frequently asked questions (faqs) about the flexifed range€¦ · nedbank account: 1029 279 489...

Frequently Asked Questions (FAQs) about the flexiFED range

How do you activate your MediVault and transfer funds into your Wallet?

• For new members it will form part of the application form, if they want to activate their MediVault on their membership join date.• Members can contact the Customer Contact Centre.• Members can also access the Fedhealth Family Room and complete the required steps. • An instalment calculator is made available to every user in the Fedhealth Family Room in order to guide the member through the process.• MediVault activations for principal members who are below the age of 18 can be facilitated by the legal guardian or parent.• Email activations will not be allowed, since we cannot confirm if the email is indeed coming from the principal member and that they have consented to pay the claim.

MediVault transfers to Wallet:

• Transfers to the Wallet must take place in increments of R600. • If a value lower than R600 is available in the MediVault, the member can transfer the full remaining amount into their Wallet.• Members can transfer their entire MediVault benefit into their Wallet at once.• A member can make multiple transfers within the benefit year in to the Wallet, provided there are funds available in the MediVault.• Transfers of funds to the Wallet can only take place if the member has accepted the Ts and Cs and their membership is active. Who qualifies for the MediVault?

• The MediVault is available to all members on the flexiFED range which offers this benefit and who’ve accepted the terms and conditions of the MediVault. • To qualify for the MediVault, the member must be in good standing with the Scheme and over the age of 18 years.• Suspended and terminated members are not eligible for any MediVault activation.• The legal guardian of a member younger than 18 years of age can apply for the benefit on behalf of the minor member.• The MediVault is only available to active beneficiaries of the Scheme.

When will funds be available in my Wallet and when will Fedhealth start paying for claims out of my Wallet?

• Once funds are transferred it is available immediately for claims payment. • Claims will be paid from the benefit once the claim has been captured and finalised in our systems. • If a rejected claim needs to be paid from the Wallet, a member needs to transfer funds and immediately request a reversal of the claim to have it paid for by Fedhealth.• Claims will always be paid from available Savings first; thereafter any funds in the Wallet will be utilised.

Can I keep funds in the Wallet for specific claims?

• Once you transfer monies into your Wallet, any claim that comes into the system will automatically pay from the Wallet. Therefore, you cannot transfer the money and wait for a specific event, e.g. if you know you need spectacles three months from now. Only transfer monies into the Wallet closer to the time of the claim to avoid other claims being paid from the Wallet. • If a claim is rejected due to “funds being depleted”, you can transfer monies into your Wallet at that point and request the claim to be reversed and reprocessed via the Customer Contact Centre, Fedhealth Family Room, or by emailing [email protected] How is the instalment paid back?

• The payment must be facilitated via a debit order.• The instalment period can be reduced by paying additional funds into the stipulated bank account. Please note that this will not reduce your monthly instalment, it will only reduce the repayment period. • Employer groups have the option to contribute towards their members’ MediVault instalments. Participating paypoints will be flagged on the system. • It is important to note that the MediVault will not gain the benefit back as the instalments are paid. The MediVault will only be available during the benefit year from 1 January to 31 December.• The instalments will be a separate deduction from the member’s monthly Risk contributions. Therefore a member will have two debit orders: one for MediVault instalments and the other for the member’s contributions. The same will apply to paypoints. Two different bank accounts are used for contributions and the MediVault:

Contribution payments Account holder: Fedhealth Medical Scheme Bank: Nedbank Branch: Randburg Account number: 1984 563 009 Branch code: 19 84 05 Reference number: <Membership Number>

MediVault instalments Fedhealth Medical Scheme PMSA Nedbank Account: 1029 279 489 Branch: Corporate Client Services Branch Code: 19 87 65 Reference: < MediVault membership number>

• If a member defers from their instalment only, the MediVault benefit will become suspended. If the member continues to defer on payments, an ITC process will follow. • If a member terminates their membership, the total MediVault amount utilised will be due upon termination.


If I transfer funds to my Wallet at month-end or close to the instalment due date, when do I start paying these fees back?

