Overall, the Suremed Health Navigator Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and a medical savings account for its family Members. The Suremed Health Navigator Medical Aid Plan starts from R4,270 ZAR.
| 👤 Main Member Contribution | R4,270 |
| 👥 Adult Dependent Contribution | R3,340 |
| 🍼 Child Dependent Contribution | R1,270 |
| 🔁 Gap Cover | ✅ Yes |
| ↪️ Hospital Cover | Unlimited |
| ➡️ Oncology Cover | R262,500 |
| 💶 Prescribed Minimum Benefits | ✅ Yes |
| 📉 Screening and Prevention | ✅ Yes |
| 💙 Medical Savings Account | ✅ Yes |
| 🟦 Maternity Benefits | ✅ Yes |
💙 The Suremed Health Navigator Medical Aid Plan is one of 4, starting from R4,270 and includes additional out-of-hospital benefits, a medical savings account, advanced dentistry, internal and external prostheses, and more.
💙 Gap Cover is available on the Suremed Health Navigator 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 NAVIGATOR PLAN for 2025
| 💶 Amount | 👤 Main Member | 👥 Adult Dependent | 🍼 Child Dependent |
| 💵 Monthly Risk Contribution | R3,695 | R2,895 | R1,080 |
| 💴 Savings per Month Contribution | R575 | R445 | R190 |
| 💷 Total Contribution | R4,270 | R3,340 | R1,270 |
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| 📌 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. |
| 📍 Emergency Stabilisation and Transportation | Emergency transport only. Pre-authorisation required by phoning ER24 on 084 124. |
| ☑️ Hospitalisation Alternatives | Limited to R21,000 per member family (PMF). Pre-authorization is required. |
| ✅ GP and Specialist Consultation | Unlimited cover provided. Covered up to 125% 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 R16,800 PMF. This benefit includes all costs relating to hospitalization and doctors. |
| 💖 Organ Transplants | Limited to R157,500 PMF. Covered up to 100% of PMBs treated at a DSP. Pre-authorization required. All services are covered, including anti-rejection medication, and harvesting. |
| 🦾 Internal/Surgical Prostheses | Limited to R36,750 per beneficiary. Spinal fusion limited to 2 levels per year to a maximum of R26 250 PB. Intra-occular lenses limited to R2 625 per lens. Mesh limited to R8 400 PB. Subject to Scheme protocols |
| 🦿 Physiotherapy while in the hospital | Limited to R5,933 per beneficiary unless it is a PMB. |
| 📉 Basic Radiology and Pathology | Unlimited cover. |
| 📈 Dentistry | Limited to R11,235 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 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. |
| ➡️ Chronic Medication | Unlimited when using a Preferred Provider. Pre-authorization is required. Subject to preferred provider-managed care protocols. |
| ↪️ Dialysis | Unlimited PMF. PMBs are covered up to 100% when using a DSP. Pre-approval is required. Subject to case and treatment management. |
| 🎗️ HIV/AIDS | Unlimited cover but subject to LifeSense protocols. |
| 🟥 Oncology | Limited to R262,500 PMF. Benefits must be pre-approved via ICON. PMBs are covered up to 100% 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 R17,745 PMF. Pre-approval is required, or cover is only up to 80%. |
| 🟨 Acute Medicine | Paid from available funds in the PMSA. Once funds are depleted, there is a sub-limit of R3,323 within the overall day-to-day limit. OTC medication is limited to R168 per prescription per month, up to a maximum of R1,496 per year. |
| 🟩 Alcoholism and Drug Dependency. | Paid from available funds in the PMSA. Once funds are depleted, there is a sub-limit of R1,628 within the overall day-to-day limit. Pre-approval is required before treatment. Treatment includes accommodation, medication, materials, and visits. |
| 🟦 Paramedical, Auxiliary, and Mental Health | Paid from available funds in the PMSA. Once funds are depleted, the benefit is subject to the day-to-day limit. This benefit includes the following: Audiology Dietetics Hearing Aid Acoustics Homoeopathy Podiatry Speech Therapy Social Workers Clinical and Counselling Psychology |
| 🟪 Ambulance Services | Unlimited cover if ER24 is used. |
| 🩺 Appliances | Paid from available funds in the PMSA. Once funds are depleted, there is a sub-limit of R2,625 within the overall day-to-day limit. There is a limit of R4,200 paid to 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 R5,250 per 3-year cycle. Nebulizers/Humidifiers are limited to R525. CPAP Machines are limited to R5,250 per 3-year cycle. Glucometers are limited to R525 per 3-year cycle. Back support/braces are limited to R2,625. Orthotics are limited to R1,050. |
| 🪥 Basic Dentistry | Paid from available funds in the PMSA. Once depleted, the benefit will be subject to the day-to-day limit. Basic dentistry includes fillings, extractions, etc. |
