Sizwe Platinum Enhanced EDO:
in-and-out of hospital benefits (2024)

This page has information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Sizwe Platinum Enhanced EDO.

We also have information on: Dentistry, Optometry, Wellness and Preventative, Other, Maternity, Cancer, Mental Health and Prosthetics benefits.

Find all the open medical aid plans here.
Compare any two plans
side by side, instantly.

Monthly Costs:

Platinum Enhanced EDO 2024 prices
Main member: Adult member: Child member:
Total Cost pm:
  • R4,511
  • R4,511
  • R1149
  • Only pay for 3 children
Savings:
  • R12144
  • R11628
  • R3084
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
.



You'll get the printable guide as well as a weekly newsletter 🙂

In-hospital Procedures for 2021:

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

Sizwe: Platinum Enhanced EDO
Assume scheme pays all these costs, unless otherwise stated
non-Network Specialists:
  • 100% scheme tariff
network Specialists:
  • 100% scheme tariff
non-Network GPs:
  • 100% scheme tariff
network GPs:
  • 100% scheme tariff
Hospital Choice:
  • Network Hospital
Day Hospitals:
  • Some minor procedures are only paid if done in day hospitals or doctor's rooms
Penalty for using other hospital:
  • R12,000 co-payment if you voluntarily choose another hospital
Other Co-payments:
Specialised Radiology:
  • MRI, CT Scan, Angiogram: R32,794 per family, in and out of hospital
Supplementary Services: (Physio, etc)
  • 100% scheme rate
Transplants:
  • 100% scheme rate , at DSP and from protocols
Dialysis:
  • PMBs only
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)

Sizwe: Platinum Enhanced EDO
Assume scheme pays all these costs, unless otherwise stated
Summary of day-to-day benefits:
Main Member: Adult: Child:
Savings:
  • R12144
  • R11628
  • R3084
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
PMBs out of hospital:
  • 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.
General info:
  • 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
GP consultations:
  • M =7 consults
  • M1 =14 consults
  • M2 =16 consults
  • M3 =18 consults
  • M4 =20 consults
  • M5 =21 consults
  • M6 =22 consults
Childcare:
Specialists consultations: .
Pathology:
General radiology:
Specialised radiology:
  • MRI, PET, CT Scan:R32,794 per family, in and out of hospital.
Supplementary Services: (Physio, etc)
  • 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
General Appliances:
  • M =R1,673
  • M1+ =R2,936
1.1. Hearing Aids:
  • R13,325 per family. One unit per person every 3 years
1.2. Wheelchairs:
  • R3,494 per family. One unit per person every 4 years
Note:
  • 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)

Sizwe: Platinum Enhanced EDO
Assume scheme pays all these costs, unless otherwise stated
Summary of day-to-day benefits:
Main Member: Adult: Child:
Savings:
  • R12144
  • R11628
  • R3084
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
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
Acute (presrcibed) medication:
  • M =R3,800
    M1 =R5,789
    M2 =R6,841
    M3 =R7,357
    M4 =R8,420
    M5 =R8,683
    M6 =R8,946
Over-the-counter:
  • Benefit shared with Acute Medicine benefit
Birth Control:
  • R2,905 per family
On Discharge:
  • 7 days supply
Biological:
  • PMBs only
Note:
  • 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.

Also see these: