Fedhealth preserves core benefits with higher increase
Fedhealth, the fourth largest open scheme in the country, has announced a 15,9% average increase for 2010 in order to maintain its core benefits and its reimbursement rate of 300% of NHRPL across its Maxima Plus, Ultimax and Ultima 300 options. NHRPL is the standard rate set by the Council for Medical Schemes.
Peter Jordaan, Fedhealth Principal Officer, confirms that 2009 has proved to be one of the toughest years in determining increases. “Unfortunately, the economic pressures experienced by the entire industry were not the only factors to be considered this year,” says Jordaan. “A high-claiming pattern during the current year and a higher than expected increase in NHRPL and SEP (Single Exit Price – the legislated price for medicines), have added to the pressure.”
Jordaan says Fedhealth has opted for a slightly higher increase while maintaining most of its core benefits. “We had to reduce the reimbursement rate of 300% to 200% on our lower options, but we have managed to maintain 300% in the case of certain procedures required as a result of accident and injury as well as for normal maternity deliveries. This allows us to maintain our promise to members to be there when they need us the most. It also ensures sustainability of the scheme for 2010 and into the future.”
Jordaan confirmed that the value of the scheme’s day-to-day benefits, including the Out-of-Hospital Expenses Benefit and savings, remain unchanged for 2010 and that all Benefit limits and Safety Net levels remain the same. He said that a 20% co-payment had been introduced on certain options for members who have reached safety net. Various other co-payments have also been introduced on lower options.
“We believe the current offering allows us to maintain all our unique benefits and provide our members with real medical aid. We remain the scheme that pays for more benefits from risk than any other scheme,” says Jordaan.
Some of these unique benefits include:
· Specialised radiology, e.g. MRI & CT scans (whether in orout-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
· Emergency treatment in a casualty ward and not necessarily in hospital
· Oral contraceptives on most options
Fedhealth also covers professional sports and hazardous pursuits; has a comprehensive maternity programme; offers free accidental injury cover for cats and dogs; free 24 hour Trauma Management for emotional and practical support; and provides cover for financially dependent children at child rates until they turn 27.
Two of the new benefits for 2010 include an emergency transport benefit extended to the 22nd parallel which includes parts of our neighbouring states and a Technogym offering which makes it easier for companies to bring fitness and health to the workplace.
