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SA's No 1 Insurance Blog

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Two questions before we start:

  1. Hands up if the thought of going to hospital scares the *@##! Out of you?
  2. Hands up if you’re pretty comfortable using a state hospital instead of a private one?

I’d love to know how many hands went up for the last one which brings me back to Fedhealth.

If you remember, a while back I wrote an article on the Fedhealth Blue Door Plus plan which was based on income. But what if you need something different?

Fedhealth calls it their Maxima range. Think of 2 levels with Blue Door Plus being the lowest one and Maxima being one step up. Right at the bottom of the Maxima options we have their two Maxima hospital plans.

So what type of person would choose a Maxima hospital plan anyway?

Here’s the safe answer – Someone who’s young and healthy with no dependants
But you know what:

  • As the cost of medical aid goes up and up, and
  • as I use the benefits less and less,
  • I’m also considering at downgrade – and I’m more young at heart than young. I’m also not dependant free.

Tell us more about the Maxima Hospital Plan?

Maxima offers two plans:

  • Maxima Entryzone, and
  • Maxima Core

Both of these plans offer unlimited hospital cover. This is important because getting a hospital bill for R1 million is a problem when your cover is limited to R500, 000.

The difference between the two is that the cheaper option (Maxima Entryzone) uses networked hospitals whereas Maxima Core uses any private hospital. Let’s compare them, shall we?


So here’s the thing. A main member on the Maxima Entryzone plan costs R1, 179 a month in 2016. On the Maxima Core plan this jumps to R1, 695 a month.

That’s a R516 monthly difference in cost which now begs the question of why?
Turns out it has everything to do with networked hospitals. A networked hospital is one with whom Fedhealth has some sort of discount arrangement. In other words, you send us tons of patients and we’ll give you a fat discount.

The three questions we need to ask ourselves are:

  • Am I comfortable with using any of these networked hospitals? By that I mean: “Is this hospital close to where I work or stay?
  • What if the specialist I’m seeing doesn’t operate at this hospital? I’ve had this happen a few times where a client was forced to use another hospital and had to make a fairly large co-payment as a result. By the way, the co-payment on Maxima Entryzone for 2016 is R5, 270 which isn’t too bad as these things go. For instance, the co-payment at Discovery Health on Delta networked options is R6, 450.
  • What happens in an emergency? They can take you to the nearest hospital. Once you’re stable they’ll move you to a networked hospital. No co-payment will apply.

Everything else is pretty much the same between the two plans. I did notice that the Maxima Core plan pays 200% of the Fedhealth rate for ‘other healthcare providers’ (such as physiotherapists while in hospital and dietetics) while the Maxima Entryzone only pays 100%. If you consider the R516 a month price difference, you could take out medical gap cover and boost your 100% right up to 500% from as little as R165 a month.

But be aware of the following:

  • Medical specialists and general practitioners not on the Fedhealth network are paid at 100% of the Fedhealth rate. Any overcharge is for your account which is why medical gap cover is so important. Specialists on the Fedhealth network are paid for in full. Remember that this is where your risk lies.
  • Cancer cover on hospital plans is basic at best. Fortunately Fedhealth does allow you the option of an upgrade upon diagnosis of a serious illness.
  • There are various co-payments for having certain procedures done while in hospital. You pay a R5, 000 co-payment for procedures ranging from bunions to caesarean sections. Just make sure you’re comfortable with them.

If you’re in the market for a medical aid membership, and specifically a hospital plan, then why not investigate Fedhealth? The two things I really like about Fedhealth are:

  1. Upgrade at any time of the year if diagnosed with a dreaded disease, and
  2. Child rates for financially dependant children until they turn 27

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Until next time.

The InsuranceFundi Team


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