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Fedhealth introduces unlimited GP network and two new options

04 October 2010 Fedhealth
Katy Caldis, Fedhealth CEO and Principal Officer

Katy Caldis, Fedhealth CEO and Principal Officer

In a concerted move to drive down expenses and maintain affordability, Fedhealth, the fourth largest open scheme in the country, has just announced its 2011 options including an extended product range with a new entry option to target the young and healthy; a new bridging top end option as well as the introduction of a new unlimited GP Network.

Katy Caldis, Fedhealth CEO and Principal Officer says that prudent financial management, coupled with a good claiming year has also enabled the scheme to put forward a much lower annual increase and to keep reserves comfortably above the 25% minimum requirement. The forecast for year end is an encouraging 29%.

"We have focused on greater differentiation of our options for next year so that the more affordable options are now available for budget conscious members without compromising freedom of choice on more comprehensive options. Our increases range from 3% - 12,2% with a weighted average for the scheme as a whole of 9,7%," says Caldis.

One of the most exciting additions to the 2011 benefit package is the introduction of a new unlimited GP Network. Caldis says one of the biggest challenges facing medical schemes is to keep the monthly contributions members pay within acceptable limits and this can only be achieved by removing wastage and inefficiencies from the system, resulting in cost savings that will benefit both members and schemes.

"Currently a large percentage of members go directly to specialists, instead of firstly consulting a primary health care professional. We believe the introduction of a GP network will go a long way in helping to get the balance right and bring down costs.

Should a member's day-to-day benefits be depleted, the scheme will continue to cover all GP visits. The only condition is that members make use of the expansive Fedhealth GP network that will be introduced on 1 January 2011.

This benefit will be available to members on all options except the Hospital

Plans, which do not include day to day benefits by design.

Caldis says the scheme will be working closely with contracted GPs and assisting those in the network to practice more cost effectively. "GPs will be profiled and encouraged to improve the quality of care delivered and encouraged to be the coordinator of care for each patient.

To support this we will be launching a major education and advisory campaign for members, supported by a strong wellness theme early in the new year. In addition we will be making available electronic health records to each beneficiary of the scheme to assist them in understanding and taking accountability for their own health status."

"The wellness drive will assist our members in achieving a state of wellness and in maintaining that state of wellness. It's about a new holistic approach to health management, from prevention of disease to achieving a state of overall wellbeing of mind, body and soul. The proposed initiatives will not necessarily make big demands on existing lifestyle, but rather small changes delivered in a fun and easy way that will have an impact on the member's overall health," says Caldis.

In terms of overall product range, Fedhealth is presenting an extended product range for 2011 that will appeal specifically to the corporate market.

The key addition will be a new cost effective hospital plan, EntryZone, aimed specifically at young, healthy people looking for hospital cover.

"Although this option has an overall annual limit of R1m per year, this limit becomes unlimited in the case of accident or injury related hospital treatment providing members with peace-of-mind," she says. Another new product, Maxima Exec, has been introduced to fill the gap between Maxima Standard and Maxima Plus. This option provides unlimited private hospitalisation at 200% of the Fedhealth rate, covers 51 chronic conditions and ample day-to-day benefits. A family of 4 on this option will have almost

R14 000 per annum available for day-to-day benefits.

The full Fedhealth option ladder for 2011 now comprises Maxima EntryZone, Maxima Core, Maxima Basis, Maxima Standard, Maxima Exec and Maxima Plus.

"We remain the scheme who pays the most from Risk than any other scheme in the country and the one scheme to host a myriad of other unique benefits."

These include:

. Specialised radiology, e.g. MRI & CT scans (whether in or out-of-hospital)
. 30-day post-hospitalisation benefit paid from risk for related treatment
. Certain procedures performed in day wards paid from risk
. 7 days take-out medicines after hospitalisation
. Unlimited GP benefits
. Emergency treatment in a casualty ward and not necessarily in hospital
. Oral contraceptives on most options
. Professional sports and hazardous pursuits cover
. Free 24 hour Trauma Management for emotional and practical support
. Cover for financially dependent children at child rates until they turn 27.

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