Suremed Navigator:
in-and-out of hospital benefits (2025)

What's on this page:

  1. Monthly Costs (2025)
  2. In-hospital Procedures ():
  3. Out-of-hospital Procedures ():
  4. Medication Benefit ():
This page has information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Suremed Navigator.

Monthly Costs (2025)

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Navigator 2025 prices
Main member: Adult member: Child member:
Total Cost pm:
  • R4,270
  • R3,340
  • R1270
  • Pay for all children
Savings:
  • R6900
  • R5340
  • R2280
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • Main= R14,394
  • Main+1= R28,238
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:
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.
.

In-hospital Procedures ():

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Suremed: Navigator
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
non-Network Specialists:
  • 125% specific scheme tariff
 Scheme rate is set by Suremed
network Specialists:
  • 125% specific scheme tariff
non-Network GPs:
  • 125% specific scheme tariff
network GPs:
  • 125% specific scheme tariff
Hospital Choice:
  • Choose any hospital
Day Hospitals:
  • n/a
Penalty for using other hospital:
  • n/a
 You don't pay a penalty if admission was unavoidable due an emergency
Other Co-payments: * There might be other co-payments if you don't use scheme-chosen provider for some services.

* Treatment required for PMB level care is always paid by scheme, with no co-payment, if you follow the protocols.
That means that these co-payments might not apply in your case! More info here
Specialised Radiology:
  • R16,900 per family, in and out of hospital.
 No limits or co-payments for PMB level care and/or for emergency
Scopes: . No limits or co-payments for PMB level care and/or for emergency
Supplementary Services: (Physio, etc)
  • Physiotherapy: R5,650 per family, unless PMB
 No limits or co-payments for PMB level care and/or for emergency
Transplants:
  • R150,000 per family, unless PMB
Dialysis:
  • Unlimited
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.
 * Treatment required for PMB level of care is always paid by scheme, if you follow the protocols. It cannot be excluded. More info here.

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)

Suremed: Navigator
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
Summary of day-to-day benefits:
Main Member: Adult: Child:
Savings:
  • R6900
  • R5340
  • R2280
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • Main= R14,394
  • Main+1= R28,238
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:
  • From day-to-day benefit
 Treatment required for PMB conditions is always paid paid by scheme, with no co-payment, if you follow the protocols. More info here
Childcare: .
Specialists consultations:
  • From day-to-day benefit
 Treatment required for PMB conditions is always paid paid by scheme, with no co-payment, if you follow the protocols. More info here
Pathology:
  • From day-to-day benefit
General radiology:
  • From day-to-day benefit
Specialised radiology:
  • R16,900 per family, in and out of hospital.
 Scans required for PMB level care are paid paid by scheme, with no co-payment, if you follow the protocols. More info here
Scopes: . No limits or co-payments for PMB level care and/or for emergency
Supplementary Services: (Physio, etc)
  • From day-to-day benefit
General Appliances:
  • From day-to-day benefit
  • Sublimit R2,500 per family once savings account is depleted
1.1. Hearing Aids:
  • No benefit
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:
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)

Suremed: Navigator
Assume scheme pays all these costs, unless otherwise stated
Summary of day-to-day benefits:
Main Member: Adult: Child:
Savings:
  • R6900
  • R5340
  • R2280
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • Main= R14,394
  • Main+1= R28,238
Chronic:
  • PMBs only
You might be required to use specific pharmacies and be limited to specific medicines
Acute (presrcibed) medication:
  • R160 per script and R1,425 per year
  • Shared with acute medicine benefit
Over-the-counter:
  • R500 per event supply
Birth Control:
  • From day-to-day benefit and R3,165 per family
  • Sublimit R1,260 per person once savings account is depleted
On Discharge: .
Biological:
  • From day-to-day benefit
  • Sublimit R3,165 per person once savings account is depleted
 Treatment that is required (by law) for PMB conditions is always paid paid by scheme, with no co-payment, if you follow the protocols. More info here.)
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:
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.


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