Note: We are updating 2024 benefits as they are released. Some plans show old benefits until schemes release new plans.

Suremed Explorer A:
in-and-out of hospital benefits (2022)


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Monthly Costs:

Explorer A 2023 prices
Main member: Adult member: Child member:
Total Cost pm:
  • R1,290
  • R1145
  • R595
  • Pay for all children
Savings (per year):
  • No savings account option on this plan
  • The scheme might still cover some or all day-to-day claims. See below, and see benefits.
Children Rates:
  • Pay for all children
Income band:
Note:
  • Exclusions: Note that all schemes have extensive exclusions. We've tried to list the major ones, but you must consult with your scheme to get the full list.
  • All treatments and procedures are subject to authorisation and protocols
  • All benefits are listed as an indication only. Please verify with your broker and scheme
♦️View all the other benefits for this plan:♦️
Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics

You can also:
♦️Compare any two plans, side by side | ♦️View all the Suremed plans, with costs and brief summary
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In-hospital Procedures for 2022:

Suremed: Explorer A
Assume scheme pays all these costs, unless otherwise stated
non-Network Specialists:
  • R20,000 per family, unless PMB
network Specialists:
  • R20,000 per family, unless PMB
non-Network GPs:
  • Covered
network GPs:
  • R20,000 per family, unless PMB
Hospital Choice:
  • Choose Network hospital
Day Hospitals: .
Penalty for using other hospital: .
Other Co-payments:
  • n/a
Specialised Radiology:
  • 2 scans per family, in and out of hospital.
Supplementary Services: (Physio, etc)
  • Physiotherapy: R3,550 per family, unless PMB
Transplants:
  • PMBs only
Dialysis:
  • PMBs only
Exclusions:
Alternatives to hospitals:
  • Private nurse and step down facilities: R12,500 per family
  • Terminal Care: R20,000 per family, for end-of-life costs
Casualty:
  • No benefit, unless PMB
Other:
  • Intensive care/ High care unit: 15 days
  • Pathology: R21,500 per family, unless PMB
Note:
  • PMBs: Prescribed Minimum Benefits. You can read more about PMBs, see a list of all PMB conditions or read more what "PMB only" benefit means.
  • DSPs: Designated Service Provders. Where stipulated, you must use specific specific providers to get full benefit.
  • Co-payment: Paid out of pocket, or out of savings account. Sometimes this is refundable to you if you have a gap product
♦️View all the other benefits for this plan:♦️
Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics

You can also:
♦️Compare any two plans, side by side | ♦️View all the Suremed plans, with costs and brief summary
.
.
.

Out-of-hospital Procedures for 2022:

Suremed: Explorer A
Assume scheme pays all these costs, unless otherwise stated
Summary of day-to-day benefits:
Main Member: Adult: Child:
Savings (per year):
  • No savings account option on this plan
  • The scheme might still cover some or all day-to-day claims. See below, and see benefits.
PMBs out of hospital:
  • All medical aids must pay for the diagnosis, treatment and management of all PMB conditions, in or out of hospital. You can see a full list of the conditions here.
  • This can include consults with specialists, blood or other tests, radiology and medicine
  • The benefit is paid by the scheme, and not out of your savings account
  • If you have no day-to-day funds, you still have cover for PMBs
  • Schemes usually impose the use of specific providers for treatment of PMBs. Read more about that here.
  • See our Guide to PMBs for more information.
General info: .
GP consultations:
  • 12 consults per person
Childcare: .
Specialists consultations:
  • R3,400 per person
Pathology:
  • Unlimited, when referred by nominated GP
General radiology:
  • Unlimited, when referred by nominated GP
Specialised radiology:
  • 2 scans per family, in and out of hospital.
Supplementary Services: (Physio, etc)
  • No benefit, unless PMB
General Appliances:
  • R4,000 per family, in and out of hospital
  • Other sublimits apply
1.1. Hearing Aids:
  • See "General Appliances" limit
1.2. Wheelchairs:
  • See "General Appliances" limit
Note:
  • PMBs: Prescribed Minimum Benefits. To read more about PMBs click here
  • DSPs: Designated Service Provders. Where stipulated, you must use specific specific providers to get full benefit.
  • Co-payment: Paid out of pocket, or out of savings account. Sometimes this is refundable to you if you have a gap product
♦️View all the other benefits for this plan:♦️
Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics

You can also:
♦️Compare any two plans, side by side | ♦️View all the Suremed plans, with costs and brief summary
.

All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme. The benefits listed here are an indication only. Please verify all benefits and their conditions with the scheme.

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Medication Benefit for 2022:

Suremed: Explorer A
Assume scheme pays all these costs, unless otherwise stated
Summary of day-to-day benefits:
Main Member: Adult: Child:
Savings (per year):
  • No savings account option on this plan
  • The scheme might still cover some or all day-to-day claims. See below, and see benefits.
Chronic: .
Acute (presrcibed) medication:
  • Unlimited if prescribed by nominated GP
Over-the-counter:
  • R300 per person and R355 per family
Birth Control: .
On Discharge:
  • R300 per event supply
Biological:
  • PMBs only
Note:
  • Schemes have very strict rules about where you can get your medicine to get full benefit. We do not list the requirements here, so confirm with your scheme before you collect your medicine.
  • Formulary: A pre-defined list of approved medicines. Each plan has a different list, and might not pay for non-listed medicine. Confirm with your scheme whether your required medicine is covered by them.
  • PMBs: Prescribed Minimum Benfits. To read more about PMBs click here
  • DSPs: Designated Service Provders. Where stipulated, you must use specific specific providers to get full benefit.
  • Co-payment: Paid out of pocket, or out of savings account. Sometimes this is refundable to you if you have a gap product
♦️View all the other benefits for this plan:♦️
Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics

You can also:
♦️Compare any two plans, side by side | ♦️View all the Suremed plans, with costs and brief summary
.

All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme. The benefits listed here are an indication only. Please verify all benefits and their conditions with the scheme.


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