All instalments will be due on the 1st of the month, following your Wallet transfers. All debit orders for the Wallet will take place on the 1st of the month; the 25th debit order date is not available as yet.

What will happen if there is membership movement? • Adding of dependants: Depending on family composition, the member will be entitled to a higher MediVault Benefit, and as such the benefit will be adjusted accordingly. If the family composition remains unchanged, no MediVault adjustment will take place.

E.g. if a member has five dependants, they fall under the M+2+ composition and adding another dependant will keep them in the same family composition. However, if a member with one dependant adds a dependant, their family composition changes and the MediVault will be increased.• Removing of dependants: If the family composition reduces below M+2+, the MediVault Benefit will reduce. In the event where a member has over utilised the MediVault, the member will continue with their instalments, since at that point in time they will not have any MediVault Benefit available to transfer to the Wallet. • If a child dependant becomes an adult dependant, there is no change in the MediVault Benefit as the benefit is set at the family composition. • Option upgrade during the year: If the member upgrades to a plan with the MediVault Benefit, the benefit will be available. If the member upgrades to a plan that does not have the MediVault available as a benefit, the member will continue to pay their instalments over the remaining period. However no MediVault Benefit will be available even if the member still had funds available in the MediVault.

When does the MediVault become available?

• The MediVault is available annually as per the Scheme benefit year, which runs from 1 January to 31 December. The MediVault can be accessed at any time during the benefit year.• The MediVault will be at 100% of the benefit structure, which is based on your selected benefit option and family size or composition.• The MediVault will not be prorated for a principal member (member) joining the Scheme during the benefit year, and they can start using it upon acceptance of the Ts and Cs.• For members joining on any other date than 1 January will have access to the entire MediVault benefit (no proration applies). You can start using your MediVault upon your join date. This benefit will become available again on 1 January of the following year. Does the MediVault carry over to the next year?

• Seeing that the MediVault is not a Savings account, any MediVault benefits not used by 31 December will not carry over to the next year. By 1 January you will be given a new MediVault based on the particular benefit year’s Scheme Rules and structure.

Can I activate my MediVault and use my Wallet during a waiting period?

• Yes, the Wallet is available to members and their dependants during a general and condition specific waiting period imposed on the membership, if applicable.

What happens to Wallet monies not used?• Any unused Wallet benefits will carry over into the next year, however it will not gain any interest, as it is not a traditional savings account.

For which services does the Wallet pay?• The Wallet is used to fund day-to-day medical expenses, like basic dental services. The Fedhealth Scheme Rules will apply to services covered. • Co-payments may also be funded from the Wallet, upon request from the member.

How do I access the Benefit Maximiser?The Benefit Maximiser on flexiFED 1, 2 and 3 can be reached by one of the following means:

• Transfer and use your entire MediVault Benefit.• Self-fund day-to-day expenditure and accumulate until the predetermined Benefit Maximiser Threshold Level is reached. • Make use of a combination of MediVault transfers and self-funding of claims, up to the predetermined Benefit Maximiser Threshold Level.

Which benefits will be covered from the Benefit Maximiser?That depends on the option. However, the Benefit Maximiser provides the following additional benefits:

• Unlimited GP consultations at a nominated Fedhealth Network GP on flexiFED 1, 2 and 3• Basic Dentistry (flexiFED 2 and 3)• Preventative dentistry on flexiFED 1 Please note: The optical benefit on flexiFED 3 is funded from Risk from Rand one.

Are there any Fedhealth options that do not have the MediVault?Yes, the following plans don’t have the MediVault:

• myFED• maxima EXEC • maxima EXECGRID

• maxima PLUS


Will there be an instant notification of how much my monthly instalment will be to repay my MediVault?

Yes, communication will be triggered to members to inform them of their monthly instalments. You can view your instalments due as well as previous instalments made, on your monthly member statement, and on the Fedhealth Family Room.

