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DStv Channel 403 Tuesday, 03 October 2023

How do day-to-day funds work?

Medical aid is an essential tool that gives people access to a range of medical facilities, especially financial protection in the event of unexpected hospitalisation.

How do day-to-day funds work?

Medical aid is an essential tool that gives people access to a range of medical facilities, especially financial protection in the event of unexpected hospitalisation. You also get other benefits such as preventative screening, chronic medication cover and day-to-day benefits for over-the-counter medicines, as well as prescription medicine, but, more crucially, it prevents you from incurring high medical costs that could leave the average South African in serious financial trouble.

When you take up medical aid cover, you pay a monthly contribution and that contribution is split into two parts: Risk cover and day-to-day cover.

The Risk benefit pays for unlimited private hospitalisation and a chronic disease benefit, while the day-to-day benefit covers your additional consultations such as doctor’s, dentist and optometry visits.

Depending on your chosen medical aid, a certain percentage of your contribution is put aside and allocated for your day-to-day medical expenditure.


What makes Fedhealth different to other medical aids?

Fedhealth developed a unique option range that enables members to create their own medical aid plan with benefits and a day-to-day payment structure of their choosing at a price that works for them. Members are no longer required to fit into a universal generic medical aid plan that offers them few benefits, yet charges exorbitantly high contributions. Fedhealth offers members three ways to customise their day-to-day benefits, namely through the Supercharged Hospital Plan, Supercharged Savings Plan, and the Supercharged Flexible Savings Plan.

Supercharged Hospital Plan: This plan allows you to leave out day-to-day funds entirely, and use your medical aid option as a hospital plan only.

Supercharged Savings Plan: This plan is considered to be a standard plan – that uses the two-portion system. An set amount of funds for day-to-day is allocated to you at the beginning of ever year, and you pay it back in equal portions every month.

Supercharged Flexible Savings Plan: This is where Fedhealth truly stands out from other medical schemes. You can choose this route if you want mostly a hospital plan, but like the idea of having flexible savings in case it’s needed.

By using your day-to-day benefits only when needed, say for a new pair of glasses, you will only pay for the portion you use – interest free over 12 months. Different from other schemes, you get to choose how much savings you want to use from the generous amount we make available to you based on your flexiFED option and family composition.

With Fedhealth, you have a choice over how to structure your day-to-day medical aid expenses - something that no other medical scheme does.


What is flexiFED?

The flexiFED plans are our flagship line of plans that provide you with choice, flexibility, and control.

flexiFED 1: If you are looking for first-time medical aid cover, perhaps as a student or entry level employee or young working professional, flexiFED 1 is a well priced hospital plan that provides good hospital cover. You have access to Fedhealth Savings powered by the MediVault to help you pay for day-to-day medical expenses, while the Threshold Benefit kicks in once your claims reach a set amount. If you're young and healthy, this is the ideal entry-level hospital plan.

flexiFED 2: If you're planning on a baby or just starting out as a parent, flexiFED 2 is the ideal family hospital plan choice, with generous maternity and childhood benefits to give you extra peace of mind. Add access to Fedhealth Savings powered by the MediVault for unexpected day-to-day medical expenditures, as well as the Threshold benefit which kicks in after your claims reach a the Threshold level, and you're looking at great overall value.

flexiFED 3: This option is ideal for growing families, since it provides enhanced maternity and childhood benefits. It also includes access to Fedhealth Savings powered by the MediVault for day-to-day medical bills, and a Threshold benefit that covers unlimited network GP visits and basic dentistry once claims have reached a certain level.

flexiFED 4: This plan ensures solid cover for mature families who’re done with changing nappies. Apart from good in-hospital cover, it also offers Fedhealth Savings powered by the MediVault for unplanned day-to-day medical expenses, as well as a Threshold benefit that pays for unlimited network GP visits from Rand 1. This option leaves nothing to chance when taking care of your more mature family.

Why do we call all our flexiFED hospital plans “supercharged”? Because they come packed with unique benefits by default, which other schemes will pay for from a member’s day-to-day allowance.


What are risk benefits?

Risk cover is essentially cover that applies when you are admitted to hospital. All medical schemes must cover also cover Prescribed Minimum Benefits (PMBs). The PMB list of conditions lists all the conditions which all medical schemes need to cover on all health plans they offer to their members. This cover includes funding for the diagnosis, treatment and ongoing care for the listed conditions which is provided from the Risk cover.

Fedhealth also covers a range of unique benefits from Risk which other schemes will cover from members’ day-to-day benefits. These include:

Post-hospitalisation treatment – For 30 days after you’re discharged from hospital, certain follow-up treatment like physiotherapy and X-rays will be paid directly from Risk to preserve your day-to-day benefits.

Seven days of paid take-home medication – After you’ve been discharged from hospital, Fedhealth will pay for medication to cover the first seven days, as long as it’s dispensed by the hospital pharmacy or another pharmacy on the day of your discharge.

Specialised radiology like MRI/ CT scans – These will be paid for from Risk, no matter what option you’re on or whether they are performed in- or out-of-hospital. A co-payment may apply.

Trauma treatment at a casualty ward – Whether you’re admitted to hospital or not, emergency treatment such as stitches is always paid from Risk and never from your day-to-day benefits.

Cover for female contraception – Everyone has the right to family planning, at least until they decide to have children. They should also be able to avoid unintended pregnancies. Fedhealth gives women this choice by paying for certain contraceptives from Risk, including oral contraceptives, patches, contraceptive rings, certain injectables, and IUDs like the Mirena.

In-hospital dentistry for children under 7 – Fedhealth pays for the hospital account and anaesthesia from your in-hospital benefit, while the dentist account will be paid from your day-to-day benefits.

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