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S A L E S P R E S E N T A T I O N Medical aid control, flexibility - PowerPoint PPT Presentation

Apr 11, 2024 •388 likes •958 views

S A L E S P R E S E N T A T I O N Medical aid control, flexibility and choice like never before. Boasting an 83-year track record, Fedhealth has a solvency rate of 31.42% (as at 31 December 2018) and a Global Credit Rating of AA-, retained

  1. S A L E S P R E S E N T A T I O N

  2. Medical aid control, flexibility and choice like never before. Boasting an 83-year track record, Fedhealth has a solvency rate of 31.42% (as • at 31 December 2018) and a Global Credit Rating of AA-, retained for 13 consecutive years Moving away from a one-size fits-all approach and embracing customisation. • Fedhealth pays more benefits from Risk than other schemes. • Choice, flexibility and control with our flexiFED range with up to 25% discounts • on contributions and day-to-day funding that puts the member in control.

  3. Customised interaction with members Fedhealth Website Fedhealth Family Room LiveChat & Chatbot Network GP, Specialist and Hospital locator FedChat

  4. More about Fedhealth’s hospital cover All Fedhealth options have unlimited private hospitalisation. • Any private hospital may be used except on certain options where • members must use a Fedhealth network hospital. Emergency treatment will be covered at any hospital no matter the option. The in-hospital benefit covers hospital costs as well as the accounts • for doctors, specialists and other healthcare providers. Also unlimited cover for selected procedures performed in day • wards, day clinics and doctors’ rooms. Some treatments and procedures may have a co-payment • depending on the option.

  5. Chronic medicine benefit Fedhealth provides unlimited chronic medication cover on all • options for the 27 chronic conditions on the Prescribed Minimum Benefit (PMB) Chronic Disease List (CDL). The benefit covers medication for the list of CDL conditions paid • from a formulary and must be obtained from a preferred provider or DSP, depending on the option. Certain options cover medicine for additional chronic conditions – • up to 72 on the highest option. Fedhealth is the only scheme that allows option upgrades anytime of the year within 30 days of diagnosis of a dread disease or a life-changing event …

  6. Maternity Benefits 2 x 2D antenatal scans • 8 x ante- and postnatal consultations with a midwife, network GP or • gynaecologist on flexFED2 and 12 consultations on flexiFED3 and 4, maxima EXEC and maxima PLUS Antenatal classes up to R1 090 • Amniocentesis • Fedhealth Baby programme • Private ward cover for delivery on flexiFED3 and 4, maxima EXEC and • Maxima PLUS Doula benefit: R3 000 per delivery • Postnatal midwifery benefit: 4 consults per delivery in- and out of hospital • Paid from risk and not day-to-day benefits. Upgrade anytime of the year to a higher option – pregnancy included

  7. Great childhood benefits 24/7 Pead-IQ parenting hub • Paediatric consultations without referral from a GP – up to 12 months of • age on flexiFED2 and up to 24 months on flexiFED3 and 4 Infant hearing screening benefit • Childhood immunisations • Trauma treatment in a casualty ward • Childhood illness specialised drug benefit up to 18 years on flexiFED 2, 3 • and 4 Child rates up to the age of 27 • Only pay for three children • Paid from risk and not day-to-day benefits

  8. A proactive stance on health: screening benefits Womens Health – all options except on myFED Cervical cancer screening Women; ages 21 to 65 1 every 3 years Breast cancer screening with All lives; aged 45 and older 1 every 3 years mammography Men’s Health – all options except Prostate specific Antigen Men; ages 45 - 69 1 every year (PSA) Children’s Health – all options except on myFED Immunisation Programme (as Birth to 12 years Various per State EPI) Cardiac Health – all options except on myFED Cholesterol screening (full All lives; aged 20 and older 1 every 5 years lipogram)

  9. A proactive stance on health: screening benefits Over 45’s – all options except for myFED Bone densitometry (only Women; aged 65 and older 1 every 2 years available on maxima PLUS Men; aged 70 and older and maxima EXEC) Breast cancer screening with All lives; aged 45 and older 1 every 3 years mammography Colorectal cancer screening All lives; aged 50 – 75 1 every year Pneumococcal vaccination All lives; aged 65 and older 1 per lifetime General – all options Flu vaccination All lives 1 every year HIV finger prick test All lives 1 every year

  10. A proactive stance on health: screening benefits Health risk assessments – all options Wellness screening (BMI, Women; aged 65 and older 1 every 2 years blood pressure, finger prick Men; aged 70 and older cholesterol & glucose test) Preventative screening All lives; aged 45 and older 1 every 3 years (waist-to-hip ratio, body fat%, flexibility, posture & fitness

