Overall, the Suremed Health Explorer Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and gap cover for its Family Members. The Suremed Health Explorer Medical Aid Plan starts from R1,545 ZAR.
| 👤 Main Member Contribution | R1,545 – R3,860 |
| 👥 Adult Dependent Contribution | R1,370 – R3,860 |
| 🍼 Child Dependent Contribution | R715 – R1,200 |
| 🔁 Gap Cover | ✅ Yes |
| 🦾 Internal Prosthesis | Only PMBs are covered |
| 🦿 External Prosthesis | Only PMBs are covered |
| 💙 Hospital Cover | Unlimited |
| 💶 Prescribed Minimum Benefits | ✅ Yes |
| 📉 Screening and Prevention | ✅ Yes |
| ➡️ Medical Savings Account | None |
💙 The Suremed Health Explorer Medical Aid Plan is one of 4, starting from R1,545 and includes unlimited hospitalization in Netcare hospitals, a comprehensive network of GPs, Dentists, Optometrists, and Pharmacies, extended day-to-day benefits, and more.
💙 Gap Cover is available on the Suremed Health Explorer 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:
👉🏿 Download the EXPLORER PLAN for 2025
💙 The Suremed Health Explorer Student Plan for 2025 offers comprehensive and affordable health coverage tailored to meet the unique needs of students for only R625 per month but your income must only be between 0-R500 to be eligible to qualify for this plan.
💙 This plan provides access to a wide network of healthcare providers, ensuring quality care for routine checkups, preventive services, and emergencies.
💙 Designed with flexibility in mind, it includes customizable options such as mental health support, telemedicine services, and prescription benefits. With competitive premiums and easy enrollment, the plan empowers students to focus on their education while staying healthy and protected.
👉🏿 Download the EXPLORER 2025 STUDENT PLAN
| 💴 Income Bracket | 👤 Main Member | 👥 Adult Dependent | 🍼 Child Dependent |
| 💵 R501 – R8,500 | R1 545 | R1,370 | R715 |
| 💶 R8,501 – R13,000 | R1,950 | R1,725 | R870 |
| 💷 R13,001 – R17,000 | R3,095 | R3,095 | R901 |
| 💴 R17,001> | R3,860 | R3,860 | R1,200 |
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| 📌 Prescribed Minimum Benefits (PMB) | A Preferred Provider provides unlimited coverage. PMBs are unlimited when using a scheme DSP. |
| 📍 Emergency Stabilisation and Transportation | Emergency transport only. Pre-authorisation required by phoning ER24 on 084 124. Unlimited cover provided. |
| ☑️ Hospitalisation Alternatives | Limited to R13,125 per member family (PMF). Pre-authorization is required. |
| ✅ GP and Specialist Consultation | The unlimited cover is provided by a Preferred Provider. Specialists are limited to R21,000 PMF unless it involves a PMB. |
| 🅰️ Maternity | Unlimited only when using a Preferred Provider. Pre-approval is required. |
| 🅱️ Basic Radiology and Pathology | Unlimited only when using a Preferred Provider. Pathology is limited to R22,575PMF unless PMBs apply. |
| 📉 Physiotherapy | Members must use a Preferred Provider. Limited to R3,728 PMF unless PMBs apply. Only covers in-hospital treatment. |
| 📈 Prostheses | Limited to PMBs. Pre-approval is required before admission. Unlimited when using a DSP, but scheme protocols will apply. |
| 📊 Take-home Medication | Limited to R300 per beneficiary per event. Subject to the formulary. |
| ❤️ Compassionate Care | Limited to R21,000 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. |
| 🩺 Medical Equipment | Limited to R4,200 PMF when using a Preferred Provider. Includes wheelchairs, oxygen, and cylinders. Pre-approval is required. |
| 💊 Chronic Medication | Unlimited when using a Preferred Provider. Pre-authorization is required via the Prime Cure formulary. Subject to preferred provider-managed care protocols. |
| ➡️ Dialysis | Unlimited when using a Preferred Provider and only for PMBs. Pre-approval is required. Subject to case and treatment management. |
| 🎗️ HIV/AIDS | Unlimited cover but subject to managed care protocols. |
| ↪️ Oncology | Unlimited when using a Preferred Provider and for PMBs. Pre-approval and registration with the necessary program are required. |
| 🤕 Acute Medicine | Unlimited acute (prescribed) medicine from a nominated provider. Limited to R368 per beneficiary per year and up to R446 PMF. Maximum R120 per event via Prime Cure. |
| 🟥 Contraceptives | R2 340 PMF. Limited to R180 script limit PMF |
| 🤧 Chronic Medicine | Unlimited coverage is provided if prescribed by a nominated provider. Subject to registration through Prime Cure. Subject to the Prime Cure medication formulary. |
| 🪥 Basic Dentistry | Unlimited when treatment is obtained from a Primary care network provider. Only covers approved dental codes. Limited to one preventative consultation per beneficiary per year. |
| 🦷 Dentures | Covers one set of acrylic dentures PMF per 2 years, with a limit of R4,505 per family. Covered up to 80% at cost. Pre-authorization required. The benefit is only covered for beneficiaries older than 21 years. |
| 👩⚕️ GP Consultations | Limited to 12 consultations per beneficiary. Authorization is required for the twelfth consultation to activate the PMB benefit. Members may only change doctors twice a year. |
