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In-hospital Procedures for 2024:
(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)
Assume scheme pays all these costs, unless otherwise stated
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non-Network Specialists: |
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network Specialists: |
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non-Network GPs: |
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network GPs: |
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Hospital Choice: |
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Day Hospitals: |
PMBs conditions only :
- Biopsy
- Breast Biopsy
- Cataract
- Colonoscopy
- Cone Biopsy/ Colposcopy
- Cystoscopy
- ERCP
- Excision of Extensive/ Skin lesions
- Repair Skin Graft
- Gastroscopy or Colonoscopy or Oesophagoscopy
- Haemorrhoidectomy
- Hysteroscopy, D&C, Minor Gynaecological Procedures
- Myringotomy / Grommets
- Repair of Wounds
- Termination of Pregnancy
- Tonsillectomy and Adenoidectomy
- Umbilical and Inguinal Hernia
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Penalty for using other hospital: |
- non-DSP Hospital: 30% co-payment
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Other Co-payments: |
- Joint Replacement: R5,000 co-payment
- Umbilical Hernia Repair: R5,000 co-payment
- Hysterectomy: R5,000 co-payment
- Functional Nasal Surgery: R5,000 co-payment
- Elective caesarean section: R5,000 co-payment
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Specialised Radiology: |
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Supplementary Services: (Physio, etc) |
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Transplants: |
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Dialysis: |
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Exclusions: |
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Alternatives to hospitals: |
- Rehab facilities: PMBs only ,
- Private nursing: 14 days per person
- Step-down facilities: PMBs only
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Casualty: |
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Other: |
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Note: |
- PMBs: Prescribed Minimum Benefits. You can read more about PMBs, see a list of all PMB conditions or read more what "PMB only" benefit means.
- DSPs: Designated Service Provders. Where stipulated, you must use specific specific providers to get full benefit.
- Co-payment: Paid out of pocket, or out of savings account. Sometimes this is refundable to you if you have a gap product
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♦️View all the other benefits for this plan:♦️
Inhospital |
Out of hospital |
Medication |
Maternity |
Cancer |
Mental Health |
Dentistry |
Optometry |
Other/Extra Benefits |
Wellness |
Prosthetics
You can also:
♦️Compare any two plans, side by side |
♦️View all the Sizwe plans, with costs and brief summary
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Out-of-hospital Procedures for 2024:
(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)
Assume scheme pays all these costs, unless otherwise stated |
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Main Member: |
Adult: |
Child: |
- No savings account option on this plan
- The scheme might still cover some or all day-to-day claims. See below, and see benefits.
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- All medical aids must pay for the diagnosis, treatment and management of all PMB conditions, in or out of hospital. You can see a full list of the conditions here.
- This can include consults with specialists, blood or other tests, radiology and medicine
- The benefit is paid by the scheme, and not out of your savings account
- If you have no day-to-day funds, you still have cover for PMBs
- Schemes usually impose the use of specific providers for treatment of PMBs. Read more about that here.
- See our Guide to PMBs for more information.
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- DSP network: Unlimited
- non-DSP network: 30% co-payment
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- 1 heart screening for babies under 2 years
- 1 hearing and vision screening for babies under 2 years old
- Immnisations: Covered up to 12 yrs
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- PMBs only
- 3 consults per family
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- PMBs only
- R1,800 per person
- (Note: Scheme can't actually impose these limits for PMB level of treatment)
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- PMBs only
- R1,890 per person
- (Note: Scheme can't actually impose these limits for PMB level of treatment)
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- 2 scans per person, in and out of hospital, PMBs only
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- In and out of hospital: R2,244 per family
- Blood Pressure monitors R629
- PMBs only
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- PMBs: Prescribed Minimum Benefits. To read more about PMBs click here
- DSPs: Designated Service Provders. Where stipulated, you must use specific specific providers to get full benefit.
- Co-payment: Paid out of pocket, or out of savings account. Sometimes this is refundable to you if you have a gap product
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♦️View all the other benefits for this plan:♦️
Inhospital |
Out of hospital |
Medication |
Maternity |
Cancer |
Mental Health |
Dentistry |
Optometry |
Other/Extra Benefits |
Wellness |
Prosthetics
You can also:
♦️Compare any two plans, side by side |
♦️View all the Sizwe plans, with costs and brief summary
|
. |
All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme. The benefits listed here are an indication only. Please verify all benefits and their conditions with the scheme.
Medication Benefit for 2024:
(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)
Assume scheme pays all these costs, unless otherwise stated |
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Main Member: |
Adult: |
Child: |
- No savings account option on this plan
- The scheme might still cover some or all day-to-day claims. See below, and see benefits.
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Chronic: |
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- From DSP GP: Unlimited
- From Pharmacy: R1,767 per person and R4,927 per family
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- R744 per family and R116 per script
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- Schemes have very strict rules about where you can get your medicine to get full benefit. We do not list the requirements here, so confirm with your scheme before you collect your medicine.
- Formulary: A pre-defined list of approved medicines. Each plan has a different list, and might not pay for non-listed medicine. Confirm with your scheme whether your required medicine is covered by them.
- PMBs: Prescribed Minimum Benfits. To read more about PMBs click here
- DSPs: Designated Service Provders. Where stipulated, you must use specific specific providers to get full benefit.
- Co-payment: Paid out of pocket, or out of savings account. Sometimes this is refundable to you if you have a gap product
|
♦️View all the other benefits for this plan:♦️
Inhospital |
Out of hospital |
Medication |
Maternity |
Cancer |
Mental Health |
Dentistry |
Optometry |
Other/Extra Benefits |
Wellness |
Prosthetics
You can also:
♦️Compare any two plans, side by side |
♦️View all the Sizwe plans, with costs and brief summary
|
. |
All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme. The benefits listed here are an indication only. Please verify all benefits and their conditions with the scheme.
|