Find all the open medical aid plans here. Compare any two plans side by side, instantly.
Monthly Costs:
|
|
- R1297
- Only pay for 3 children
|
|
|
|
- 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
|
- Child rates up to age 25. Grandchildren included.
- Only pay for 3 children
|
|
- 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
|
. |
In-hospital Procedures for 2021:
(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
|
non-Network Specialists: |
|
network Specialists: |
|
non-Network GPs: |
|
network GPs: |
|
Hospital Choice: |
|
|
Day Hospitals: |
- Some minor procedures are only paid if done in day hospitals or doctor's rooms
|
|
Penalty for using other hospital: |
|
Other Co-payments: |
|
Specialised Radiology: |
- MRI, CT Scan, Angiogram: R32,794 per family, in and out of hospital
|
Supplementary Services: (Physio, etc) |
|
Transplants: |
- 100% scheme rate , at DSP and from protocols
|
|
Dialysis: |
|
|
Exclusions: |
|
Alternatives to hospitals: |
- Rehab facilities: Limited to speech and occupational therapy
- Private nursing: R7,826 per family
- Step-down facilities: 100% scheme rate
-
|
|
Casualty: |
|
Other: |
|
|
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
|
♦️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
|
. |
Out-of-hospital Procedures for 2021:
(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 |
|
Main Member: |
Adult: |
Child: |
|
|
|
- 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
|
|
- 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.
|
- There is a day-to-day limit for physiotherapy, radiology, pathology and acute medication
- M =R10,925
M1 =R15,661 M2 =R18,019 M3 =R19,608 M4 =R21,976 M5 =R24,355 M6 =R26,576
|
- M =7 consults
- M1 =14 consults
- M2 =16 consults
- M3 =18 consults
- M4 =20 consults
- M5 =21 consults
- M6 =22 consults
|
|
|
. |
|
|
- MRI, PET, CT Scan:R32,794 per family, in and out of hospital.
|
- R1,740 per person and R3,053 per family
- Limited to: speech therapy, podiatry, occupational therapy, social worker, dietics, audiology, homeopathy, educational psychologits, biokineticist and registered counsellor
- Chiropractors: R1,161 per person
|
|
|
- R13,325 per family. One unit per person every 3 years
|
- R3,494 per family. One unit per person every 4 years
|
- 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
|
♦️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 2021:
(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 |
|
Main Member: |
Adult: |
Child: |
|
|
|
- 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
|
|
Chronic: |
- An additional 13 conditions are covered
- Other chronic: R6,147 per person. PMBsmedicines accumulate to this limit.
- In addition to the per person limt, there is also a per family limit: M =R6,147
M1 =R12,314 M2 =R18,482 M3 =R24,639 M4 =R30,796 M5 =R36,974 M6 =R43,142
|
- M =R3,800
M1 =R5,789 M2 =R6,841 M3 =R7,357 M4 =R8,420 M5 =R8,683 M6 =R8,946
|
|
- Benefit shared with Acute Medicine benefit
|
|
|
|
- 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.
|