Suremed Challenger medical aid plan: 2019

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Please note that these benefits are still being updated as more information is made available to us. Always consult with your broker before making final decisions regarding your healthcare cover.

Challanger
2018 Costs:
Total Cost pm:

Main member:

R

Adult:

R

Child:

R
2019 Costs:
Total Cost pm:

Main member:

R4,540
(%)

Adult:

R3410

Child:

R900
Savings (per year):
  • No savings option on this plan
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In brief (2018): See full benefits below

IN HOSPITAL PROCEDURES:
Challanger
Scheme Benefits: Gap Benefits:
Specialists:
Hospital Choice:
Specialised Radiology: 2018 benefits coming soon. 2017 benefits:
  • R16,900 per family,in and out of hospital
Supplementary Services: (Physio, etc)
Transplants:
Co-payments:
Alternatives to hospitals:
Casualty:
Other:
Note:
  • Gap cover is an add-on to your medical aid, not a stand alone product
  • Gap cover has a maximum benefit payout of R150,000 per person per year for all gap benefits (except dread disease and premium waiver benefits which do not count towards the R150,000 limit)
  • Gap only supplements payment for procedures approved or authorised by your medical aid, and does not cover “penalties” (such as if, for example, you choose a non-DSP doctor for your procedure when the plan required a DSP doctor)
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All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme.
The gap benefits listed are for AskAdam gaps, unless otherwise stated. Actual benefits depend on gap choice option.

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OUT OF HOSPITAL BENEFITS (non-PMB):
Challanger
Scheme Benefits Gap benefits
Main: Adult: Child:
General info:
GP consultations:
Childcare:
  • No extra benefit available
Specialists consultations:
Pathology:
General radiology:
Specialised radiology:
Supplementary Services: (Physio, etc)
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MATERNITY BENEFITS:
Challanger
Scheme Benefits Gap benefits
Hospital stay:
Consultations:
Scans:
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CANCER (ONCOLOGY):
Challanger
Scheme Benefits Gap benefits
Overall coverage (in and out of hospital):
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DENTISTRY:
Challanger
Scheme Benefits Gap benefits
Standard Dentistry:
Specialised Dentistry:
In-Hospital Dentistry:
Orthodontics:
Maxillo Facial Surgery:
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MEDICATION:
Challanger
Scheme Benefits Gap benefits
Chronic:
Acute (presrcibed) medication:
Over-the-counter:
Birth Control:
On Discharge:
Biological:
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OPTOMETRY:
Challanger
Scheme Benefits Gap benefits
Optometry:
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MENTAL HEALTH:
Challanger
Scheme Benefits Gap benefits
In-hospital:
Out-of-hospital:
Trauma:
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OTHER BENEFITS:
Challanger
Scheme Benefits Gap benefits
General Appliances:
  • No benefit
1.1. Hearing Aids:
  • No benefit
1.2. Wheelchairs:
  • No benefit
Dialysis:
HIV:
  • No benefit
Emergency Transport:
  • No benefit
International Insurance:
  • No benefit
Other:
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WELLNESS/PREVENTATIVE BENEFITS:
Challanger
Scheme Benefits Gap benefits
Flu vaccination:
  • No benefit
Pneumonia vaccines:
  • No benefit
Back Rehabilitation Programme:
  • No benefit
Biometric Screening:
  • No benefit
Child Immunisation:
  • No benefit
Pap Smear:
  • No benefit
Mammogram:
  • No benefit
PAS Test:
  • No benefit
HIV Test:
  • No benefit
Other:
  • No benefit
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PROSTHETICS:
Challanger
Scheme Benefits Gap benefits
Overal Limit:
Sub-limits:
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    Important!
  • Unless specified, assume that all benefits are paid 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