Suremed Navigator medical aid plan: 2017 vs 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:
Navigator
2018 costs In brief:
What’s new in 2018?
Main: Adult: Child:
Cost 2018: R R R
Cost 2017: (R2,400) (R1,900) (R720)
Gap (optional): KaeloXelus: R350 per family
(R600 per family if anyone is 60yrs+)
Overal Limit: 2018 benefits coming soon. 2017 benefits:
  • Unlimited
PMBs: Day-to-day expenses for PMBs (eg. cancer) are always paid for by the scheme, according to protocols. Find out more
Children:

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Avoid bills! Get up to: 800% scheme rate;  R12,800 per ER visit; unlimited cancer cover;  

co-payments paid and cash payout for hospital stay. R350pm per family


IN HOSPITAL PROCEDURES:
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2017 v 2018 benefits Gap benefits Notes
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

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Hospital Choice: 2018 benefits coming soon. 2017 benefits:
  • Unlimited
Specialised Radiology: 2018 benefits coming soon. 2017 benefits:
  • R14,800 per family,in and out of hospital
Supplementary Services: (Physio, etc) 2018 benefits coming soon. 2017 benefits:
  • Physiotherapy: R5,000 per person
Transplants: 2018 benefits coming soon. 2017 benefits:
  • In and out of hospital: R140,000 per family
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: R20,000 per family
  • Hospice: R20,000 per family
Casualty: 2018 benefits coming soon. 2017 benefits:
  • No benefit, unless PMB
Other: 2018 benefits are coming soon!
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OUT OF HOSPITAL BENEFITS:
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2017 v 2018 benefits Gap benefits Notes
GP consultations: 2018 benefits coming soon. 2017 benefits:
  • Paid from day-to-day benefit


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Childcare:
  • No benefit
Specialists consultations: 2018 benefits coming soon. 2017 benefits:
  • Paid from day-to-day benefit
Pathology: 2018 benefits coming soon. 2017 benefits:
  • Paid from day-to-day benefit
General radiology: 2018 benefits coming soon. 2017 benefits:
  • Paid from day-to-day benefit
Specialised radiology: 2018 benefits coming soon. 2017 benefits:
  • R14,800 per family, in and out of hospital. Paid by scheme
Supplementary Services: (Physio, etc) 2018 benefits coming soon. 2017 benefits:
  • Paid from day-to-day benefit
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MATERNITY BENEFITS:
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2017 v 2018 benefits Gap benefits Notes
Hospital stay: 2018 benefits coming soon. 2017 benefits:
  • Unlimited
  • Elective caesarean: Covered up to vaginal birth benefit

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Consultations: 2018 benefits coming soon. 2017 benefits:
  • 9 consults, and one post-natal consultation. Paid by scheme.
  • Antenatal classes: R370
Scans: 2018 benefits coming soon. 2017 benefits:
  • 2 x 2D scans, paid by scheme
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CANCER (ONCOLOGY):
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2017 v 2018 benefits Gap benefits Notes
Overall coverage (in and out of hospital): 2018 benefits coming soon. 2017 benefits:
  • R125,000 per person and R250,000 per family
All oncology benefits are assessed on a case-by-case basis, and are subject to protocols, preferred providers and scheme rules. Benefit covers out-of-hospital treatment too, like chemotherapy.
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DENTISTRY:
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2017 v 2018 benefits Gap benefits Notes
Dentistry: 2018 benefits coming soon. 2017 benefits:
  • Standard dentistry: from day-today benefit
  • Specialised dentistry: from savings, thereafter limited to R4,000 per person from day-to-day benefit
  • In-hospital: R9,000 per family, for children under 12yrs old and impacted wisdom teeth

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Orthodontics: 2018 benefits are coming soon!
Maxillo Facial Surgery: 2018 benefits are coming soon!

Avoid bills! Get up to: 800% scheme rate;  R12,800 per ER visit; unlimited cancer cover;  

co-payments paid and cash payout for hospital stay. R350pm per family

MEDICATION:
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2017 v 2018 benefits Gap benefits Notes
Chronic: 2018 benefits coming soon. 2017 benefits:
  • PMBs chronic: paid by scheme

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Acute (presrcibed) medication: 2018 benefits coming soon. 2017 benefits:
  • Paid from savings first. Thereafter R2,640 per person from overall day-to-day benefit
Over-the-counter: 2018 benefits coming soon. 2017 benefits:
  • R140 per prescription per month, limited to R1,250 per family per year
  • Included in acute medicine benefit
Birth Control:
On Discharge: 2018 benefits coming soon. 2017 benefits:
  • R500 per person per admission
Biological:
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OPTOMETRY:
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2017 v 2018 benefits Gap benefits Notes
Optometry: 2018 benefits coming soon. 2017 benefits:
  • Paid from savings first. Thereafter, R1,100 per person and R2,700 per family, from overall day-to-day benefit

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MENTAL HEALTH:
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2017 v 2018 benefits Gap benefits Notes
In-hospital: 2018 benefits coming soon. 2017 benefits:
  • R14,800 per family

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Out-of-hospital: 2018 benefits coming soon. 2017 benefits:
  • Paid from day-to-day benefit
  • Alcoholism and drug dependency: from savings, then sublimit of R1,550 per person from overall day-to-day benefit
Trauma:
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OTHER BENEFITS:
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2017 v 2018 benefits Gap benefits Notes
General Appliances: 2018 benefits coming soon. 2017 benefits:
  • From savings first. Thereafter, limited to R2,330 per family, from overallday-to-day benefit
2018 benefits coming soon. 2017 benefits:
  • CPAP machine: R5,000 every 3 years
  • Nebulisers/Humidifiers: R500
  • Glucometers: R500 every 3 years
  • Back support: R2,500
  • Orthotics: R1,000
  • No benefit

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1.1. Hearing Aids: 2018 benefits coming soon. 2017 benefits:
  • Limited to R5,000 every 3 years, subject to appliance limit
  • No benefit
1.2. Wheelchairs: 2018 benefits are coming soon!
  • No benefit
Dialysis: 2018 benefits coming soon. 2017 benefits:
  • R132,000 per family
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:
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2017 v 2018 benefits Gap benefits Notes
Flu vaccination: See "Other"
  • No benefit

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Pneumonia vaccines: See "Other"
  • No benefit
Back Rehabilitation Programme: See "Other"
  • No benefit
Biometric Screening: See "Other"
  • No benefit
Child Immunisation: See "Other"
  • No benefit
Pap Smear: See "Other"
  • No benefit
Mammogram: See "Other"
  • No benefit
PAS Test: See "Other"
  • No benefit
HIV Test: See "Other"
  • No benefit
Other: 2018 benefits coming soon. 2017 benefits:
  • Paid from savings first. Thereafter sub limit of R920 per person and R1,750 per family, from day-to-day benefit
  • No benefit

Avoid bills! Get up to: 800% scheme rate;  R12,800 per ER visit; unlimited cancer cover;  

co-payments paid and cash payout for hospital stay. R350pm per family

2017 v 2018 benefits Gap benefits Notes
Overal Limit:
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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