I have a number of clients that are on Fedhealth and would like to bring their attention to a change that has a significant affect on their cover for 2012.
The change relates to the Maxima Standard plan and specifically to the percentage cover that the plan offers for specialists used in-hospital. What Fedhealth decided was to decrease this to 100 % of medical aid rates for non-Fedhealth specialist partners. What they are doing is forcing members to make use of their specialist network. If you choose to use an out-of-network specialist you will be liable for the charges in excess of the 100 %.
The expected shortfall is easy to cover through taking out a top-up product of which there are many. The ones that we make use of are the Stratum and Turnberry options. I tend to focus more on the Stratum service offering as I am on it personally, and have had good experiences when dealing with and claiming from them.
What is top-up cover?
Top-up cover is medical insurance and is not a medical aid. Medical insurance fills the gap between what your medical aid covers and what a provider charges, including what is discussed above. Medical insurance can also cover co-payments and deductibles that one incurs on specific procedures (invaluable if you are on Medihelp or Discovery’s Priority plans). There are also options that increase sub-limits and provide excess cover for MRI & CT scans. Prices for top-up cover ranges from under R 100 to around R 220 for the whole family.
Top-up cover is medical insurance and is not a medical aid. Medical insurance fills the gap between what your medical aid covers and what a provider charges, including what is discussed above. Medical insurance can also cover co-payments and deductibles that one incurs on specific procedures (invaluable if you are on Medihelp or Discovery’s Priority plans). There are also options that increase sub-limits and provide excess cover for MRI & CT scans. Prices for top-up cover ranges from under R 100 to around R 220 for the whole family.
The change that Fedhealth has imposed on us as members and service providers is quite unfortunate. They were one of the flagship medical aid brands out there but have, in recent years, removed their uniqueness. I still maintain that they are one of the better providers of medical coverage and their administration, by Medscheme, is one of the most reliable. Their continual downgrading of their plans is frustrating.
So if you are on the Maxima Standard plan please consider taking out some medical insurance so that you can keep the freedom-of-choice that you are used to. Having the top-up cover in place is a recommendation that I give to all my medical aid clients. No medical aid covers everything and with a comprehensive medical insurance you will ensure that you cover all your bases.
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