Suremed Explorer A medical aid plan: 2018

View all plans in this scheme.
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.

COSTS and OVERVIEW:
Explorer A
Quick Overview
Main: Adult: Child:
Total Cost pm: R R R
Gap (optional): KaeloXelus: R350 per family
(R600 per family if anyone is 60yrs+)
Overal Limit: 2018 benefits coming soon. 2017 benefits:
  • Intensive/High Care: 15 days
PMBs: Day-to-day expenses for PMBs (eg. cancer) are always paid for by the scheme, according to protocols. Find out more
Children:
Income band: This plan is only available to households with income in pm band.
View other income bands
See full benefits below

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IN HOSPITAL PROCEDURES:
Explorer A
Benefits Gap benefits
Payout Rate for Specialists: 2018 benefits coming soon. 2017 benefits:
  • Up to 500% of scheme rate
  • In case of admission related to accident:
    • R300 per day, for days 1-13
    • R600 per day for days 14-20
    • R1,200 per day for days 21-30
Hospital Choice: 2018 benefits coming soon. 2017 benefits:
  • Network
  • R12,800 per person per year for use of a non-network hospital
Specialised Radiology: 2018 benefits coming soon. 2017 benefits:
  • 2 scans per family,in and out of hospital
Supplementary Services: (Physio, etc) 2018 benefits coming soon. 2017 benefits:
  • Physiotherapy: R3,300 per family
Transplants: 2018 benefits are coming soon!
Co-payments: none
  • Gap covers co-payments for most scopes and a defined list of other procedures, incl MRIs etc See full list
Alternatives to hospitals: 2018 benefits coming soon. 2017 benefits:
  • Private nursing and step down facilities: R12,500 per family
  • Hospice: R20,000 per family
Casualty: 2018 benefits coming soon. 2017 benefits:
  • No benefit, unless PMB
Other: 2018 benefits coming soon. 2017 benefits:
  • ICU and High Care limited to 15 days
  • Pathology: R20,000 per family
  • Specialists: R20,000 per family
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OUT OF HOSPITAL BENEFITS:
Explorer A
Benefits Gap benefits
GP consultations: 2018 benefits coming soon. 2017 benefits:
  • 12 consults per person
Childcare:
  • No benefit
Specialists consultations: 2018 benefits coming soon. 2017 benefits:
  • R3,000 per person, if referred
Pathology: 2018 benefits coming soon. 2017 benefits:
  • Unlimited if referred by GP
General radiology: 2018 benefits coming soon. 2017 benefits:
  • Unlimited if referred by GP
Specialised radiology: 2018 benefits coming soon. 2017 benefits:
  • 2 scans per family, in and out of hospital
Supplementary Services: (Physio, etc) 2018 benefits coming soon. 2017 benefits:
  • No benefit, unless PMB
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MATERNITY BENEFITS:
Explorer A
Benefits Gap benefits
Hospital stay: 2018 benefits coming soon. 2017 benefits:
  • 100% scheme rate
Consultations: 2018 benefits coming soon. 2017 benefits:
  • 2 consults, and one paediatric consult. Paid by scheme.
Scans: 2018 benefits coming soon. 2017 benefits:
  • 2 x 2D scans, paid by scheme
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CANCER (ONCOLOGY):
Explorer A
Benefits Gap benefits
Overall coverage (in and out of hospital): 2018 benefits coming soon. 2017 benefits:
  • PMBs only
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DENTISTRY:
Explorer A
Benefits Gap benefits
Dentistry: 2018 benefits coming soon. 2017 benefits:
  • Standard dentistry: unlimited, through Prime Cure provider
  • Specialised dentistry: 1 set of acrylic dentures. Every 2 years, limited to R3,150 and paid at 80%
  • In-hospital: no benefit
Orthodontics: 2018 benefits are coming soon!
Maxillo Facial Surgery: 2018 benefits are coming soon!
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MEDICATION:
Explorer A
Benefits Gap benefits
Chronic: 2018 benefits coming soon. 2017 benefits:
  • PMBs chronic: paid by scheme
Acute (presrcibed) medication: 2018 benefits coming soon. 2017 benefits:
  • Unlimited if prescribed by nominated provider, limited to R70 per event
Over-the-counter: 2018 benefits coming soon. 2017 benefits:
  • R230 per person and R265 per family
Birth Control:
On Discharge: 2018 benefits coming soon. 2017 benefits:
  • R300 per event
Biological:
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OPTOMETRY:
Explorer A
Benefits Gap benefits
Optometry: 2018 benefits coming soon. 2017 benefits:
  • Eye test
  • One pre-selected frame every 2 years
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MENTAL HEALTH:
Explorer A
Benefits Gap benefits
In-hospital: 2018 benefits coming soon. 2017 benefits:
  • PMBs only
Out-of-hospital: 2018 benefits coming soon. 2017 benefits:
  • PMBs only
Trauma:
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OTHER BENEFITS:
Explorer A
Benefits Gap benefits
General Appliances: 2018 benefits coming soon. 2017 benefits:
  • R3,700 per family, at preferred provider in and out of hospital
  • No benefit
1.1. Hearing Aids: 2018 benefits coming soon. 2017 benefits:
  • See "General Appliances" limit
  • No benefit
1.2. Wheelchairs: 2018 benefits coming soon. 2017 benefits:
  • See "General Appliances" limit
  • No benefit
Dialysis: 2018 benefits coming soon. 2017 benefits:
  • PMBs only
HIV: 2018 benefits coming soon. 2017 benefits:
  • Since HIV is a PMB certain out-of-hospital benefits are automatically covered by all schemes according to protocols
  • No benefit
Emergency Transport:
  • No benefit
International Insurance: 2018 benefits are coming soon!
  • No benefit
Other: 2018 benefits are coming soon!
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WELLNESS/PREVENTATIVE BENEFITS:
Explorer A
Benefits Gap benefits
Flu vaccination: 2018 benefits coming soon. 2017 benefits:
  • Covered
  • No benefit
Pneumonia vaccines: 2018 benefits are coming soon!
  • No benefit
Back Rehabilitation Programme: 2018 benefits are coming soon!
  • No benefit
Biometric Screening: 2018 benefits are coming soon!
  • No benefit
Child Immunisation: 2018 benefits are coming soon!
  • No benefit
Pap Smear: 2018 benefits are coming soon!
  • No benefit
Mammogram: 2018 benefits are coming soon!
  • No benefit
PAS Test: 2018 benefits are coming soon!
  • No benefit
HIV Test: 2018 benefits are coming soon!
  • No benefit
Other:
  • No benefit
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PROSTHETICS:
Explorer A
Benefits Gap benefits
Overal Limit:
Sub-limits:

    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