This page has information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Suremed Navigator.
In-hospital Procedures ():
(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated |
non-Network Specialists: |
- 125% specific scheme tariff
|
network Specialists: |
- 125% specific scheme tariff
|
non-Network GPs: |
- 125% specific scheme tariff
|
network GPs: |
- 125% specific scheme tariff
|
Hospital Choice: |
|
|
Day Hospitals: |
|
|
Penalty for using other hospital: |
|
Other Co-payments: |
|
Specialised Radiology: |
- R16,900 per family, in and out of hospital.
|
Scopes: |
. |
Supplementary Services: (Physio, etc) |
- Physiotherapy: R5,650 per family, unless PMB
|
Transplants: |
- R150,000 per family, unless PMB
|
|
Dialysis: |
|
|
Exclusions: |
Exclusions:
- Note: All schemes have extensive exclusions. We've tried to list the major ones here, but please consult your scheme or broker to get the full list.
|
Alternatives to hospitals: |
. |
|
Casualty: |
- Covered
- Elective C-section: Covered up to vaginal delivery
|
Other: |
|
|
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:
In-hospital |
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.
Find all other open medical aid plans here.
|
. |
Out-of-hospital Procedures ():
(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated |
|
Main Member: |
Adult: |
Child: |
|
|
|
- Main= R14,394
- Main+1= R28,238
|
|
- 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.
|
. |
|
. |
|
|
|
|
- R16,900 per family, in and out of hospital.
|
Scopes: |
. |
|
|
- From day-to-day benefit
- Sublimit R2,500 per family once savings account is depleted
|
|
- See "General Appliances" limit
|
- 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:
In-hospital |
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.
Find all other open medical aid plans here.
|
. |
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.
Medication Benefit ():
(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)
Assume scheme pays all these costs, unless otherwise stated |
|
Main Member: |
Adult: |
Child: |
|
|
|
- Main= R14,394
- Main+1= R28,238
|
|
Chronic: |
|
- R160 per script and R1,425 per year
- Shared with acute medicine benefit
|
|
|
- From day-to-day benefit and R3,165 per family
- Sublimit R1,260 per person once savings account is depleted
|
. |
- From day-to-day benefit
- Sublimit R3,165 per person once savings account is depleted
|
- 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:
In-hospital |
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.
Find all other open medical aid plans here.
|
. |
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.
|