Suremed Health Challenger Plan
Overall, the Health Challenger Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and comprehensive cover to up to 3 Family Members. The Health Challenger Medical Aid Plan starts from R6,245 ZAR.
| 👤 Main Member Contribution | R6,245 |
| 👥 Adult Dependent Contribution | R4,655 |
| 🍼 Child Dependent Contribution | R1,230 |
| 🌎 International Cover | None |
| 🔁 Gap Cover | ✅ Yes |
| ↪️ Hospital Cover | Unlimited |
| 💶 Prescribed Minimum Benefits | ✅ Yes |
| 📉 Screening and Prevention | ✅ Yes |
| 💙 Medical Savings Account | ✅ Yes |
| 🟦 Maternity Benefits | ✅ Yes |
Suremed Health Challenger Plan – 7 Key Point Quick Overview
- ✅ Suremed Health Challenger Plan Overview
- ✅ Suremed Health Challenger Plan Contributions
- ✅ Suremed Health Challenger Plan Benefits and Cover Comprehensive Breakdown
- ✅ Suremed Health Challenger Plan Exclusions and Waiting Periods
- ✅ Suremed Health Challenger Plan vs Similar Plans from Other Medical Schemes
- ✅ Our Verdict on the Suremed Health Challenger Plan
- ✅ Suremed Health Challenger Plan Frequently Asked Questions
Suremed Health Challenger Plan Overview
The Suremed Health Challenger Medical Aid Plan is one of 4, starting from R6,245 and is a traditional plan that offers comprehensive cover, no annual limits, and extensive medical benefits with generous sub-limits on several day-to-day benefits. Gap Cover is available on the Suremed Health Challenger Plan, along with 24/7 medical emergency assistance. According to the Trust Index, Suremed Health has a trust rating of 2.1.
Suremed Health Medical Aid Scheme has the following plans:
Suremed Health Challenger Plan Contributions
| 👤 Main Member | 👥 Adult Dependent | 🍼 Child Dependent |
| R6,245 | R4,655 | R1,230 |
Suremed Health Challenger Plan Benefits and Cover Comprehensive Breakdown
| 📌 Prescribed Minimum Benefits (PMB) | Unlimited cover provided.
Covered up to 100% of the Suremed Scheme Tariff.
Pre-authorization is required before admission, or an R1,000 co-payment is required.
The benefit includes medication upon discharge of up to R500 per beneficiary per event. |
| 📍 Emergency Stabilisation and Transportation | Netcare 911 is the preferred provider for road or air transport and stabilization.
Unlimited cover provided. |
| ☑️ Hospitalisation Alternatives | Limited to R20,000 per member family (PMF).
Pre-authorization is required. |
| ✅ GP and Specialist Consultation | Unlimited cover provided.
Covered up to 150% of the Suremed Scheme Tariff. |
| 👶 Maternity | Unlimited cover provided.
Pre-approval is required.
Cesarean Section is only covered if clinically necessary or will be paid up to natural delivery rates.
The benefit includes the following:
Accommodation
Medication
Materials
Anaesthetist
Gynaecologist
Paediatrician |
| 🧠 Mental Health | Limited to R19,200 PMF.
This benefit includes all costs relating to hospitalization and doctors. |
| ❤️ Organ Transplants | Limited to R170,000 PMF.
Pre-authorization required.
Member must be registered on the Disease Management Program.
All services are covered, including anti-rejection medication and harvesting. |
| 📉 Physiotherapy, Biokinetics, Chiropractics | Subject to the Paramedical, Auxiliary, or Physiotherapy limits.
Treatment in-hospital is limited to R6,000 per beneficiary unless it is a PMB. |
| 📈 Internal/Surgical Prostheses | Limited to R40,000 per beneficiary.
Spinal fusions are limited to two levels per year and up to R23,000 per beneficiary.
Intra-ocular lenses are limited to R2,500 per lens.
Mesh is limited to R7,000 per beneficiary.
Subject to Suremed protocols. |
| 📊 Basic Radiology and Pathology | Unlimited cover. |
| 🦷 Dentistry | Limited to R13,820 PMF.
The benefit covers general anesthetic for dental procedures on patients <12 years for impacted wisdom teeth.
The benefit includes all hospital and doctor’s accounts.
Subject to the Suremed protocol and requires pre-approval. |
| 🟥 Compassionate Care | Limited to R20,000 PMF only for clinically appropriate medical care.
PMBs are unlimited when using a DSP.
Pre-approval is required.
A doctor’s letter is required to confirm end-of-life treatment. |
| 🟧 Chronic Medication | Unlimited cover for CDL, including additional non-PMB conditions.
Pre-authorization is required.
Subject to formulary and managed care protocols. |
| 🟨 Dialysis | Unlimited PMF.
