis	Limited to R499,100 up to the Fedhealth Rate at Designated Service Provider (DSP). A 40% co-payment will apply if a DSP is not used.
🟨 Childhood illness specialized drug benefit	Childhood sickness specialized drug benefit for children under 18.
🟩 Specialized Radiology	Unlimited according to the Fedhealth rate. The first R2,630 for non-PMB MRI/CT scans is for the member’s account.
🟦 Spinal Surgery	No advantage without Conservative Back & Neck Rehabilitation Programme. The hospital co-payment is R6,690
🟪 Terminal Care Benefit	Limited to R34,500 per family per year.

FlexiFED 4 Co-Payments

Members of the Fedhealth FlexiFED 4 plan must note that the following co-payments may apply according to the procedure performed. These co-payments are for the member’s account.

Co-payments per event applicable on hospital or facility account:

✅ Arthroscopic procedures – knee, shoulder, ankle, wrist, hip: R2,970 per event.
✅ Back & neck procedures: R2,760 per event.
✅ Colonoscopy, upper GI endoscopy: R2,970 per event.

Joint Replacement Co-Payments

✅ Laparoscopic hernia repairs (bilateral inguinal, repeated inguinal hernias & Nissen/ Toupet hernia repairs only), laparoscopic procedures: R5,100 per event.
✅ Single hip and knee replacement (voluntary non-use of a CP): R31,400.
✅ Other joint replacements (voluntarily non-use of CP) for single hip and knee replacements: R7,450 per event.
✅ Spinal Surgery: R6,690 per event.
✅ Surgical extraction of impacted wisdom teeth: R5,100 per event.

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FlexiFED 4 Prothesis Benefits

External Prostheses: Limited to R12,900 at cost.
Internal Prostheses:

1️⃣ Aorta Stent Grafts	Limited to R65,500.
2️⃣ Bone lengthening devices, carotid stents, embolic protection devices, and more.	Covered under the combined benefit limit for all unlisted internal prostheses
3️⃣ Cardiac pacemakers, cardiac stents, cardiac valves	Limited to R31,000.
4️⃣ Detachable platinum coils	Limited to R56,700.
5️⃣ Elbow, hip, knee, and shoulder replacement	Limited to R31,000.
6️⃣ Total ankle replacement	Covered under the combined benefit limit for all unlisted internal prostheses
7️⃣ Intraocular lenses (per lens)	Limited to R3,500.
8️⃣ Combined benefit limit for all unlisted internal prosthesis	R27,900

FlexiFED 4 Chronic Disease Benefits

️ Chronic disease coverage is unlimited (CDL).
️ HIV/AIDS treatment for mother-to-child transmission, rape, and post-exposure prophylaxis is unlimited.

FlexiFED 4 CDL List

☑️ Addison’s Disease
☑️ Asthma
☑️ Bipolar Mood Disorder
☑️ Bronchiectasis
☑️ Cardiac Failure
☑️ Cardiomyopathy
☑️ COPD/ Emphysema/ Chronic Bronchitis
☑️ Chronic Renal Disease
☑️ Coronary Artery Disease
☑️ Crohn’s Disease
☑️ Epilepsy

and many more.

FlexiFED 4 Screening and Prevention Benefits

Women’s Health
Cervical Cancer Screening (Pap smear): One every three years for female beneficiaries between 21 and 65.

Men’s Health
Prostate Specific Antigen (PSA): One every year for male beneficiaries between 45 and 69.

Children’s Health
Immunisation Programme according to the State EPI: Various frequencies from birth to 12 years.
HPV Vaccine: Limited to two doses per lifetime for female beneficiaries between 9 to 14.
Optical Screening: One per lifetime for kids between 5 to 8.

Cardiac Health
Cholesterol screening (full lipogram): Once every five years for all beneficiaries aged 20>

Beneficiary over 45
Breast cancer screening with mammography: One every two years for all beneficiaries 45>
Colorectal cancer screening via a fecal occult blood test: One every year for beneficiaries 50 to 75.
Pneumococcal vaccines: Once per lifetime for beneficiaries 65>

General
Flu Vaccine: Once every year for all beneficiaries.
HIV finger prick test: Once every year for all beneficiaries.

Health Risk Assessment
Wellness screening (BMI, blood pressure, finger prick cholesterol, and glucose tests): Once a year for all beneficiaries.
Preventative screening (Waist-to-hip ratio, body fat percentage, flexibility, posture, and fitness): Once a year for all beneficiaries.