  11. Programmes and wellness initiatives by Fedhealth • Corporate wellness days • Health Risk Assessments • Sisters-on-Site • Conservative Back and Neck Rehabilitation Programme • Mental Health Programme • Emotional Wellbeing Programme • Weight Management Programme • GoSmokeFree Smoking Cessation Programme • Aid for Aids (HIV Management) • Paed IQ • Diabetes Care

  12. What about cancer? On myFED and flexiFED1 , oncology is covered unlimited at PMB level of • care at the Designated Service Provider (DSP), ICON, subject to Level 1 treatment protocols. On flexiFED2 and flexiFED3 , oncology is covered up to R290 400 per • family per year at the DSP, ICON, subject to Level 1 treatment protocols. On flexiFED4 , oncology is covered up to R464 700 per family per year at • the DSP, ICON, subject to Level 1 treatment protocols. On maxima EXEC , oncology is covered up to R580 900 per family per • year at a preferred provider, ICON, subject to Level 2 treatment protocols. On maxima PLUS , oncology is covered unlimited at a preferred provider, • ICON, subject to Level 3 treatment protocols. Fedhealth is the only scheme that allows option upgrades anytime of the year within 30 days of diagnosis of a dread disease or a life-changing event …

  13. Fedhealth: We pay more from risk … The numbers that matter: how much we’re saving our members by covering day-to-day benefits from Risk What we pay from Risk, rather than Savings How much we saved our Most other medical schemes will deduct these expenses from a member’s members in the last year day-to-day benefits MRI and CT Scans R97 875 548 Unlimited GP Consultations R61 794 913 Unlimited cover for certain female contraceptives R 8 101 239 Trauma treatment in a casualty ward R 6 357 678 Take home medication R 5 883 259 Mental Health Programme R 4 066 398 Emotional Wellbeing Programme R 720 000

  14. Fedhealth: We pay more from risk … The numbers that matter: how much we’re saving our members by covering day-to-day benefits from Risk What we pay from Risk, rather than Savings How much we saved our Most other medical schemes will deduct these expenses from a member’s members in the last year day-to-day benefits Baby Programme R 998 442 Preventative screening and wellness benefits: Cholesterol Screenings R4 469 843 Breast Cancer Screenings R3 193 844 Childhood Immunisations R2 552 207 Flu Vaccinations R 626 242

  15. Fedhealth: We pay more from risk … Unlimited network GP visits • Unlimited post-hospitalisation treatment for up to 30 days • Unlimited take-home medication for 7 days after discharge from • hospital Unlimited cover for certain female contraceptives • Unlimited trauma treatment in a casualty ward • Unlimited specialised radiology (MRI/CT scans) whether they are • performed in or out of hospital In-hospital dentistry for children under 7 • We pay more from Risk so day-to-day benefits last longer

  16. These benefits show we really care Upgrades any time of the year SOS Call me • • within 30 days of a life changing Emergency Transport • event Response 24-hour Nurse Line • MediTaxi Service • Emotional Wellbeing • Child rates for financially • Programme dependent children up to Fedhealth Baby Programme the age of 27* • Paed-IQ Only pay for three children • • Covering just one child at child rates on flexiFED4 will save the member R24 216 per year in contributions

  17. Overview of the Fedhealth option range

  19. On myFED, members enjoy the following benefits: In-hospital benefit – No overall annual limit for hospitalisation, at • network hospitals. Chronic disease benefit – Members are covered for conditions on • the Chronic Disease List (CDL). Covered in full up to the Medicine Price List if the member uses medicine on the basic formulary and obtains it from one of our DSPs: Clicks, Dis-Chem, MediRite and Pharmacy Direct. Screening benefit – this benefit pays for lifestyle and wellness • screenings. Day-to-day benefits – We provide comprehensive day-to-day • benefits like unlimited contracted nominated GP visits. Additional benefits – lots of additional valuable benefits like the • myFED Baby Programme, oral and injectable contraceptives and the free Fedhealth Nurse Line.

  20. Hospitalisation No overall annual limit Network hospitals only Network GPs and Covered in full Specialists Non-network GPs Up to the Fedhealth Rate. Limited to R2 300 per In-Hospital and Specialists beneficiary per year Benefit Other healthcare Up to 100% of Fedhealth Rate professionals Specialised R14 000 per beneficiary, paid from an overall limit of Radiology R28 300 per family per year Limited to R38 100 per maternity event, with a limit Maternity of R56 400 per family per year. Unlimited at cost at PMB level of care once limits are reached.

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