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

Share on facebook
Share on twitter
Share on linkedin
Share on email

Table of Contents

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

Pricing:

Navigator
Main member: Adult member: Child member:
Total Cost pm: R3,120 R2,460 R930
(Pay for all children)
Savings: R5040 R3960 R1620
Extended Fund: RM= R10,180
M+ =R19,960
R R
Children:
  • (Pay for all children)
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:

Navigator
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:
  • Choose any hospital
Penalty for using other hospital:
  • n/a
Specialised Radiology:
  • R16,900 per family, in and out of hospital.
Supplementary Services: (Physio, etc)
  • Physiotherapy: R5,650 per family, unless PMB
Transplants:
  • R150,000 per family, unless PMB
Dialysis:
  • Unlimited
Day Hospitals: .
Co-payments:
  • n/a
Alternatives to hospitals:
  • Private nurse and step down facilities: R20,000 per family
  • Terminal Care: R20,000 per family, for end-of-life costs
Casualty:
  • From day-to-day benefit
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
  • 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:

Navigator
Summary of day-to-day benefits:
Main Member: Adult: Child:
Savings /yr: R5040 R3960 R1620
Extended Fund: RM= R10,180
M+ =R19,960
R R
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
Childcare: .
Specialists consultations:
  • From day-to-day benefit
Pathology:
  • From day-to-day benefit
General radiology:
  • From day-to-day benefit
Specialised radiology:
  • R16,900 per family, in and out of hospital.
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:
  • 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:

Navigator
Summary of day-to-day benefits:
Main Member: Adult: Child:
Savings /yr: R5040 R3960 R1620
Extended Fund: RM= R10,180
M+ =R19,960
R R
Chronic: .
Acute (presrcibed) medication:
  • From day-to-day benefit
  • Sublimit R3,165 per person once savings account is depleted
Over-the-counter:
  • R160 per script and R1,425 per year
  • Shared with acute medicine benefit
Birth Control: .
On Discharge:
  • R500 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:

Hi! I'm Eve Dmochowska, rehealth's founder.

Thanks for reading this far! I hope it was useful.

rehealth is a small, self-funded startup, growing the mission to help South Africans make informed healthcare choices. An informed patient is a healthier patient!

If you found this helpful, please share it using buttons below:-)

And if you are in the business of healthcare and see opportunities here, please give me a shout. hello@rehealth.co.za

Share on facebook
Share on twitter
Share on linkedin
Share on email