| 👨⚕️ Out-of-Network and After-Hour GP Consultations | Limited to one visit per beneficiary or two per family. Limited to R1,260 per event. Authorization is required within 72 hours of the visit. |
| 💉 Immunizations | Limited to one per beneficiary per year and only for high-risk patients. This only covers flu injections. |
| 🤓 Optometry | Unlimited at any Primary Care Network Optometrist 1 Eye test PB per year. Frame from selected range. 1 Pair of spectacles PB per 24 month cycle. Lenses limited to R2 500 PB. Contact Lenses – no benefit. Frames range up to the value of R840. Any frames selected. |
| ⚠️ Radiology and Pathology | Unlimited cover when referred by a nominated doctor. Subject to the approved Radiology and Pathology codes. |
| 🍼 Maternity | Subject to registration on maternity programme through Momentum TYB 0860 08 08 88 or (041) 395 4545. 2 x 2D scans per pregnancy. Limited to 2 visits (GP or Gynae) and 1 paediatrician visit / Ante-natal Vitamins: R120 per month for 9 months. |
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💙 The Suremed Health Explorer Plan Exclusions include, but are not limited to, the following:
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💙 Waiting periods prevent members from anti-selecting or joining a program solely when ill. There are two types of wait times:
💙 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.
| 🔎 Medical Aid Plan | 🥇 Suremed Health Explorer | 🥈 Medimed Alpha | 🥉 Discovery Health Essential Delta Core |
| 👤 Main Member Contribution | R1,545 – R3,860 | R1,820 | R2,507 |
| 👥 Adult Dependent Contribution | R1,370 – R3,860 | R1,820 | R1,887 |
| 🍼 Child Dependent Contribution | R715 – R1,200 | R700 | R1,006 |
| ➡️ Hospital Cover | Unlimited | Unlimited | Unlimited |
| ↪️ Oncology Cover | Unlimited for PMBs at a Preferred Provider | R200,000 | R250,000 |
💙 The Suremed Explorer plan offers comprehensive medical aid coverage at an affordable price. With this plan, members can access a wide range of benefits, including unlimited hospitalization, chronic medication coverage, and maternity benefits.
💙 The plan also covers out-of-hospital treatments such as consultations, diagnostic tests, and procedures. One of the main advantages of this plan is access to a large network of hospitals and medical practitioners, ensuring that members receive quality healthcare services.
💙 However, the plan has some drawbacks, such as limitations on certain treatments and procedures, co-payments, and waiting periods for certain benefits. Despite these limitations, the Suremed Explorer plan offers an attractive option for those looking for comprehensive medical aid coverage at an affordable price.
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The Suremed Explorer is a medical aid plan offered by Suremed Health that provides comprehensive healthcare coverage at an affordable price.
The Suremed Explorer plan offers unlimited hospitalization, chronic medication coverage, maternity benefits, and coverage for out-of-hospital treatments such as consultations, diagnostic tests, and procedures.
The Suremed Explorer plan provides access to a large network of hospitals within the Netcare Group and medical practitioners to ensure that members receive quality healthcare services.
Yes, there is a waiting period for certain benefits under the Suremed Explorer plan. The waiting period may vary depending on the benefit.
Yes, the Suremed Explorer plan provides coverage for chronic medication.
Yes, the Suremed Explorer plan provides maternity benefits.
Ladies can make use of our free Ovulation Calculator
Yes, the Suremed Explorer plan provides unlimited hospitalization coverage.
Yes, some benefits under the Suremed Explorer plan may require co-payments.
Yes, the Suremed Explorer plan covers out-of-hospital treatments such as consultations, diagnostic tests, and procedures.
Yes, members can choose their medical practitioners, subject to the plan’s limitations.
The Suremed Explorer plan may have limitations on certain treatments and procedures and waiting periods for certain benefits.
Pre-existing conditions may be covered under the Suremed Explorer plan, subject to certain limitations and waiting periods.
Premiums for the Suremed Explorer plan are based on the level of cover selected and the income bracket of the main member, 1,545 starting from for the main member R1,370 per adult, and R715 per child dependent.
Members can submit claims for healthcare services through the online portal or by completing and submitting a claims form.
Yes, emergency medical care is covered under the Suremed Explorer plan, subject to the limitations and conditions of the plan.
Adriaan holds an MBA and specializes in medical aid research. With his commitment to perfection, he ensures the accuracy of all data presented on medicalaid.com every three months. When he is not conducting research, Adriaan can be found indulging in his passion for trout fishing amidst nature.
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