| 🦷 Advanced Dentistry | Paid from available funds in the PMSA. Once depleted, the benefit will be subject to a sub-limit of R5,040 per beneficiary within the day-to-day limit. This benefit includes crowns, bridges, orthodontics, inlays, dental technician fees, and Osseo-integrated implants. |
| 👩⚕️ GP Consultations | Paid from available funds in the PMSA. Once depleted, the benefit will be subject to the day-to-day limit. This benefit includes casualty or emergency room visits. |
| 🍼 Maternity | Included in benefit parameters. Subject to early registration on Maternity Programme. 2 x 2D scans per pregnancy, includes 9 Ante-natal consultations and R390 for Ante-natal classes. 1 Postnatal consultation with GP / Specialist / Mid-wife / Ante-natal Vitamins: R68 per month for 9 months. |
| 🤓 Optometry | Paid from available funds in the PMSA. Subject to available PMSA thereafter a sub limit of R1 418 PB. Limited to R3 549 PMF within the overall Day-to-Day limit. Benefit for 1 pair of spectacles per beneficiary every two years or contact lenses every year. |
| ⚽ Physiotherapy | Paid from available funds in the PMSA. Once depleted, the benefit will be subject to the day-to-day limit. This benefit includes physiotherapy, chiropractics, and biokinetics. |
| 🧪 Pathology and Basic Radiology | Paid from available funds in the PMSA. Once depleted, the benefit will be subject to the day-to-day limit. 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 R1,166 per beneficiary and up to R2,205 PMF within the day-to-day limit. This benefit covers the following: Mammograms Pap Smears Prostate Check-ups (PSA) Tonometry |
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💙 The Suremed Health Navigator Plan Exclusions include, but are not limited to, the following:
💙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 Plans | 🥇 Suremed Health Navigator | 🥈 Fedhealth FlexiFED 3 | 🥉 Medimed Medisave Max |
| 👤 Main Member Contribution | R4,270 | R3,236 – R4,320 | R4,200 – R4,920 |
| 👥 Adult Dependent Contribution | R3,340 | R2,968 – R3,957 | R4,200 – R4,920 |
| 🍼 Child Dependent Contribution | R1,270 | R1,148 – R1,531 | R770 – R860 |
| ☑️ Hospital Cover | Unlimited ,R1000 levy per submission | Unlimited | Unlimited |
| ✅ Oncology Cover | R262,500 | R311,900 | R400,000 |
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💙 Suremed Navigator is a comprehensive medical aid plan designed to provide its members with access to quality healthcare services at an affordable cost. The plan offers a range of features and benefits catering to individuals’ and families’ diverse healthcare needs.
💙 One of the key benefits of the Suremed Navigator plan is that it provides members with unlimited private hospital coverage. This means that members can receive medical treatment in a private hospital of their choice without worrying about the cost of treatment. The plan also covers the chronic medication, an essential benefit for individuals with chronic conditions.
💙 Another advantage of the Suremed Navigator plan is that it offers a wellness program that gives members access to various health and wellness services, such as preventative care, health assessments, and disease management programs.
💙 Furthermore, this program helps members stay healthy and manage their health conditions effectively. However, there are also some drawbacks to the Suremed Navigator plan.
💙 One of the drawbacks is that it does not cover certain medical procedures and treatments, such as cosmetic surgery and infertility treatments.
💙 Additionally, the plan has waiting periods for some benefits, which can disadvantage individuals needing immediate medical treatment.
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Suremed Navigator is a medical aid plan that provides affordable access to quality healthcare services, including private hospital cover, chronic medication, and a wellness program.
Yes, Suremed Navigator provides unlimited private hospital cover, allowing members to receive medical treatment in a private hospital of their choice.
Yes, Suremed Navigator covers the chronic medication, which is an essential benefit for individuals with chronic conditions.
The Suremed Navigator wellness program provides members access to various health and wellness services, including preventative care, health assessments, and disease management programs.
Yes, there are waiting periods for some benefits under the Suremed Navigator plan. These waiting periods may vary depending on the specific benefit.
No, Suremed Navigator does not cover cosmetic surgery.
No, Suremed Navigator does not cover infertility treatments.
Yes, there may be limitations to Suremed Navigator cover, such as exclusions for certain medical procedures and treatments.
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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