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20/04/2022

5 Ways to Avoid Co-Payments with Fedhealth

Saving Tips in 2022

1. Use a Network Facility on Network Options

Members on network options, i.e. myFED, flexiFED 1 and the three GRID options (flexiFED 2GRID, flexiFED 3GRID and flexiFED 4GRID), need to use hospitals and day surgery facilities on the relevant network for all elective procedures in order to avoid a co-payment of either R13 000, R7 300 or R2 100, depending on your option:

  • On flexiFED 1, the co-payment is R7 300 for using non-network hospitals and R2 100 for use of non-network day surgery facilities.
  • On myFED, the co-payment is R13 000 for using non-network hospitals and R2 100 for using non-network day surgery facilities.
  • On the GRID options, the co-payment is R13 000 for using non-network hospitals and R2 100 for use of non-network day surgery facilities.

You can find network facilities using the locator. Go to www.fedhealth.co.za/network-hospital-list/

2. These 7 hospitals WILL attract a co-payment for electives

flexiFED 2, 3 and 4 covers all admissions at any private hospital except the following seven hospitals:

Zuid-Afrikaans Hospital (City of Tshwane), Arwyp Medical Centre (Ekurhuleni), Busamed Modder- fontein Private Hospital (City of Johannesburg), Hibiscus Hospital (Ugu), Mooimed Private Hospital (Dr Kenneth Kaunda), St Helena Private Hospital (Lejweleputswa) and Capital Hospital (Durban), which will not be covered in full for 2022

3. Use a Network Doctor for In-Hospital Treatment

Fedhealth Network GPs and specialists are covered in full, and non-network GPs and specialists are covered up to the Fedhealth Rate.

All Fedhealth options have a GP and specialist network applicable. Should you choose not to use network providers, they will only refund treatment up to the Fedhealth Rate for non-network GPs and specialists. You will have a shortfall should the healthcare professional charge more.

Go to www.fedhealth.co.za/provider-locator to find network providers in your area.

4. Use the Correct Formulary and Medication within Medicine Price List (MPL)

All Fedhealth options have a benefit for the 27 chronic conditions on the Prescribed Minimum Benefit Chronic Disease List (CDL). The benefit covers medicine for the list of CDL conditions paid from a formulary. Conditions on the CDL are covered in full, as long as you use medicine on the formulary applicable to your option. If medicine on the formulary isn’t used, you will have to pay a 40% co-payment on the cost of the medicine. Click here to see the formularies.

5. Use a Preferred Provider for Chronic Medicine

myFED, flexiFED 1 and flexiFED 2GRID

Members must obtain chronic medicine from one of the Scheme’s designated service providers. If they don’t, they may have to pay a co-payment if the pharmacy charges a dispensing fee in excess of 25% / R26.50, or in the case of courier pharmacies, the agreed courier rate. Fedhealth’s designated service providers for these options are Clicks, DisChem, Medirite and the following courier pharmacies: Clicks Direct Medicines, DisChem Direct, Medirite Courier Pharmacy and Pharmacy Direct.

Elect option variants

Members must obtain chronic medicine from one of the Scheme’s designated service providers. If they don’t, they may have to pay a co-payment if the pharmacy charges a dispensing fee in excess of the agreed courier rate. Fedhealth’s designated service providers for Elect options are the following courier pharmacies: Clicks Direct Medicines, DisChem Direct, Medirite Courier Pharmacy and Pharmacy Direct.

All other flexiFED and maxiFED options

Members can obtain their chronic medicine from any of our preferred provider pharmacies namely Clicks, DisChem, Medirite and the following courier pharmacies: Clicks Direct Medicines, DisChem Direct, Medirite Courier Pharmacy and Pharmacy Direct. These preferred provider pharmacies ensure price certainty for members when obtaining medication.

Members may also use any other pharmacy including independent pharmacies, however if a dispensing fee in excess of 25% / R26.50 is charged, the member will have to pay the difference.

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