Unlimited cover for PMBs when using a DSP.
Pre-approval is required.
Subject to case and treatment management.
Includes all medication and materials associated with treating Renal Dialysis. |
| 🟩 HIV/AIDS | Unlimited cover but subject to LifeSense protocols. |
| 🟦 Oncology | Limited to R300,000 PMF.
Benefits must be pre-approved via ICON.
PMBs have unlimited coverage when using a DSP.
Pre-authorization is required, and the benefit includes medication and chemicals used during active treatment periods. |
| 🟪 Specialized Radiology and Pathology | Limited to R18,700 PMF.
Pre-approval is required, or cover is only up to 80%. |
| 💊 Acute Medicine | Limited to R7,055 per beneficiary and R22,500 PMF.
There is a 20% co-payment once the benefit utilization of R3,900 per beneficiary is reached.
Over-the-counter medication is limited to R170 per monthly prescription up to R1,630 PMF per year.
This benefit is included in the overall acute medication limit. |
| 🩺 Appliances | Limited to R9,300 PMF in and out-of-hospital.
There is a limit of R6,000 PMF for Oxygen.
The benefit is subject to Suremed protocols and must be pre-approved.
The following additional limits apply:
Hearing aids are limited to R5,000 per 3-year cycle.
Nebulizers/Humidifiers are limited to R500.
CPAP Machines are limited to R5,000 per 3-year cycle.
Glucometers are limited to R500 per 3-year cycle.
Back support/braces are limited to R2,500.
Orthotics are limited to R1,000. |
| 🪥 Basic Dentistry | Unlimited cover.
Basic dentistry includes fillings, extractions, etc. |
| 🦷 Advanced Dentistry | Limited to R6,960 per beneficiary and R15,852 PMF.
This benefit includes crowns, bridges, orthodontics, inlays, dental technician fees, and Osseo-integrated implants. |
| 👩⚕️ GP Consultations | Limited to R5,500 per beneficiary and R15,000 PMF.
This benefit includes casualty or emergency room visits up to R500. |
| 🍼 Maternity | The benefit is included in the benefit parameters.
Pregnant members must register for the Maternity Program on the Suremed Challenger App.
The benefit includes the following:
One Amniocentesis by a GP or specialist.
Nine antenatal consultations.
R470 for antenatal classes.
One postnatal consultation with a GP, midwife, or specialist.
R65 for antenatal vitamins per month for 9 months. |
| 🤓 Optometry | Limited to R2,250 per beneficiary and R6,300 PMF.
Limited to R1,150 for frames, subject to the optical limit.
The benefit covers one pair of glasses per beneficiary every two years or contact lenses yearly. |
| 🤍 Paramedical, Auxiliary, and Mental Health | Limited to R2,250 per beneficiary and R5,700 PMF.
This benefit includes the following:
Audiology
Dietetics
Hearing Aid Acoustics
Homoeopathy
Podiatry
Speech Therapy
Social Workers
Clinical and Counselling Psychology |
| 🅰️ Pathology and Basic Radiology | Unlimited cover provided.
This benefit includes X-rays, blood tests, etc. |
| 🅱️ Preventative Care and Wellness | Paid from available funds in the PMSA.
Once depleted, the benefit will be subject to a sub-limit of R1,600 per beneficiary and up to R3,210 PMF.
This benefit covers the following:
Mammograms
Pap Smears
Prostate Check-ups (PSA)
Tonometry |
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Suremed Health Challenger Plan Exclusions and Waiting Periods
Challenger Plan Exclusions
The Suremed Health Challenger Plan Exclusions include, but are not limited to, the following:
- Costs exceeding the annual or biennial maximums.
- Medical, surgical, and orthopedic appliances, devices, and products not specifically provided for.
- Operations, medicines, treatments, and procedures for cosmetic purposes or personal reasons.
- Medicines not included in a prescription from a legally entitled medical practitioner or healthcare professional (except schedule 0, 1, and 2 medicines supplied by a registered pharmacist).
- Healthcare services are not appropriate or necessary for symptoms, diagnosis, or treatment of a medical condition.
- Medicines not registered and approved by SAHPRA for clinical treatment of a condition.
- Treatment where efficacy and safety cannot be scientifically proven.
- MRI scans are ordered by a general practitioner (except in emergencies).
- Specialist referral for second opinions unless authorized by the scheme.
- Injuries sustained while participating voluntarily in certain activities or any injuries arising from professional sports or speed contests.
- Organ and tissue donations to anyone other than a member or dependent of a member.
- Treatment of a sickness condition directly attributable to the failure to carry out medical practitioner instructions (except if the sickness condition is a PMB).
and many more.
