Sizwe Gold Ascend EDO:
in-and-out of hospital benefits (2025)

This page has overview information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Sizwe Gold Ascend EDO. 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: Gold Acend EDO
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:	Back surgery: R5,000 co-payment MRIs, CT scans etc: 10% 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.	Gap Cover: Can cover most co-payments (Plans coming soon)
Specialised Radiology:	MRI, CT Scan, Angiogram: R24,976 per family, in and out of hospital with a 10% co-payment	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)	100% scheme rate
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:	Rehab facilities, home care: 100% scheme rate Private nursing: R6,069 per family Step-down facilities: 100% scheme rate
Casualty/ER:		Gap Cover: Can cover ER claims (Plans coming soon)
Other:
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: Gold Acend EDO
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
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. Extended Fund: Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account Main= R7,589 Main+1= R11,239 Main+2= R13,152 Main+3= R15,041 Main+4= R16,953 Main+5= R18,854 Main+6+= R20,743 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 Main =R7,589 Main +1 =R11,239 Main +2 =R13,152 Main +3 =R15,041 Main +4 =R16,953 Main +5 =R18,854 Main +6 =R20,743 Shared with GP, Specialists, Pathology, Physiotherapy and Acute medication
Childcare:	Heart screening test Newborn hearing test Immunisations	Gap Cover: Can pay for child ER visits (Plans coming soon)
Specialists consultations:	From day to day benefit Main =R7,589 Main +1 =R11,239 Main +2 =R13,152 Main +3 =R15,041 Main +4 =R16,953 Main +5 =R18,854 Main +6 =R20,743 Shared with GP, Specialists, Pathology, Physiotherapy and Acute medication
Pathology:	M =R7,589 M1 =R11,239 M2 =R13,152 M3 =R15,041 M4 =R16,953 M5 =R18,854 M6 =R20,743 Shared with GP, Specialists, Pathology, Physiotherapy and Acute medication From day to day benefit
General radiology:	From day to day benefit
Specialised radiology:	MRI, CT Scan, Angiogram: R24,976 per family, in and out of hospital with a 10% co-payment	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: R1,344 per person Audiology, Speech therapy, Dieticians, Occupational Therapy, Prosthetist, Educational Psychologist, Orthotics, Social Workers and registered counsellors: From day-to-day benefit , R1,356 per personR2,178 per family Biokinetics & Physiotherapy: 100% scheme rate
General Appliances:	Callipers, Nebulizer, Glucometer, Insulin Pump, Morphine pump, C-PAP machine: R1,355 per person and R2,177 per family
1.1. Hearing Aids:	R8,325 per family . One unit per person every 4 years
1.2. Wheelchairs:	R2,508 per family . One every 4 years
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: Gold Acend EDO
Assume scheme pays all these costs, unless otherwise stated
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. Extended Fund: Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account Main= R7,589 Main+1= R11,239 Main+2= R13,152 Main+3= R15,041 Main+4= R16,953 Main+5= R18,854 Main+6+= R20,743 Other Day-to-Day Funds:
Chronic:	27 PMB conditions: Covered. You can see the full PMB list here. .
Acute (prescribed) medication:	M =R2,368 M1 =R4,270 M2 =R4,751 M3 =R5,385 M4 =R5,536 M5 =R5,841 M6 =R6,323 Subject to overall limit shared with GP, Specialists, Pathology, Physiotherapy From day to day benefit
Over-the-counter:	R2,442 per family and R181 per script Benefit shared with Acute Medicine benefit From day to day benefit
Birth Control:	R3,497 Includes Mirena device From day to day benefit
On Discharge:	7 days supply
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