Suremed Navigator 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 savings or out of pocket, unless PMB. Pay for all children.

View all plans in this scheme

IN HOSPITAL PROCEDURES:
Payout Rate for Specialists:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,400 R1,900 R720
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 savings or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R3,960 R3,180 R1,200
Extended Fund: R8,500 pp R17,680 pf R

Compare with these plans:
Hospital Choice:
  • Unlimited
Specialised Radiology:
  • R14,800 per family,in and out of hospital
Supplementary Services: (Physio, etc)
  • Physiotherapy: R5,000 per person
Transplants:
  • In and out of hospital: R140,000 per family
Co-payments: none
Alternatives to hospitals:
  • Private nursing and step down facilities: R20,000 per family
  • Hospice: R20,000 per family

.
.

OUT OF HOSPITAL BENEFITS:
GP consultations:
  • Paid from day-to-day benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,400 R1,900 R720
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 savings or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R3,960 R3,180 R1,200
Extended Fund: R8,500 pp R17,680 pf R

Compare with these plans:

Specialists consultations:
  • Paid from day-to-day benefit
Pathology:
  • Paid from day-to-day benefit
General radiology:
  • Paid from day-to-day benefit
Specialised radiology:
  • R14,800 per family, in and out of hospital. Paid by scheme
Supplementary Services: (Physio, etc)
  • Paid from day-to-day benefit

.
.

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: R2,400 R1,900 R720
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 savings or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R3,960 R3,180 R1,200
Extended Fund: R8,500 pp R17,680 pf R

Compare with these plans:

Consultations:
  • 9 consults, and one post-natal consultation. Paid by scheme.
  • Antenatal classes: R370
Scans:
  • 2 x 2D scans, paid by scheme

.
.

CANCER (ONCOLOGY):
Overall coverage (in and out of hospital):
  • R125,000 per person and R250,000 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: R2,400 R1,900 R720
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 savings or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R3,960 R3,180 R1,200
Extended Fund: R8,500 pp R17,680 pf R

Compare with these plans:

.
.

DENTISTRY:
Dentistry:
  • 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
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,400 R1,900 R720
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 savings or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R3,960 R3,180 R1,200
Extended Fund: R8,500 pp R17,680 pf R

Compare with these plans:

Orthodontics:
Maxillo Facial Surgery:

.
.

MEDICATION:
Chronic:
  • PMBs chronic: paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,400 R1,900 R720
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 savings or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R3,960 R3,180 R1,200
Extended Fund: R8,500 pp R17,680 pf R

Compare with these plans:
Acute (presrcibed) medication:
  • Paid from savings first. Thereafter R2,640 per person from overall day-to-day benefit
Over-the-counter:
  • R140 per prescription per month, limited to R1,250 per family per year
  • Included in acute medicine benefit
Birth Control:
On Discharge:
  • R500 per person per admission
Notes:

.
.

OPTOMETRY:
Optometry:
  • Paid from savings first. Thereafter, R1,100 per person and R2,700 per family, from overall day-to-day benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,400 R1,900 R720
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 savings or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R3,960 R3,180 R1,200
Extended Fund: R8,500 pp R17,680 pf R

Compare with these plans:

.
.

MENTAL HEALTH:
In-hospital:
  • R14,800 per family
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,400 R1,900 R720
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 savings or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R3,960 R3,180 R1,200
Extended Fund: R8,500 pp R17,680 pf R

Compare with these plans:


Out-of-hospital:
  • 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

.
.

OTHER BENEFITS:
General Appliances:
  • From savings first. Thereafter, limited to R2,330 per family, from overallday-to-day benefit
  • 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: R2,400 R1,900 R720
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 savings or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R3,960 R3,180 R1,200
Extended Fund: R8,500 pp R17,680 pf R

Compare with these plans:

1.1. Hearing Aids:
  • Limited to R5,000 every 3 years, subject to appliance limit
1.2. Wheelchairs:
Dialysis:
  • R132,000 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:

.
.

WELLNESS/PREVENTATIVE BENEFITS:
Flu vaccination: See "Other"
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,400 R1,900 R720
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 savings or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R3,960 R3,180 R1,200
Extended Fund: R8,500 pp R17,680 pf R

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"

.
.

PROSTHESIS:
Overal Limit:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,400 R1,900 R720
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 savings or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R3,960 R3,180 R1,200
Extended Fund: R8,500 pp R17,680 pf R

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