Is there a mobisite available and if so, how can I access it? We have a self-service member portal, which is available on any device, known as the Fedhealth Family Room. You’ll have access to the following functionalities:

• View your MediVault availability• View what is available in your Wallet• An instalment calculator which will show you what your instalment would be for specific amounts• Transfer funds from your MediVault to the Wallet• View instalments due• View instalments made

What’s the maximum amount that I can get from the MediVault?

The maximum amount is dependent on your option and family composition, up to a maximum of 25% of your Risk contribution.

Will that amount be based up to a maximum of three children?

The MediVault benefit does not take into account the dependant type like your Savings account does. The MediVault benefit is made up of your family size and not the type of dependant. Below is a structure of family sizes that will have a benefit:

• Member + 0 = Membership with only a principal member• Member + 1 = Principal member and one dependant (either adult or child)• Member + 2 = Principal member with two dependants (either adult or child)• Member + 2 + = Principal member with more than two dependants (either adult or child)

I belong to a company that funds my contribution. How will the MediVault work?

This will be based on your employee benefits and how your

employer chooses to fund it. Along with this your employer can make a decision based on when your MediVault should be activated. The member is ultimately responsible for the instalment of the activated MediVault Benefit, and needs to sign the Ts and Cs before activation of a Wallet amount.

I would like to downgrade to have my Savings paid out. Is this possible?

All Fedhealth options with the exception of myFED have a Savings component, so a Savings refund will only take place if you downgrade to this plan. Any other option downgrades will not entitle you to a refund. It is always advisable to seek advice from your broker before these decisions are made.

I’m leaving my current employer who pays my MediVault instalment and I’d like to become a direct paying member (DPM). What do I need to do to ensure my monthly instalment is paid?

If there’s no break in membership, you will be transferred to a DPM account which will include your MediVault instalment and Wallet account. If you did not provide MediVault banking details for collection of instalments on your acceptance of the MediVault Ts and Cs, you need to provide the banking details by completing the Fedhealth Member Record Amendment Form.

I’m moving from my current employer who pays my MediVault instalment to a new employer and am not sure how the benefit structure for medical aid is structured yet. What do I need to do to ensure that my monthly instalment is paid?

Firstly, you need to get confirmation on your benefit offered by your new employer. If they agree to contribute towards your previously activated MediVault Benefit, your payroll will facilitate the change on your membership. If they don’t pay towards this, you need to provide the Scheme with the MediVault banking details for collection of the instalments if you did not provide this when you accepted the MediVault Ts and Cs*.

*This is also subject to the new employer’s employee benefits and rules.

Will I get a new membership card?

Members will not receive new membership cards. They will only be sent on request. The reason being that we send cards via courier and we might not have your correct delivery address. Also note that your membership number will remain unchanged, and therefore you don’t require a new membership card just yet.

We have a membership e-card facility which has been communicated to providers and is accepted by all healthcare providers. The e-cards are available on the following platforms:

1. An SMS will be sent to all members once the option change has taken place. The SMS will contain a link to your e-card.2. FedChat app, download it in the Google Play Store or Apple App Store. 3. The Fedhealth Family Room.

All these platforms allow you to share your e-card.

What are the new option names?

FEDHEALTH FAMILY ROOM


OLD PLAN NEW PLAN

Blue Door Plus myFED

Maxima EntryZoneflexiFED 1

Maxima EntrySaver

Maxima Saver flexiFED 2

Maxima BasisflexiFED 3

Maxima Core

Maxima StandardflexiFED 4

Maxima Advanced

Maxima Exec maxima EXEC

Maxima Plusmaxima PLUS

Ultimax

Which options have an EDO (or efficiency discount layer)?

OPTION NAME GRID Elect

myFED - -

flexiFED 1 - a

flexiFED 2 a a

flexiFED 3 a a

flexiFED 4 a a

maxima EXEC a -

maxima PLUS - -

Why did Fedhealth make this change?

We wanted to give our members more control over their medical aid options, hence the introduction of discounted layers. We also wanted to give members the opportunity to decide when to fund their day-to-day benefits, providing them with more flexibility. The discounted layers, and the removal of savings from your risk contribution, have contributed to the reduction in your monthly contributions.

