Suremed Challenger medical aid plan: 2017

Out-of-hospital, scheme pays for some: medication, appliances, dentistry, GPs and specialists, maternity, non surgical procedures, optometry, supplementary services, pathology, radiology, specialised radiology, preventative care, alternative to hospitals. Limits apply. All else paid out of pocket, unless PMB. Pay for all children.

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IN HOSPITAL PROCEDURES:
Payout Rate for Specialists:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R4,000 R3,000 R800
Children: Pay for all children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: medication, appliances, dentistry, GPs and specialists, maternity, non surgical procedures, optometry, supplementary services, pathology, radiology, specialised radiology, preventative care, alternative to hospitals. Limits apply. All else paid out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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Hospital Choice:
  • Unlimited
Specialised Radiology:
  • R16,900 per family,in and out of hospital
Supplementary Services: (Physio, etc)
  • Physiotherapy: R5,000 per person
Transplants:
  • In and out of hospital: R170,000 per family
Co-payments: none
Alternatives to hospitals:
  • Private nursing and step down facilities: R20,000 per family
  • Hospice: R20,000 per family

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OUT OF HOSPITAL BENEFITS:
GP consultations:
  • R4,500 per person and R12,300 per family
  • Shared with Specialist and Casualty Benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R4,000 R3,000 R800
Children: Pay for all children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: medication, appliances, dentistry, GPs and specialists, maternity, non surgical procedures, optometry, supplementary services, pathology, radiology, specialised radiology, preventative care, alternative to hospitals. Limits apply. All else paid out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

Specialists consultations:
  • R4,500 per person and R12,300 per family
  • Shared with GP and Casualty Benefit
Pathology:
  • Unlimited
General radiology:
  • Unlimited
Specialised radiology:
  • R16,900 per family, in and out of hospital
Supplementary Services: (Physio, etc)
  • R2,100 per person and R5,300 per family
  • Includes mental health

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MATERNITY BENEFITS:
Hospital stay:
  • Unlimited
  • Elective caesarean: Covered up to vaginal birth benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R4,000 R3,000 R800
Children: Pay for all children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: medication, appliances, dentistry, GPs and specialists, maternity, non surgical procedures, optometry, supplementary services, pathology, radiology, specialised radiology, preventative care, alternative to hospitals. Limits apply. All else paid out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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Consultations:
  • 9 consults, and one post-natal consultation
  • Antenatal classes: R500
Scans:
  • 2 x 2D scans

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CANCER (ONCOLOGY):
Overall coverage (in and out of hospital):
    R150,000 per person and R300,000 per family

Note: 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.
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R4,000 R3,000 R800
Children: Pay for all children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: medication, appliances, dentistry, GPs and specialists, maternity, non surgical procedures, optometry, supplementary services, pathology, radiology, specialised radiology, preventative care, alternative to hospitals. Limits apply. All else paid out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

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DENTISTRY:
Dentistry:
  • Standard dentistry: unlimited, subject to protocols
  • Specialised dentistry: R5,300 per person and R12,300 per family
  • In-hospital: R11,750 per family, for children under 12yrs old and impacted wisdom teeth
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R4,000 R3,000 R800
Children: Pay for all children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: medication, appliances, dentistry, GPs and specialists, maternity, non surgical procedures, optometry, supplementary services, pathology, radiology, specialised radiology, preventative care, alternative to hospitals. Limits apply. All else paid out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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Orthodontics:
Maxillo Facial Surgery:

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MEDICATION:
Chronic:
  • PMBs chronic: paid by scheme
  • Some non-PMB conditions are also covered
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R4,000 R3,000 R800
Children: Pay for all children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: medication, appliances, dentistry, GPs and specialists, maternity, non surgical procedures, optometry, supplementary services, pathology, radiology, specialised radiology, preventative care, alternative to hospitals. Limits apply. All else paid out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:
Acute (presrcibed) medication:
  • R5,500 per person and R19,550 per family
  • 20% co-payment once R3,100 per person is reached
Over-the-counter:
  • R140 per prescription per month, limited to R1,350 per family per year
  • Included in acute medicine benefit
Birth Control:
On Discharge:
  • R500 per person per admission
Notes:

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OPTOMETRY:
Optometry:
  • R2,000 per person and R5,600 per family for glasses every two years or contact lenses every year
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R4,000 R3,000 R800
Children: Pay for all children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: medication, appliances, dentistry, GPs and specialists, maternity, non surgical procedures, optometry, supplementary services, pathology, radiology, specialised radiology, preventative care, alternative to hospitals. Limits apply. All else paid out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

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MENTAL HEALTH:
In-hospital:
  • R17,950 per family
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R4,000 R3,000 R800
Children: Pay for all children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: medication, appliances, dentistry, GPs and specialists, maternity, non surgical procedures, optometry, supplementary services, pathology, radiology, specialised radiology, preventative care, alternative to hospitals. Limits apply. All else paid out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:


Out-of-hospital:
  • R2,100 per person and R5,300 per family
  • Shared with supplementary services benefit

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OTHER BENEFITS:
General Appliances:
  • R8,700 per family, in and out of hospital, with sub limits as below
    • CPAP machine: R5,000 every 3 years
    • Nebulisers/Humidifiers: R500
    • Glucometers: R500 every 3 years
    • Back support: R2,500
    • Orthotics: R1,000
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R4,000 R3,000 R800
Children: Pay for all children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: medication, appliances, dentistry, GPs and specialists, maternity, non surgical procedures, optometry, supplementary services, pathology, radiology, specialised radiology, preventative care, alternative to hospitals. Limits apply. All else paid out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

1.1. Hearing Aids:
  • Limited to R5,000 every 3 years, subject to appliance limit
1.2. Wheelchairs:
Dialysis:
  • R165,000 per family
HIV:
  • Since HIV is a PMB certain out-of-hospital benefits are automatically covered by all schemes according to protocols
Emergency Transport: ER24
International Coverage:
Other:

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WELLNESS/PREVENTATIVE BENEFITS:
Flu vaccination: See "Other"
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R4,000 R3,000 R800
Children: Pay for all children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: medication, appliances, dentistry, GPs and specialists, maternity, non surgical procedures, optometry, supplementary services, pathology, radiology, specialised radiology, preventative care, alternative to hospitals. Limits apply. All else paid out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

Pneumonia vaccines: See "Other"
Back Rehabilitation Programme: See "Other"
Biometric Screening: See "Other"
Child Immunisation: See "Other"
Pap Smear: See "Other"
Mammogram: See "Other"
PAS Test: See "Other"
HIV Test: See "Other"

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PROSTHESIS:
Overal Limit:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R4,000 R3,000 R800
Children: Pay for all children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: medication, appliances, dentistry, GPs and specialists, maternity, non surgical procedures, optometry, supplementary services, pathology, radiology, specialised radiology, preventative care, alternative to hospitals. Limits apply. All else paid out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:
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