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

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".

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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.

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	Gap Cover: Can push payout up to 700% scheme rate (Plans coming soon)
Hospital Choice:	Choose any hospital
Penalty for using other hospital:	n/a	Gap Cover: Can cover the penalty in full (Plans coming soon)
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.	Gap Cover: Can cover most co-payments (Plans coming soon)
Specialised Radiology:	R17,745 per family, in and out of hospital.	Gap Cover: Can cover most co-payments and increase sublimits (Plans coming soon)
Scopes:	.	Gap Cover: Can cover most co-payments and increase sublimits (Plans coming soon)
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!	Gap Cover: Coming soon
Alternatives to hospitals:	Hospital Alternatives: R21,000 per family Terminal care: R21,000 per family
Casualty/ER:	From day to day benefit	Gap Cover: Can cover ER claims (Plans coming soon)
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 Other Day-to-Day Funds:
PMBs out of hospital:	All schemes 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 PMB benefits must never be paid from your savings account 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.
GP consultations:	From day to day benefit
Childcare:	.	Gap Cover: Can pay for child ER visits (Plans coming soon)
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.	Gap Cover: Can pay co-payments and increase sublimits (Plans coming soon)
Scopes:	.	Gap Cover: Can pay co-payments and increase sublimits (Plans coming soon)
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

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 Other Day-to-Day Funds:
Chronic:	27 PMB conditions: Covered. You can see the full PMB list here. .
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