Sizwe Essential Copper:
cancer, maternity and mental health (2025)

Table of Contents:

This page has information on: Costs, Maternity, Oncology, Mental Health for Sizwe Essential Copper

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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.

Monthly Costs (2025)

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

Sizwe:Essential Copper (2025 prices)
Main member: Adult member: Child member:
Total Cost pm:
  • R3,023
  • R3023
  • R1046
  • Only pay for 3 children
Savings (per year):
  • No savings account option on this plan
  • The scheme might still cover some or all day-to-day claims. See below, and see benefits.
Children Rates:
  • Up to age 26
  • Only pay for 3 children

Monthly Costs (2026)

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

Sizwe:Essential Copper (2026 prices)
Main member: Adult member: Child member:
Total Cost pm:
  • R3,625
  • R3625
  • R1255
  • Only pay for 3 children
Savings (per year):
  • No savings account option on this plan
  • The scheme might still cover some or all day-to-day claims. See below, and see benefits.
Children Rates:
  • Up to age 26
  • Only pay for 3 children

Cancer/ Oncology benefits (2025):

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

Sizwe: Essential Copper
Assume scheme pays all these costs, unless otherwise stated
Overall cancer coverage (in and out of hospital):
  • PMBs only
  • Note: Most cancers are PMBs, and treatment is paid in full by scheme. More info here
  • Most schemes require use of specific providers (DSPs) for oncology treatment.
 Gap Cover:
Can cover the penalty in full
(Plans coming soon)

Maternity benefits (2025):

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

Sizwe: Essential Copper
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.
 Gap Cover:
Can cover most shortfalls
(Plans coming soon)
Consultations:
  • Antenatal: 10 consults
  • Vitamins: R283 per pregnancy
Scans:
  • 2 x 2D scans, paid by scheme
Note:

Mental Health benefits (2025):

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

Sizwe: Essential Copper
Assume scheme pays all these costs, unless otherwise stated
Summary of day-to-day benefits:
Main Member: Adult: Child:
Savings (per year):
  • No savings account option on this plan
  • The scheme might still cover some or all day-to-day claims. See below, and see benefits.
Other Day-to-Day Funds:
FYI:
  • Mental Health PMB conditions are covered for in and out of hospital treatment, even on "hospital" plans. 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. Scheme will pay this in full, if you use a DSP.
In-hospital:
  • PMBs: 21 days admission
  • Alcoholism/Drug Addiction: R14,881 per family
 Gap Cover:
Can cover most co-payments and increase sublimits
(Plans coming soon)
Out-of-hospital:
  • PMBs only
Other: .

    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
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What does a “PMBs only” restriction mean?
In this case, the scheme will only pay for diagnosis, treatment and management of a claim for one of 270 pre-defined conditions (PMBs). Read more, and see full list of PMB conditions. 

What does “From Risk” mean?
The scheme will pay for this claim from its own funds, not from your savings or other day-to-day benefits. 

What is a DSP?
A Designated Service Provider. The scheme has a network of providers, and will often only pay claims in full if you use a DSP. If you choose another provider, you might have a co-payment, or even no cover. 

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