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Overall, the Fedhealth Maxima EXEC Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and comprehensive all-around cover for mature members to up to 3 Family Members. The Fedhealth Maxima EXEC Medical Aid Plan starts from R9,419 ZAR.
👤 Main Member Contribution | R9,419 |
👥 Adult Dependent Contribution | R8,176 |
🍼 Child Dependent Contribution | R2,910 |
↪️ Gap Cover | None |
📉 Annual Limit | Unlimited Hospital Cover |
🏥 Hospital Cover | Unlimited |
💶 Prescribed Minimum Benefits | ☑️ Yes |
😷 Screening and Prevention | ☑️ Yes |
💙 Medical Savings Account | ☑️ Yes |
➡️ Maternity Benefits | ☑️ Yes |
The Fedhealth Maxima EXEC medical aid plan is one of 8, starting from R9,419 and includes comprehensive all-around cover for mature members with day-to-day savings, in-hospital benefits, screening and prevention, and a threshold benefit. Gap Cover is not available on the Fedhealth Maxima EXEC 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
🔎 Membership | 📈 Risk | 💙 Savings | 💶 Total Contribution | 💵 Annual Threshold |
👤 Main Member | R8,456 | R963 monthly R11,556 annually | R9,419 | R18,100 |
👥 Adult Dependents | R7,340 | R836 monthly R10,032 annually | R8,176 | R13,800 |
🍼 Child Dependents | R2,613 | R297 monthly R3,564 annually | R2,910 | R4,700 |
🔎 Membership | 📈 Risk | 💶 Savings | 💵 Total Contribution | 💴 Annual Savings | 💷 Total Day-to-Day Funds | 📊 Annual Threshold | 📉 Self-Payment Gap (SPG) |
👤 Main | R8,456 | R963 p/m | R9,419 | R11,556 | R11,556 | R18,100 | R6,544 |
👥 Main + Adult | R15,796 | R1,799 p/m | R17,595 | R21,588 | R21,588 | R31,900 | R10,312 |
3️⃣ Main + Adult + Child | R18,409 | R2,096 p/m | R20,505 | R25,152 | R25,152 | R36,600 | R11,448 |
4️⃣ M + A + 2C | R21,022 | R2,393 p/m | R23,415 | R28,716 | R28,716 | R41,300 | R12,584 |
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🔎 Overall Annual Limit (OAL) | Unlimited cover at the negotiated tariff. Maxima EXEC 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 200% of 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 prefer not to use network providers, the Scheme will only reimburse you for non-network GP treatment up to the Fedhealth Rate and 200% of the Fedhealth Rate for non-network 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 savings for in and out-of-hospital treatment. The benefit will not accumulate at cost toward the Threshold level. Limited to R19,400 per family yearly, paid from Threshold. |
☑️ 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 | Paid from savings for in and out-of-hospital treatment Limited up to R17,300, which is paid from the threshold. There is an R4,860 sub-limit per beneficiary for foot orthotics. 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. |
☑️ Dentistry | – |
😊 Maxillo-Facial Surgery | Unlimited cover. |
🦷 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 R624,000 per family yearly at a designated service provider under the Essential protocol. Non-DSP users must pay a 25% co-payment. When non-DSP providers are used, reimbursement is according to the Fedhealth Rate. |
📍 Corneal Grafts | Limited to R36,300 per family yearly. |
❤️ Organ Transplants | Limited to R624,000 per family yearly. |
📈 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 Accommodation in a general ward Procedures ECT Materials Hospital Equipment Consultations and Visits Medicines Injectable Material | Limited to R35,800 per family yearly. |
➡️ Renal Dialysis Consultations Visits All services, materials, and medicine associated with the cost of renal dialysis | Limited to 624,000 up to the Fedhealth Rate at Designated Service Provider (DSP). A 40% co-payment will apply if a DSP is not used. |
💉 Specialized Medication Benefit | Up to R194,600 per family yearly, paid at cost. |
💊 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 benefit without Conservative Back & Neck Rehabilitation Programme. The hospital co-payment is R6,300. |
💟 Terminal Care Benefit | Limited to R34,500 per family per year. |
Members of the Fedhealth Maxima EXEC plan must note that the following co-payments may apply according to the procedure performed. These co-payments are for the member’s account.
