Our Health Plan gives you access to comprehensive medical benefits and is a unique Health Care product which has been designed to be affordable to Students. Members of Suremed's Explorer plan for students will enjoy free and unlimited access to most medical services once they have selected a General Practitioner from the comprehensive list of Network Doctors contracted to the scheme, to act as their Contracted Primary Care Providers. The selected General Practitioner will act as a co-ordinator for medical services that the member may require. You’ll also have personal access to our Care Co-ordinators, who will assist you in gaining access to Medical Care if you become ill or have health problems while studying.
IN-HOSPITAL BENEFITS (click to expand each group below)
HOSPITAL
General, High Care & Intensive Care Ward Fees Theatre Fees Drugs & Equipment used whilst hospitalised To Take out Medicine Annual Limit	Benefits allowed at 100% of negotiated rates at Preferred Provider Hospitals Only Authorisation Required, failing which no benefit will be allowed. Please call 0860 787 363 for authorisation Authorisation shall be obtained from the Scheme/Scheme's designated agent before a Beneficiary is admitted to a hospital or day clinic (except in the case of emergency) failing which a co-payment of R500 per admission shall apply. In the event of an emergency the Scheme shall be notified of such emergency within one working day after admission failing which the co-payment shall apply. Accommodation in an intensive care or high care unit is subject to a maximum period 15 days; hereafter authorisation must be obtained for further accommodation All in-Hospital benefits are subject to an Annual Limit of R500 000 Per Family
STEP-DOWN FACILITIES AND PHYSICAL REHABILITATION
Sub-acute facilities Hospice and rehabilitation facilities Nursing services Private nurse practitioners, including psychiatric nursing but excluding midwife services.	R12 500 Per Family, subject to hospitalisation limit
GENERAL PRACTITIONERS AND SPECIALISTS
Consultations and Visits in Hospital Surgical and non-Surgical Procedures Anaesthetics	100% of cost if performed by a contracted provider Authorisation Required, failing which no benefit will be allowed. Please call 0860 787 363 for authorisation Included in overall Hospital Limit
EMERGENCY SERVICES call 084 124
Available from ER24 only	For all medical emergencies call 084 124 ER24 provides a 24 hour call center for all medical emergencies. Once the call is made Er24 will assess your condition and if necessary dispatch the appropriate vehicle (ground or air) staff, equipment and medication directly to your location.
RADIOLOGY
Black and white Xrays Ultrasounds MRI Scans PET Scans	All Radiology Benefits, In- and Out of hospital are limited to R14,700 per Family per Annum Specialised Radiology (MRI/CAT and/or Gallium scans and/or Radio-isotopes) limited to 2 scans Per Family Included in Hospital Limit
MATERNITY
Hospitalisation & Delivery Delivery by Midwife and Post-Natal Services	Unlimited at contracted facilities Authorisation Required, failing which no benefit will be allowed. Please call 0860 787 363 for authorisation Included in overall Hospital Limi
BLOOD TRANSFUSION
Blood, Blood Equivalents and Blood Products	Included in overall limit
ORAL SURGERY
Dental Procedures Maxillo-Facial Dental Implants	No in-hospital benefits will be paid in respect of dental procedures. Maxillo-Facial surgery iro non-elective PMB cases only No benefit iro Dental Implants
DAY TO DAY BENEFITS
DENTISTRY
Consultations and visits, Pain and sepsis treatment ,Local Anaesthetic, Infection Control and Oral Hygiene Instruction Fillings Extractions Intra Oral Radiograph Specialised Dentistry Dentures	One consultation for a full mouth examination per beneficiary per annum Preventative treatments limited to one treatment per beneficiary per annum. Includes Fluoride Treatment, Cleaning, Scaling and Polishing 1 treatment per year authorization required for beneficiaries over the age of 12 years Fillings White or Amalgam Preauthorisation required for 4/more restorations or 5/more Composite fillings Extractions Only if clinically necessar. Pre-authorisation required for 5 or more extractions Intra Oral Radiograph X-Rays as per the approved list of codes Pre-authorisation for 3 or more x-rays (maximum 4) Contracted Dentists only Emergency Root Canal only No Benefit for Specialised Dental Treatment Dentures Authorisation is required call 0861 665 665 1 Set of Acrylic dentures per family per 24 month cycle. Benefit applicable to members over the age of 21 years of age only A co-payment is payable on all dentures, equal to 20% of the total fees charged by the dentist and laboratory
GENERAL PRACTITIONERS
