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Sizwe Platinum Enhanced:
cancer, maternity and mental health (2024)

This page has information on: Costs, Maternity, Oncology, Mental Health for Sizwe Platinum Enhanced

We also have information on: In-hospital, Out of hospital, Medicine, Dentistry, Optometry, Other/Extra Benefits, Wellness and Preventative and Prosthetics

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Monthly Costs:

Platinum Enhanced 2024 prices
Main member: Adult member: Child member:
Total Cost pm:
  • R4,746
  • R4,456
  • R1297
  • Only pay for 3 children
Savings:
  • R12804
  • R11232
  • R3276
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • Main= R11,362
  • Main+1= R16,287
  • Main+2= R18,740
  • Main+3= R20,392
  • Main+4= R22,855
  • Main+5= R25,329
  • Main+6+= R27,639
Children Rates:
  • Child rates up to age 25. Grandchildren included.
  • Only pay for 3 children
Income band:
Note:
  • Exclusions: Note that all schemes have extensive exclusions. We've tried to list the major ones, but you must consult with your scheme to get the full list.
  • All treatments and procedures are subject to authorisation and protocols
  • All benefits are listed as an indication only. Please verify with your broker and scheme
♦️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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Cancer/ Oncology benefits for 2021:

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Sizwe: Platinum Enhanced
Assume scheme pays all these costs, unless otherwise stated
Overall coverage (in and out of hospital):
  • Unlimited. After the first R520,000, a 20% co-payment applies for non-PMB
 Treatment required for PMB conditions is always paid by scheme, with no co-payment, if you follow the protocols. Most cancers are PMBs! More info here

Most schemes require use of specific providers (DSPs) for oncology treatment.
♦️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
.
.
.

Maternity benefits for 2021:

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Sizwe: Platinum Enhanced
Assume scheme pays all these costs, unless otherwise stated
Hospital stay:
  • 100% scheme rate
 Usually covered for 2 nights for natural birth, and 3 nights for C-sections. All newborns receive immediate full medical aid cover at birth, even if parents are on a waiting period.
Consultations:
  • GP, midwife, specialist: 9 consults
  • Specialist: Limited to 4 consults
Scans:
  • 2 x 2D scans, paid by scheme
  • 2 x haemoglobin tests
  • 1 x blood group test
  • 1 x VDRL test for syphillis
  • 1 x HIV Elisa test
Note:
♦️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
.
.
.

Mental Health benefits for 2021:

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(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Sizwe: Platinum Enhanced
Assume scheme pays all these costs, unless otherwise stated
In-hospital:
  • 21 days per person, including 6 in-hospital consults with psychiatrist
    • R42,000 per person per admission and R2,000 per day
  • Can be substituted with 10 consults in lieu of hospitalisation
  • Alcoholism/Drug Addiction: 3 days withdrawal treatment plus 21 days rehab at an appropriate facility
Out-of-hospital:
  • PMBs: 10+ consults, paid by scheme
  • R9,525 per family for psychologists and psychiatrists for mental health disorders
Trauma:
  • Mental Health PMB conditions are covered for in and out of hospital treatment. For a full list see here.
  • Example of PMB condition: Acute stress disorder accompanied by recent significant trauma, including physical or sexual abuse. Treatment includes hospital admission for psychotherapy / counselling up to 3 days, or up to 12 outpatient psychotherapy / counselling contacts
Note:
  • PMBs: Prescribed Minimum Benefits. Here is a list of PMB conditions: Mental Illness.
  • 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
.

    Important!
  • Unless specified, assume that all benefits are paid are paid at 100% scheme rate
  • No limits or co-payments can apply to treatment of PMBs, which is always unlimited, although subject to strict protocols and scheme rules.
  • "Unlimited" benefits are still subject to authorisation, protocols and sublimits
  • Assume that all benefits need to be pre-authorised

Also see these:




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