Suremed Explorer B: in-and-out of hospital benefits (2021)

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Table of Contents

This page shows the In-hospital, Out-of-hospital and Medicine benefits for Suremed Explorer B.

Pricing:

Explorer B
Main member: Adult member: Child member:
Total Cost pm: R1,410 R1245 R625
(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, though. See below, and see benefits.
Children:
  • (Pay for all children)
Income band:
View all benefits: Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics
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

You can also:

In-hospital Procedures:

Explorer B
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
Penalty for using other hospital: .
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
Day Hospitals: .
Co-payments:
  • n/a
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
  • Exclusions: Note that all schemes have extensive exclusions. We've tried to list the major ones here, but you must consult with your scheme to get the full list.

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.

Looking for this plan's other benefits?

Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics


Out-of-hospital Procedures:

Explorer B
Summary of day-to-day benefits:
Main Member: Adult: Child:
Savings /yr: No savings option on this plan
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 visits 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 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

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.

Looking for this plan's other benefits?

Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics


Medication cover:

Explorer B
Summary of day-to-day benefits:
Main Member: Adult: Child:
Savings /yr: No savings option on this plan
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:
  • No benefit, unless PMB
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

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.

Important!

  • Unless specified, assume that all benefits are paid at 100% scheme rate
  • No limits or co-payments can apply to treatment of PMBs, which is always unlimited, although subject to strict protocols and scheme rules.
  • "Unlimited" benefits are still subject to authorisation, protocols and sublimits
  • Assume that all benefits need to be pre-authorised

There’s more help here:

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