FlexiFED 4 Day-to-Day Benefits

💶 Tariff	Covered up to the Fedhealth rate.
💴 Co-payments in Threshold	20% co-payment.
🦻 Appliances, External Accessories, and Orthotics: For example: Hearing Aids Wheelchairs, etc.	In and out of the hospital: Fedhealth Savings or self-funding. Not threshold-accumulating. Threshold pays R12,900 per family each year. R4,860 sub-limit for foot orthotics per beneficiary.
🪡 Alternative Healthcare For example: Acupuncture Homoeopathy	Covered from available savings or must be funded by the member. Will not accumulate at a cost to the Threshold level.
⚕️ Additional Medical Services For example: Audiology Dietetics Genetic Counselling	Covered from available savings or must be funded by the member. Will not accumulate at a cost to the Threshold level. Threshold pays R12,900 per family each year.
🦷 Advanced Dentistry For example: Inlays Crowns Bridges Mounted Study Models	Covered from available savings or must be funded by the member. R8,270 per person, R24,700 per family per year before and beyond Threshold
➡️ Osseo-integrated Implants and Orthognathic Surgery	Covered from available savings or must be funded by the member. Will not accumulate at a cost to the Threshold level.
🪥 Basic Dentistry	Self-funded or paid from Fedhealth Savings. Unlimited cover once the threshold is reached.
🅰️ Fedhealth Network GPs	Paid from Fedhealth Savings, then unlimited visits to a selected network Physician after the Threshold is achieved. Each beneficiary may choose up to two network doctors. Each beneficiary is only allowed two mental health visits per year. Up to two out-of-area GP consultations per recipient per year are permitted.
🅱️ Non-network GPs	Fedhealth Savings or self-funded, plus Threshold. Threshold accumulation and refund are unlimited at the Fedhealth Rate. Each beneficiary is only allowed two mental health visits per year.
🤰 Maternity	Covered from available savings or must be funded by the member. Will accumulate at a cost to the Threshold level.
💙 Scans	Two 2D Scans
👶 Antenatal Classes	Limited up to R1,160.
💟 Antenatal and Postnatal Consultations	Twelve consults with a midwife, network GP or gynecologist
📈 Amniocentesis	The test is included in the benefit.
🙂 Fedhealth Baby Programme	Pregnant Fedhealth members and beneficiaries receive free support, guidance, and a baby pack.
😊 Doula Benefit	Fedhealth pays up to R3,000 per delivery for a doula.
🍼 Postnatal Midwifery Benefit	Four consultations with a midwife in and out-of-hospital.
✅ Pediatric Consultations	One consultation per beneficiary. For children up to 2 years. A network pediatrician must be used, and referral is not necessary.
🦻 Infant hearing Screening Benefit	Includes a screening test from birth up to 8 weeks. Covered up to the Fedhealth Rate.
💊 Childhood Illness Specialised Drug Benefit	Fedhealth covers specialized drugs for children up to 18.
📍 Appliances and devices	Fedhealth covers breast pumps and nebulizers from medical savings if there is a NAPPI code. Benefit accumulates to the Threshold on the appliances, external accessories, and orthotics limit.
🤓 Optometry	Self-funded or Fedhealth Savings. Before and after Threshold, limited to R3,740 per beneficiary, R11,400 per family per year.
🟥 Over-the-Counter Medication	Covered from available savings or must be funded by the member. Will not accumulate at a cost to the Threshold level.
🟧 Pathology	Covered from available savings or must be funded by the member. Unlimited cover once the Threshold is reached.
🟨 Physical Therapy	Self-funded or Fedhealth Savings. Not Threshold-accumulating. Threshold pays up to R12,900 per household every year for Extra Medical Services.
🟩 Prescribed Medication	Fedhealth Savings, self-funded, and Threshold cover. Before and after Threshold, R6,330 per beneficiary and R12,770 per household annually.
🟦 Basic Radiology	Covered from available savings or must be funded by the member. Unlimited cover once the threshold is reached.
🟪 Specialists (excl. Psychiatrists)	Network GP referral is required for consults Including PMB conditions. The benefit is paid from Risk benefits.
👩‍⚕️ Fedhealth Network Specialists	Covered from available savings or must be funded by the member. Unlimited at cost once the Threshold is reached. 20% co-payment for no GP referral.
👨‍⚕️ Non-network Specialists	Covered from available savings or must be funded by the member. Accumulation to and reimbursement from Threshold only up to (and including) the Fedhealth Rate. Unlimited at cost once the Threshold is reached. 20% co-payment for no GP referral.
🧠 Specialists – Psychiatrists	Network GP referral is required for consults Including PMB conditions. The benefit is paid from Risk benefits.
📌 Fedhealth Network Psychiatrists	Self-funded or paid from Fedhealth Savings. Does accumulate to the Threshold. Paid from Threshold at a cost of up to R12,900 per family per year for Extra Medical Services. If a GP referral is not obtained, a 20% co-payment is required.
📍 Non-network Psychiatrists	Self-funded or paid from Fedhealth Savings. Does not accumulate to the Threshold. Paid from the Threshold up to the Fedhealth Rate, with a maximum of R12 900 per family per year for Extra Medical Services. If a GP referral is not obtained, a 20% co-payment is required.