Can PMB claims be funded from the Wallet?For the 2019 benefit year PMB claims will not be funded from the Wallet.

Who are the DSPs for Fedhealth?

BENEFIT DSP

Renal dialysis Dr Patel

Hip and knee replacements ICPS, Joint Care and Dr Diamond

Oncology related treatment ICON

Optical ISO Leso

Back and neck programme DBC Clinics

Chronic medication (myFED) Pharmacy Direct, Clicks Pharmacy, Dis-Chem and MediRite

Can the broker also activate the MediVault on behalf of the member?

No, only a principal member over the age of 18 may activate their MediVault. By transferring monies from the MediVault to the Wallet, an interest-free loan is activated. Due to this, there is legal liability created for the principal member. Therefore, an agreement must be entered into by the principal member with Fedhealth.

Is there a network for paediatric consultations in the Benefit Maximiser?

The paediatric consultations on flexiFED 2 and 3 are funded from Risk from Rand one and not the Benefit Maximiser; you need to consult a paediatrician on the Fedhealth network to gain access to the benefit. If these consultations have already been used, the member can fund their paediatric consultations from their Savings and Wallet. If this is the case, any paediatrician can be consulted.

What does the childhood illness specialised drug benefit entail?

• Which drugs are covered? o Botox o Synagis o Growth hormones (e.g. Humatrope®, Norditropin Nordilet®, and Genotropin)

• Which conditions will qualify for this? o Synagis is used for respiratory syncytial virus (RSV), a respiratory disease in newborns. It will ONLY be used for this condition. o Botox is used for a number of conditions. This will be case specific – e.g. for muscle dystonias in spasticity. Botox will be approved where it is clinically appropriate, and needs to be approved by Managed Care. o Growth hormone is used for growth conditions (e.g. short stature where children are not growing normally). There are a number of drugs that fall under growth hormones, some examples are Humatrope®, Norditropin Nordilet®, and Genotropin.

For both Botox and growth hormone treatment, clinical appropriateness will be evaluated irrespective of the condition before the benefit is granted.

Threshold levels: why are we looking at it as M + 1 as


opposed to principal member + child (like how we calculate the Benefit Maximiser limits)?

The Benefit Maximiser levels are based on the MediVault benefit provided. The MediVault benefit is set up on family composition, therefore the Benefit Maximiser Threshold Levels are set up in the same manner.

Are there tax implications for members in terms of how SARS will view the payment of the MediVault contribution?

No, the payment of claims from your Wallet will be seen the same as claims paid from Savings.

How will we handle this with our employers? *Refer to the HR manual. Employers will have to inform us if they want to be a participating paypoint. This will be done by means of the paypoint application form.

A participating paypoint is a paypoint that is willing to facilitate or contribute 100% towards their members’ MediVault instalment. An additional unique paypoint number for the MediVault Instalment Statement will be allocated to the company to facilitate instalment collection and payment.

Will the employer make a decision to activate the MediVault for all their employees at the beginning of the year? If so, is this legal? Will members still need to complete forms after this?

This will be a decision made by the paypoint. If they opt to pay for the MediVault, they can inform their employees that the benefit must be taken at the beginning of the year to ensure the employer pays for the benefit.

Yes, the employer will be the party paying for the benefit.

Yes, the member will still need to activate the MediVault and accept terms and conditions before they can transfer the funds into the Wallet. As part of the terms and conditions, we make mention of the event when a member moves away from his/her employer he/she will become responsible for the debt incurred on the MediVault transfers. Will we blacklist members who default on their MediVault

repayments? If so, is this legal and does it fall under NCA rules? If not, why not?

If a member continues to defer on their instalments, we will list them on ITC after a range of communications and pre-warnings. This is legal as the NCA allows for any outstanding debt to be passed on to the ITC listing process.

Will the employer be informed about the activation of MediVaults for their employees as and when this happens so that there are no discrepancies at billing time?The paypoint will receive a pro forma billing, detailing the list of MediVault instalments per member.

Will members be able to activate MediVault after working hours/ weekends?