Consultations and Visits In-rooms Procedures Materials and Disposables	Unlimited when clinically appropriate at Prime Cure agreed tariff Pre-Authorisation and member verification is to be performed by the Prime Cure designated service provider All visits from the 7th consultation per beneficiary per benefit year must be pre-authorized by the beneficiary / provider. It is the Beneficiaries responsibility to ensure that pre - authorization is obtained if the provider fails to obtain pre - authorisation on the members behalf Should the beneficiaries nominated General Practitioner not be available the member may see any Prime Cure contracted General Practitioner provided the member obtains a pre-authorisation before the consultation. Beneficiaries may only make two changes to a General Practitioner per annum
Out of Area/ Out of Network Visits (When you visit a doctor other than the doctor that you have nominated as your primary care provider)	Authorisation is required- call 086 166 5665 prior to or with-in 72 hours after the visit. 1 (one) visit per beneficiary or 2 (two) per family per annum to a non-DSP for conditions not requiring hospitalisation or specialized intervention.Limited to a total cost of R700 per event / visit including all services and medication with a 20% co-payment by the member. Member must pay the claim and thereafter submit a claim for reimbursement.
Emergency Visits	Unlimited without co-payment provided the episode meets the definition of an emergency medical condition at any registered emergency medical facility. Authorisation is required- call 086 166 5665 prior to or with-in 72 hours after the visit.
24 HOUR ADVICE LINE
The 24-Hour Medical Advice Line is a share-call dial in service. Call 084 124
MEDICINE - ACUTE
Acute Medicines	100% cover for Acute Medicine prescribed by your nominated General Practitioner Unlimited, but according to a medicine formulary and Prime Cure protocols only. Acute Medication prescribed by a Specialist out-of-hospital is not covered
MEDICINE - SELF MEDICATION
Self Medication Benefit	Self Medication is limited to R180 Per Family per annum and to a maximum of R60 per event and a maximum of 3 events per beneficiary
MEDICINE - CHRONIC
Chronic Medicine used to treat conditions on the Chronic Disease List	Unlimited Chronic Medication but according to the medication formulary only. Member must first call 086 166 5665 to obtain permission for the supply of chronic medication. You nominated provider is to complete the Prime Cure Chronic Application Form and submit to Prime Cure Only medication prescribed by a Prime Cure nominated general practitioner will be covered. Chronic Medication prescribed by a specialist out-of-hospital is only covered for the first month under acute if the you are referred by your nominated service provide the medicine is on the formulary the medication is dispensed by a Prime Cure accredited Pharmacy and you have pre-authorised the claim by calling 086 166 5665
OPTICAL
Eye Test Lenses Frames	Eye Test One optometric examination per beneficiary per annum. 1 Pair of spectacles per beneficiary per 24 month period Lenses Includes High quality clear plastic lenses Single Vision or Bi-focal lenses Frames Range 1 Frame for spectacles allowed per beneficiary every 24 months An excess is payable by the member for any frame not from the specified range. Qualifying Norms Spectacles are granted if the following norms are met: An unaided visual acuity of worse than 6/9 on the Snellen scale for distance vision and near vision. A refraction requirement exceeding 0,5 dioptre sphere and or 0,5 dioptre cylinder on distance vision and 1,25 dioptre sphere on near vision. For the granting of bi-focals, members have to comply with both the distance vision and near vision qualifying norms for both eyes. Exclusions Contact lenses, Mirror or other graded Tinted lenses, Accessories (e.g. Clip on sunglasses) or other enhancements, Contact Lens Solutions
PATHOLOGY & MEDICAL TECHNOLOGY
All Tests performed out of hospital	Primary care tests only Must be referred by your nominated doctor All Radiologyand Pathology Benefits, In- and Out of hospital are limited to R14,700 per Family per Annum
RADIOLOGY
Black and White Xrays Only	Examinations must be requested by your nominated Doctor All Radiologyand Pathology Benefits, In- and Out of hospital are limited to R14,700 per Family per Annum
SPECIALISTS
Consultations & Visits	Limited to 8 visits per Family per annum Please call 0860 08 08 08 for authorisation
This is a summary of the benefits offered by the scheme. A full set of registered benefits and rates is available on request. E&OE Download Benefit Schedule and forms

Refer a friend rewards

Once your membership is activated and you have received your membership confirmation letter and medical aid number, you will receive R25 credit on your Zwing rewards card for each person that you refer to us that successfully signs up online and pays the resultant membership fee. Zwing cards are backed by Mastercard and can be used at any shop that accepts Mastercards.

All you need to do to ensure that you receive the reward is to enter your Medical Aid Number in the Consultant Code field in your friend's on-line application.

Once you have accumulated R100 or more you will be issued with the Zwing reward card with the full value of your credit in the card. New rewards will be credited automatically once you are in receipt of the rewards card.