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FlexiFED 4 Programs and Wellness Initiatives

Fedhealth offers all FlexiFED 4 Members access to additional programs, benefits, and initiatives as indicated below.

😷 HIV Management	Fedhealth provides the AfA program to help HIV-positive members manage their illnesses. Besides paying essential drug and pathology claims, the benefits of being on the program include therapeutic and emotional assistance with strict secrecy.
↪️ Aligned	Fedhealth has teamed with Aligned to provide additional care to members suffering from critical illnesses such as advanced cancer. The benefit includes an initial consultation with a clinician trained in palliative care to examine their needs holistically. Counseling for the individual and their family is provided, as is establishing an advanced healthcare plan or living will. Three follow-up doctor visits and two follow-up social worker consultations are also provided yearly to support the member throughout their treatment.
💙 Corporate Wellness Days	Corporate wellness days allow for the creation of awareness, education, prevention, screening, and targeted interventions that encourage good lifestyle changes. These days are well-received because having these services at work is convenient for Fedhealth members. In addition to the therapeutic benefits that wellness days can bring, they allow Fedhealth to market the Scheme to clients and potential clients.
🍬 Diabetes Care	Fedhealth customers with diabetes can access a comprehensive program tailored to their specific needs and other chronic diseases. This involves ongoing access to a treating physician, authorized chronic medication, and blood and laboratory tests.
🚑 Emergency Transport/Response	In an emergency, Fedhealth will provide emergency transportation to all members through the partner Europ Assistance.
⚕️ Fedhealth Conservative Back and Neck Rehabilitation Program	Fedhealth has a well-established intervention for members experiencing back and neck pain. It is based on the notion of active muscle reconditioning and is supported by clinical research that indicates that exercise decreases discomfort and can restore function in many cases. The program offers qualifying participants customized treatment and takes a thorough and holistic approach to persistent back and neck pain. Following an initial assessment, recipients may get treatment twice a week for six weeks and a home-based long-term care protocol.
✳️ GoSmokeFree Smoke Cessation Program	Fedhealth encourages smokers to join up for GoSmokeFree at 200 pharmacies nationwide, including Dis-Chem, Clicks, and independent pharmacies. Smokers receive an annual GoSmokeFree benefit from risk benefits. Pre-quit assessment, support, and a smoking cessation strategy are included.
📈 Health Risk Assessments	This benefit identifies members at risk of lifestyle diseases. It helps them prevent or manage them with practical advice and Scheme advantages. Participating pharmacies and BASA biokinetics offer Health Risk Assessments.
💛 Hospital at Home	Fedhealth and Quro Medical’s technology-enabled Hospital at Home service offers in-patient care to patients’ homes, including real-time patient monitoring. Available in the Eastern Cape, Western Cape, Gauteng, and Bloemfontein, with further expansion planned. Fedhealth members can receive active treatment at home for a predetermined period without sacrificing care with this service.
⚠️ MediTaxi	Fedhealth users with hospital authorizations in Cape Town, Johannesburg, Pretoria, and Durban can use MediTaxi. If they cannot drive after a medical procedure, members can use the 24/7 MediTaxi service to get to follow-up appointments. Limited to two annual return trips per member/beneficiary.
👩‍⚕️ 24-Hour Nurse line	The Fedhealth toll-free 24-hour service is staffed by nurses who can advise on medical crises, symptoms, medication side effects, stress management, and teen support.
🩺 Paed-IQ	Parents of children under 14 can call Paed-IQ 24/7 for advice. This service assists parents with healthcare-related childcare difficulties.
😊 Sisters-on-Site	Fedhealth and SOS Corporate Wellness (Sisters-on-Site) provide nursing Sisters-on-Site to members’ workplaces.
📲 SOS Call Me	Fedhealth members and their dependents receive free USSD callbacks. The service offers three options, including the following: Emergency Medical Services (EMS) Nurse Line MediTaxi
💗 Weight Management Program	Fedhealth members with high BMI and waist circumference can participate in the Weight Management Plan. Members reduce weight and enjoy healthier, more fulfilling lives through a 12-week biokinetics-led intervention plan with a nutritionist and psychologist. After the program, continuous assistance and advice are offered.