Yes, the member can activate their MediVault on the Fedhealth Family Room, 24 hours a day seven days a week.

How does the Savings Top-Up work?

A member can voluntarily top up their Medical Savings Account by paying additional fees into their Savings. Any top-up savings cannot be extracted from the Savings account. Members will only be able to gain a refund of this amount upon termination of the membership, provided that they don’t move to a medical aid option with a Savings facility.

The top-up savings cannot be greater than 25% of your gross Risk contribution. It is important to note that claims will always pay from available Savings first, then your Wallet if funds have been transferred.

I now have access to a 25% maximum Savings, does this mean my Self Payment Gap (SPG) is smaller on flexiFED 4?

The threshold benefit structure remains unchanged, therefore the SPG levels remain at the same level as previous years.

Will my broker commission be affected due to split of premiums?

The Minister of Health has, in terms of section 65 of the Medical Schemes Act, 1998 (Act No. 131 of 1998) (“the Act “), read with Regulation 28(2)(a) of the Regulations in terms of the Medical Schemes Act, approved an increase to the maximum amount payable to brokers to R90 plus Value Added Tax (VAT) (R102.60 VAT inclusive) with effect from 1 January 2018.

As the maximum commission payable is 3% of the applicable member contributions, it means that a broker earns maximum commission on a monthly member contribution of R3 000.

From the table below, it can be seen that a reduction


DISCLAIMER: This document is a summary for information purposes only and does not supersede the rules of the Scheme. In the event of any discrepancy between this summary and the Rules, the Rules will prevail. A copy of the Rules is available on request.

Please call 0860 002 153 for all general enquiries and customer care assistance, including benefit and limit confirmation and document requests, as well as Hospital authorisations, chronic medication enquiries and oncology related authorisations.

Disease Management0860 101 306

Europ Assistance0860 333 432

MVA Third Party Recovery Department0800 117 222

Fedhealth Baby0861 116 016

in premium of R500 (Below R3 000) will result in a R15 reduction in commission per month.

CONTRIBUTION COMMISSION

R3 500 R90

R3 000 R90

R2 500 R75

R2 000 R60

R1 500 R45

R1 000 R30

If a member uses a non-network hospital due to an unforeseen or unplanned procedure, will they be stabilised and transferred to a network hospital?

Yes, a member will be stabilised and then transferred to a network hospital. If the member chooses to stay in the hospital, the member will be liable for the co-payment.

Will members be assessed as per NCA as you now provide them a loan facility?

Because the “loan” is provided to the member on an interest-free basis, the “loan” would not be subject to the provisions of the National Credit Act at all. The extension of the “top up” amount at the commencement of the year, in the form of a loan from the Scheme to the member, also means that Scheme will not be accepting “deposits from the public” as contemplated in the Banks Act.

Why the double debit, why can’t the contribution and Wallet repayment be done as a single debit order?

The MediVault is a separate legal entity and have to be accounted for separately from Risk and Savings contributions. Seeing that the MediVault instalments are only effective upon activation of the benefit and fund transfers, these payments are variable.

I have a company, how are they going to manage the two debit orders?

See the HR manual as this is defined by the paypoint. The Scheme manages the debit order collection and the paypoint will receive a detailed breakdown per staff member for their contributions and instalment collection. Their payroll will record these transactions as per their current process.I love the maternity benefits, but why only implement on

flexiFED 2 and 3 and not 4 if I can afford a better plan?

Awaiting feedback.


DISCLAIMER: This document is a summary for information purposes only and does not supersede the rules of the Scheme. In the event of any discrepancy between this summary and the Rules, the Rules will prevail. A copy of the Rules is available on request.

Please call 0860 002 153 for all general enquiries and customer care assistance, including benefit and limit confirmation and document requests, as well as Hospital authorisations, chronic medication enquiries and oncology related authorisations.

Disease Management0860 101 306

Europ Assistance0860 333 432

MVA Third Party Recovery Department0800 117 222

Fedhealth Baby0861 116 016

frequently asked questions (faqs) about the flexifed range€¦ · nedbank account: 1029 279 489...

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