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

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".

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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 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
• 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.

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
Hospital Choice:	Network Hospital
Penalty for using other hospital:	non-network hospitals: 30% penalty
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: A co-payment is a fee your medical aid can insist you pay, regardless of how much the doctor/charges. It's not the same as an "excess" payment (which is when a doctor charges more than the medical aid rate). 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 if you don't use a DSP, especially if you are being treated for a PMB or when buying medicine.
Specialised Radiology:	MRI, CT Scan, Angiogram: R3,500 per scan and R20,000 per family, in and out of hospital
Scopes:	If done in hospital, 20% co-payment (with some exceptions)
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!
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:
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
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
Specialists 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
Scopes:	If done in hospital, 20% co-payment (with some exceptions)
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

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
Chronic:	27 PMB conditions: Covered. You can see the full PMB list here. .
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
View other benefits for this plan: In-hospital | 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. Find all other open medical aid plans here.
PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider