• Scheme Plans, Sizwe Plan

Sizwe Access Saver 25:
in-and-out of hospital benefits (2025)

Contents:

This page has overview information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Sizwe Access Saver 25%. Please consult and verify with the scheme or your broker for full benefits, and an explanation of all the "fine print".

Terminology:

  • 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 Providers. Where stipulated, you must use 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.
  • All schemes have extensive exclusions. We've tried to list the non-common ones here, but please consult your scheme or broker to get the full list.

Monthly Costs (2026)

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

Sizwe:Access Saver 25 (2026)
Main member: Adult member: Child member:
Total Cost pm:
  • R3,911
  • R3,378
  • R785
Savings:
  • R11733
  • R10134
  • R2355
Children Rates:
  • Up to age 26
  • Only pay for 3 children
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In-hospital Procedures (2025):

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

Sizwe: Access Saver 25
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
GPs and Specialists:
  • 100% scheme tariff
 Gap Cover:
Can push payout up to 700% scheme rate
(Plans coming soon)
Hospital Choice:
  • Network Hospital
Penalty for using other hospital:
  • non-network hospitals: 30% penalty
 Gap Cover:
Can cover the penalty in full
(Plans coming soon)
Co-payments:
  • These co-payments apply to procedures done at Day Hospital. No cover if done in long stay hospital
  • Skin disorders: R1 867 co-payment
  • Arthroscopy: R3 734 co-payment
  • Bunionectomy: R3 734 co-payment
  • Removal of varicose veins: R1 867 co-payment
  • Refractive eye surgery, Aphakic lens: R3 734 co-payment
  • Infertility treatment: R6 224 co-payment
  • Non-cancerous breast conditions: R1 867 co-payment
Note:
  • If you use a DSP (designated service provider), you never have to pay a co-payment for protocol treatment of a PMB (Prescribed Minimum Benefit). More info here
  • There might be other co-payments, especially if you don't use a DSP for a PMB or when buying medicine.
 Gap Cover:
Can cover most co-payments
(Plans coming soon)
Specialised Radiology:
  • MRI, CT Scan, Angiogram: R3,500 per scan and R20,000 per family, in and out of hospital
 Gap Cover:
Can cover most co-payments and increase sublimits
(Plans coming soon)
Scopes:
  • If done in hospital, 20% co-payment (with some exceptions)
 Gap Cover:
Can cover most co-payments and increase sublimits
(Plans coming soon)
Supplementary Services: (Physio, etc)
  • PMBs only
Transplants:
  • 100% scheme rate, at DSP and from protocols
Dialysis:
  • PMBs only
Exclusions:
  • NB: See scheme's rules for all exclusions. All schemes have plenty!
 Gap Cover:
Coming soon
Alternatives to hospitals:
  • Home based care, in lieu of hospitalisation: 14 days per person
  • Private nursing: PMBs only
  • Step-down facilities: 14 days per person
Casualty/ER: Gap Cover:
Can cover ER claims
(Plans coming soon)
Other:
  • All benefits from PMBs
  • Back and neck surgery: PMBs only
  • Laparoscopic hospitalisation: R5,000 co-payments may apply if done outside day hospital
PMBs = Prescribed Minimum Benefits (more info) | DSP = Designated Service Provider

Out-of-hospital Procedures (2025):

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

Sizwe: Access Saver 25
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
Main Member: Adult: Child:
Savings:
  • R10080
  • R8736
  • R1992
Other Day-to-Day Funds:
PMBs out of hospital:
  • All schemes 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.
  • PMB benefits must never be paid from your savings account.
  • 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.
GP consultations:
  • From day-to-day benefit
  • After depleted, 1 consult per person and 4 consults per family
Childcare:
  • Heart screening test
  • Newborn hearing test
  • Immunisations
 Gap Cover:
Can pay for child ER visits
(Plans coming soon)
Specialist consultations:
  • From day-to-day benefit
  • After depleted, 1 consult per person with paediatrician or gynaecologist
Pathology:
  • R3,345 per person
  • From day-to-day benefit
General radiology:
  • R2,610 per person
  • From day-to-day benefit
Specialised radiology:
  • MRI, CT Scan, Angiogram: R3,500 per scan and R20,000 per family, in and out of hospital
 Gap Cover:
Can pay co-payments and increase sublimits
(Plans coming soon)
Scopes:
  • If done in hospital, 20% co-payment (with some exceptions)
 Gap Cover:
Can pay co-payments and increase sublimits
(Plans coming soon)
Supplementary Services: (Physio, etc)
  • Homeopathy, Naturopathy, Chiropractor and Podiatry: From day-to-day benefit
  • Audiology, Speech therapy, Dieticians, Occupational Therapy, Prosthetist, Educational Psychologist, Orthotics, Social Workers and registered counsellors: From day-to-day benefit , R3,009 per family
  • Biokinetics & Physiotherapy: From day-to-day benefit
General Appliances:
  • R7,486 per family
  • PMBs only. Paid by scheme.
1.1. Hearing Aids:
  • PMBs only
1.2. Wheelchairs:
  • PMBs only
PMBs = Prescribed Minimum Benefits (more info) | DSP = Designated Service Provider

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 (2025):

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

Sizwe: Access Saver 25
Assume scheme pays all these costs, unless otherwise stated
Main Member: Adult: Child:
Savings:
  • R10080
  • R8736
  • R1992
Other Day-to-Day Funds:
Chronic: .
Acute (prescribed) medication:
  • From day to day benefit
Over-the-counter:
  • From day to day benefit
Birth Control:
  • Mirena device: R2,315 per person
  • From day to day benefit
On Discharge:
  • PMBs: 7 days supply
  • Otherwise, from day to day benefit
Biological:
  • PMBs only
PMBs = Prescribed Minimum Benefits (more info) | DSP = Designated Service Provider

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.

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