1️⃣ Arthroscopic procedures – hip, wrist, knee, shoulder, ankle, other arthroscopic procedures, colonoscopy, upper GI endoscopy | R2,970 per event. |
2️⃣ Other joint replacements, laparoscopic hernia repairs (bilateral inguinal, repeated inguinal hernias & Nissen/Toupet hernia repairs only), laparoscopic procedures, rhizotomies, and facet pain blocks (limited to 1 of either procedure per beneficiary per year), surgical extraction of impacted wisdom teeth | R5,100 per event. |
3️⃣ Spinal Surgery | R6,690 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 | R5,100 per event. |
🟥 Aorta Stent Grafts | Limited to R65,500 per family yearly. |
🟧 Bi-ventricular pacemakers and implantable cardioverter defibrillators (ICDs), bone lengthening devices, carotid stents, embolic protection devices, other approved spinal implantable devices, and intervertebral discs, peripheral arterial stent-grafts, spinal plates, and screws, total ankle replacement | Covered under the combined benefit limit for all unlisted internal prostheses |
🟨 Cardiac pacemakers | Covered up to R54,500 per family yearly. |
🟩 Cardiac stents | Covered up to R56,100 per family yearly. |
🟦 Cardiac valves | Covered up to R49,800 per family yearly. |
🟪 Detachable platinum coils | Limited to R56,700 per family yearly. |
🟥 Elbow, hip, knee, and shoulder replacement | Limited to R38,900 per family yearly. |
🟧 Intraocular lenses (per lens) | Limited to R3,500 per family yearly. |
🟨 Combined benefit limit for all unlisted internal prosthesis | Limited to R32,700 per family yearly. |
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🔎 Tariff | Covered up to the Fedhealth rate. |
💶 Co-payments in Threshold | 10% 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 R17,300 per family each year. R4,860 sub-limit for foot orthotics per beneficiary. |
📌 Alternative Healthcare Acupuncture Homoeopathy Naturopathy Osteopathy Phytotherapy | Covered from available savings. Will not accumulate at a cost to the Threshold level. |
📍 Additional Medical Services Audiology Dietetics Genetic Counselling Hearing Aid Acoustics Occupational Therapy Orthoptics Podiatry Private Nursing Psychologists Social Workers Speech Therapy | Covered from available savings. Will not accumulate at a cost to the Threshold level. Threshold pays R19,400 per family each year. |
🦷 Advanced Dentistry Inlays Crowns Bridges Mounted Study Models Metal Base Partial Dentures Oral Surgery Orthodontic Treatment Periodontists Prosthodontists Dental Technicians | Covered from available savings. R8,270 per person, R24,700 per family per year before and beyond Threshold |
🟥 Osseo-integrated Implants and Orthognathic Surgery | Covered from available savings. Will not accumulate at a cost to the Threshold level. |
🟧 Basic Dentistry | Covered from available savings. Unlimited cover once the threshold is reached. |
🟨 General Practitioners | – |
🟩 Fedhealth Network GPs | Paid from 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 | Paid from savings, 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. |
☑️ Early Childhood Benefits | – |
✅ 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 | Paid from savings and Threshold. Before and after Threshold, limited to R3,740 per beneficiary, R11,400 per family per year. |
🅰️ Over-the-Counter Medication | Covered from available savings. 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 | Paid form available savings. Not Threshold-accumulating. Threshold pays up to R19,400 per household every year for Extra Medical Services. |
💊 Prescribed Medication | Fedhealth Savings, self-funded, and Threshold cover. Before and after Threshold, R7,940 per beneficiary and R14,700 per household annually. |
🧪 Basic Radiology | Paid from Risk if pre-approval is obtained. The member must pay the first R2,630 if scans are non-PMB (MRI or CT). |
🧠 Specialists (excl. Psychiatrists) | – |
👩⚕️ Fedhealth Network Specialists | Covered from available savings. Contributes to the threshold at cost. Unlimited at cost once the Threshold is reached. 10% co-payment for no GP referral. |
👨⚕️ Non-network Specialists | Covered from available savings. Contributes to the threshold at cost. Unlimited at cost once the Threshold is reached. 10% 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 | Covered from available savings. Does not contribute to the Threshold. There is an additional Medical Services limit of R19,400 per family per year. Unlimited at cost once the Threshold is reached. 10% co-payment for no GP referral. |
💟 Non-network Psychiatrists | Covered from available savings. Does not contribute to the Threshold. There is an additional Medical Services limit of R19,400 per family per year. Unlimited at cost once the Threshold is reached. 10% co-payment for no GP referral. |
Fedhealth offers all Maxima EXEC 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. Members can use the 24/7 MediTaxi service for follow-up appointments if they cannot drive after a medical procedure. 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 Maxima EXEC’s exclusions include, but are not limited to, the following:
and many more.
