Cancer treatment on flexiFED 1 is covered unlimited at PMB (Prescribed Minimum Benefit) level of care only, and you must use the designated service provider ICON. If you choose not to use ICON, a 25% upfront co-payment applies on the treatment cost. You must register on the Oncology Management Programme and submit a treatment plan.

On flexiFED 1, non-PMB oncology treatment has no benefit coverage. This includes specialised oncology drugs not covered at PMB level, brachytherapy materials, and certain advanced treatments. Only PMB-qualifying cancer treatment is covered.

Yes—trauma treatment in a casualty ward is covered from Risk, but a co-payment of R880 per visit applies for non-PMB visits. You must obtain authorisation within 48 hours (2 working days) after the visit to have the claim paid from Risk and avoid a larger penalty of R1,000.

You must nominate up to 2 network GPs per beneficiary. Pre-Threshold, visits to your nominated network GP are self-funded but accumulate toward your Threshold. Once in Threshold, you get unlimited nominated network GP visits with a 20% co-payment. Non-nominated or non-network GP visits have limited cover.

Single hip and knee replacements have no benefit on flexiFED 1 unless they qualify as PMB. Even with the contracted provider requirement, this plan states 'No benefit' for joint replacements. Members needing elective joint surgery would likely need to upgrade to a higher plan or pay the full cost.

You must use the flexiFED 1 Hospital Network. If you voluntarily choose a non-network hospital, a 30% co-payment applies on the hospital account. For day surgery facilities outside the network, a R2,710 co-payment applies. Emergency admissions allow any hospital initially, but transfer to a network facility may be required once stabilised.

Yes—for non-PMB MRI/CT scans, the first R4,230 is for your account (you pay upfront). After that, scans are covered at the Fedhealth Rate. PET and PET-CT scans for oncology are covered at PMB level of care at the network DSP, or you pay a R5,670 co-payment if using a non-DSP.

Network specialists are covered in full when treating you in-hospital. However, non-network specialists are covered only up to the Fedhealth Rate, meaning you are responsible for any shortfall if they charge more. This makes gap cover highly recommended on this plan.

Yes—colonoscopies and upper GI endoscopies (gastroscopies) in hospital have a co-payment of R8,190 on flexiFED 1. Note that general anaesthetic will not be paid for these procedures when done in a practitioner's room.

Depression is listed as an additional chronic condition covered on flexiFED 1, with depression medication covered up to R2,400 per beneficiary per annum, subject to an approved list of medications. After the R2,400 limit is reached, medication would be subject to available Fedhealth Savings (if activated).