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Challenger Plan Waiting Periods
Waiting periods prevent members from anti-selecting or joining a program solely when ill. There are two types of wait times:
- A 3-month General Waiting Period – The scheme will not fund any claims during this general waiting period.
- A 12-month Condition-Specific Waiting Period – A member is ineligible to claim benefits for a condition for which medical advice, diagnosis, care, or treatment was recommended or received within the 12 months ending on the date of the membership application.
Condition-specific waiting periods may not be imposed on related conditions unless a direct link between the conditions can be demonstrated. Furthermore, the waiting periods can also include prescribed minimum benefit (PMB) conditions for applicants who have never belonged to a medical plan before or for members who have had a break in coverage of more than 90 days.
Suremed Health Challenger Plan vs Similar Plans from Other Medical Schemes
| 🔎 Medical Aid Plan | 🥇 Suremed Health Challenger | 🥈 Sizwe Hosmed Plus | 🥉 CompCare SYMMETRY |
| 👤 Main Member Contribution | R6,245 | R | R6,071 |
| 👥 Adult Dependent Contribution | R4,655 | R | R4,733 |
| 🍼 Child Dependent Contribution | R1,230 | R | R1,713 |
| 💙 Hospital Cover | Unlimited | Unlimited for PMBs | Unlimited |
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Our Verdict on the Suremed Health Challenger Plan
The Suremed Navigator is a comprehensive medical aid plan designed to meet the healthcare needs of individuals and families. The plan offers many features, including unlimited private hospital cover, chronic medication benefits, and emergency medical assistance. Members can also benefit from wellness programs, which include access to health assessments, coaching, and support. One of the significant benefits of the Suremed Navigator plan is its unlimited private hospital cover, which provides peace of mind to members in case of any unexpected medical emergencies. The plan also covers the chronic medication, ensuring that members can manage their long-term conditions without worrying about the high medication costs.
Furthermore, the Suremed Navigator plan includes emergency medical assistance, which provides access to a 24/7 emergency helpline, medical advice, and evacuation services if needed. Members can also benefit from the wellness programs, which aim to improve their overall health and well-being and promote a healthy lifestyle. Despite these benefits, there are some drawbacks to the Suremed Navigator plan. One is that it is a relatively expensive option compared to other medical aid plans available in the market. Additionally, certain waiting periods are associated with the plan, and some benefits may be subject to limits and exclusions.
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Suremed Health Challenger Plan Frequently Asked Questions
What is Suremed Health Challenger?
Suremed Health Challenger is a medical aid plan designed to provide comprehensive healthcare coverage to individuals and families.
What are the benefits of Suremed Health Challenger?
The plan offers many benefits, including unlimited private hospital coverage, chronic medication benefits, and emergency medical assistance.
What are the rates for Suremed Health Challenger?
The Suremed Health Challenger rates depend on various factors, including the number of dependents and the level of coverage selected.
What providers are included in the Suremed Health Challenger network?
The plan includes a network of healthcare providers, including hospitals, doctors, and specialists.
Are pre-existing conditions covered under Suremed Health Challenger?
Yes, pre-existing conditions are covered under Suremed Health Challenger, subject to waiting periods.
What are the waiting periods associated with Suremed Health Challenger?
The waiting periods for the plan vary depending on the type of benefit, ranging from three to twelve months.
What is the claims process for Suremed Health Challenger?
Members can submit claims online or via email, and the plan offers a 24/7 helpline for assistance with claims.
Does Suremed Health Challenger cover chronic medication?
Yes, the plan covers chronic medication benefits, subject to certain limits and exclusions.
Does Suremed Health Challenger provide emergency medical assistance?
Yes, the plan includes emergency medical assistance, which provides access to a 24/7 emergency helpline, medical advice, and evacuation services if needed.
What wellness programs are included in Suremed Health Challenger?
The plan offers a range of wellness programs, including health assessments, coaching, and support, to help members improve their overall health and well-being.
Can I add dependents to my Suremed Health Challenger plan?
Yes, members can add dependents to their plan, subject to additional costs.
Can I change my coverage level on Suremed Health Challenger?
Yes, members can change their coverage level at any time, subject to certain restrictions.
Does Suremed Health Challenger offer dental coverage?
Yes, basic and specialized dental coverage is included in the Challenger plan.
Is there a limit on the number of hospital stays covered by Suremed Health Challenger?
No, there is no limit on the number of hospital stays covered under the plan.
Can I choose my doctor or specialist under Suremed Health Challenger?
Yes, members can choose their healthcare providers, but they may receive better benefits when using network providers.
Does Suremed Health Challenger cover alternative therapies?
Yes, certain alternative therapies are covered but are subject to scheme protocols and other rules.
Is there a maximum age limit for enrollment in Suremed Health Challenger?
No, there is no maximum age limit for enrollment in the plan.
