| 📌 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 | 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 122% 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 R16,000 PMF.
This benefit includes all costs relating to hospitalization and doctors. |
| 💖 Organ Transplants | Limited to R150,000 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 R35,000 per beneficiary.
Spinal fusions are limited to two levels per year and up to R25,000 per beneficiary.
Intra-ocular lenses are limited to R2,500 per lens.
Mesh is limited to R8,000 per beneficiary.
Subject to Suremed protocols. |
| 🦿 Physiotherapy while in the hospital | Limited to R5,650 per beneficiary unless it is a PMB. |
| 📉 Basic Radiology and Pathology | Unlimited cover. |
| 📈 Dentistry | Limited to R10,700 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 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 R250,000 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 R16,900 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 R3,165 within the overall day-to-day limit.
OTC medication is limited to R160 per prescription per month, up to a maximum of R1,425 per year. |
| 🟩 Alcoholism and Drug Dependency. | Paid from available funds in the PMSA.
Once funds are depleted, there is a sub-limit of R1,550 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 R2,500 within the overall day-to-day limit.
There is a limit of R4,000 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 R5,000 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 | 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 R4,800 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 | The benefit is included in the benefit parameters.
Pregnant members must register for the Maternity Program on the Suremed Navigator App.
The benefit includes the following:
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 | Paid from available funds in the PMSA.
Once depleted, the benefit will be subject to a sub-limit of R1,350 per beneficiary and R3,380 PMF within the day-to-day limit.
The benefit covers one pair of glasses per beneficiary every two years or contact lenses yearly. |
| ⚽ 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 R1,110 per beneficiary and up to R2,100 PMF within the day-to-day limit.
This benefit covers the following:
Mammograms
Pap Smears
Prostate Check-ups (PSA)
Tonometry |