Fedhealth Maxima EXEC typically has the following waiting periods:
Discover more about Medical Insurance Summary
🔎 Medical Aid Plan | 🥇 Fedhealth Maxima EXEC | 🥈 Medihelp MedElite | 🥉 Discovery Health Classic Comprehensive |
👤 Main Member Contribution | R9,419 | R | R8,381 |
👥 Adult Dependent Contribution | R8,176 | R | R7,927 |
🍼 Child Dependent Contribution | R2,910 | R | R1,671 |
↪️ Gap Cover | ❎ None | ❎ None | ☑️ Yes |
🚑 Hospital Cover | ☑️ Yes | ☑️ Yes | ☑️ Yes |
The Fedhealth Maxima EXEC plan is a comprehensive medical aid plan offered by Fedhealth, a leading medical scheme in South Africa. This plan offers extensive benefits, including unlimited private hospital coverage, chronic medication coverage, and generous day-to-day benefits for consultations, prescriptions, and other medical expenses. The Maxima EXEC plan also includes a range of value-added benefits, such as maternity benefits, preventative care, and access to Fedhealth’s wellness program. In addition, members can choose to add additional benefits, such as dental coverage and travel insurance, to their plan.
One of the main advantages of the Maxima EXEC plan is its extensive coverage, which provides members with access to high-quality healthcare services when they need it most. The plan also offers a wide range of benefits and value-added services to help members manage their health and well-being over the long term. However, the Maxima EXEC plan is also one of the most expensive medical aid plans offered by Fedhealth and may not be affordable for everyone. In addition, some members may find that they do not need all of the benefits offered by the plan and might be better suited to a lower-tier plan with more limited benefits and lower premiums.
You might also consider the following options FedHealth has to offer:
The Fedhealth Maxima EXEC plan is a comprehensive medical aid plan offered by Fedhealth that provides extensive healthcare coverage, including unlimited private hospital coverage, chronic medication coverage, and day-to-day benefits.
The Maxima EXEC plan offers a range of benefits, including private hospital cover, chronic medication cover, and day-to-day benefits for consultations, prescriptions, and other medical expenses. It also includes value-added services like maternity benefits, preventative care, and Fedhealth’s wellness program access.
Maxima EXEC costs R9,419 for the main member, R8,176 for an adult, and R2,910 for a child dependent.
You do not need to add dental cover because basic and advanced dentistry is covered under the Maxima EXEC plan.
Travel insurance is not included in the Maxima EXEC plan. However, members can add it as an optional extra to their plan.
Yes, the Maxima EXEC plan includes chronic medication coverage for various chronic conditions.
Yes, there are waiting periods for certain benefits under the Maxima EXEC plan. For example, there is a 3-month general waiting period and a 12-month waiting period for pre-existing conditions.
Yes, the Maxima EXEC plan members have the freedom to choose their own healthcare providers.
Yes, the Maxima EXEC plan includes preventative care benefits like wellness screenings and vaccinations.
Yes, you can change your Fedhealth plan to the Maxima EXEC plan during the annual open enrollment period or in certain qualifying life events.
Yes, the Maxima EXEC plan covers a range of alternative therapies, including acupuncture, chiropractic, and osteopathy.
Yes, there are annual limits on the day-to-day benefits offered under the Maxima EXEC plan, but these limits are quite generous.
Yes, you can get a quote for the Maxima EXEC plan by visiting the Fedhealth website and filling out a quote request form.
Yes, there are certain exclusions under the Maxima EXEC plan, such as cosmetic surgery and experimental treatments.
No, you can only cancel your Maxima EXEC plan during the annual open enrollment period or in certain qualifying life events.
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