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

What's on this page:

This page has overview information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Suremed Navigator. Please consult and verify with the scheme or your broker for full benefits, and an explanation of all the "fine print".

Terminology:

  • 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
  • All schemes have extensive exclusions. We've tried to list the non-common ones here, but please consult your scheme or broker to get the full list.

Monthly Costs (2025)

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

Suremed: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:

In-hospital Procedures (2025):

(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
GPs and Specialists:
  • 125% scheme tariff
Hospital Choice:
  • Choose any hospital
Penalty for using other hospital:
  • n/a
Co-payments: Note:
  • A co-payment is a fee your medical aid can insist you pay, regardless of how much the doctor/charges. It's not the same as an "excess" payment (which is when a doctor charges more than the medical aid rate).
  • If you use a DSP (designated service provider), you never have to pay a co-payment for protocol treatment of a PMB (Prescribed Minimum Benefit). More info here
  • There might be other co-payments if you don't use a DSP, especially if you are being treated for a PMB or when buying medicine.
Specialised Radiology:
  • R17,745 per family, in and out of hospital.
Scopes: .
Supplementary Services: (Physio, etc)
  • Physiotherapy: R5,933 per person
Transplants:
  • R157,500 per family
Dialysis:
  • Unlimited
Exclusions:
  • NB: See scheme's rules for all exclusions. All schemes have plenty!
Alternatives to hospitals:
  • Hospital Alternatives: R21,000 per family
  • Terminal care: R21,000 per family
Casualty/ER:
  • From day to day benefit
Other: .
PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider

Out-of-hospital Procedures (2025):

(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
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:
GP consultations:
  • From day to day benefit
Childcare: .
Specialists consultations:
  • From day to day benefit
Pathology:
  • From day to day benefit
General radiology:
  • From day to day benefit
Specialised radiology:
  • R17,745 per family, in and out of hospital.
Scopes: .
Supplementary Services: (Physio, etc)
  • From day to day limit
General Appliances:
  • First from savings
  • Then, R2,625 per family from overall day to day limit
  • Oxygen: R4,200 per family
  • CPAP apparatus:R5,250, every 3 years
  • Nebulisers/Humidifiers:R525
  • Back Support :R2,625
  • Orthotics:R1,050
1.1. Hearing Aids:
  • R5,250 per family,every 3 years
  • From "Appliances" benefit
1.2. Wheelchairs:
  • From "Appliances" benefit
PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider

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 (2025):

(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
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: .
Acute (prescribed) medication:
  • From savings
  • Then, R3,323 per person within overall day to day limit
Over-the-counter:
  • R168 per script and R1,496 per family
  • Shared with acute medicine benefit
Birth Control: .
On Discharge:
  • R500 per event
Biological:
  • PMBs only
View 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.

PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider

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.


What does a “PMBs only” restriction mean?
In this case, the scheme will only pay for diagnosis, treatment and management of a claim for one of 270 pre-defined conditions (PMBs). Read more, and see full list of PMB conditions. 

What does “From Risk” mean?
The scheme will pay for this claim from its own funds, not from your savings or other day-to-day benefits. 

What is a DSP?
A Designated Service Provider. The scheme has a network of providers, and will often only pay claims in full if you use a DSP. If you choose another provider, you might have a co-payment, or even no cover. 

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