Fedhealth FlexiFED 4 Plan Exclusions and Waiting Periods

FlexiFED 4 Exclusions

Fedhealth FlexiFED 4’s exclusions include but are not limited to, the following:

Art Therapy
Aromatherapy
Herbalists
Reflexology
Therapeutic massage therapy
Appliances, external accessories, and orthotics
Blood, Blood Equivalents, and Blood Products
Dentistry
Infertility
Maternity
Medicine and Injectables

FlexiFED 4 Waiting Periods

Fedhealth FlexiFED 4 typically has the following waiting periods:

General Waiting periods: This is often three months, depending on your chosen medical aid plan. During this period, you must pay your regular monthly payments. However, you are not eligible for benefits except for some PMB-related claims.
A secondary waiting period: This is typically around 12 months and pertains to therapy for any pre-existing conditions you had when you joined the program.

Fedhealth FlexiFED 4 Plan vs. Similar Plans from other Medical Schemes

🔎 Medical Aid	🥇 Fedhealth FlexiFED 4	🥈 Profmed ProSecure Savvy	🥉 Momentum Extender Plan
👤 Main Member Contribution	R5,081	R4,382	R5,544
👥 Adult Dependent Contribution	R4,637	R4,056	R9,748
🍼 Child Dependent Contribution	R1,528	R1,711	R7,173
🌎 International Cover	None	R8 million	Up to R8 million

Our Verdict on the Fedhealth FlexiFED 4 Plan

In conclusion, FlexiFED 4 is a comprehensive medical aid plan offered by Fedhealth. It provides members with various benefits to meet their healthcare needs. The plan includes in-hospital cover, chronic medication, day-to-day benefits, network providers, and a medical savings account. Members can benefit from lower co-payments on in-hospital procedures, extended oncology covers in-hospital, higher limits for increased cover, and an optical screening benefit for kids. However, the plan may not offer comprehensive coverage in hospitals in certain areas of South Africa, which can result in higher co-payments. Despite this potential drawback, FlexiFED 4 is an excellent choice for individuals and families who want comprehensive coverage and lower co-payments for in-hospital procedures.

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Fedhealth FlexiFED 4 Plan Frequently Asked Questions

What is Fedhealth FlexiFED 4?

Fedhealth FlexiFED 4 is a comprehensive medical aid plan offered by Fedhealth, providing members with various benefits to meet their healthcare needs.

What benefits does FlexiFED 4 offer?

FlexiFED 4 offers in-hospital cover, chronic medication benefits, day-to-day benefits, network providers, and a medical savings account, among other benefits.

Are there any drawbacks to FlexiFED 4?

One potential drawback is that the plan may not offer comprehensive coverage in hospitals in certain areas of South Africa, which can result in higher co-payments.

What are FlexiFED 4 chronic medication benefits?

FlexiFED 4 Chronic medication benefits cover medications prescribed for chronic conditions such as diabetes, hypertension, or asthma.

What are FlexiFED 4 day-to-day benefits?

FlexiFED 4 Day-to-day benefits cover medical expenses outside the hospital, such as doctor consultations, medication, and dental care.

What is FlexiFED 4’s extended oncology cover in-hospital?

Extended oncology cover in-hospital provides additional cover for cancer treatment received during hospital admissions, such as chemotherapy or radiation therapy.

What is the FlexiFED 4 optical screening benefit for kids?

The FlexiFED 4 optical screening benefit provides cover for eye tests for children, helping to detect any vision problems early on and ensuring proper eye health.

Adriaan Schoeman

Adriaan holds an MBA and specializes in medical aid research. With his commitment to perfection, he ensures the accuracy of all data presented on medicalaid.com every three months. When he is not conducting research, Adriaan can be found indulging in his passion for trout fishing amidst nature.