• Benefits, in-hospital, out-hospital, Scheme Plans, Sizwe Plan

Sizwe Gold Ascend:
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 Gold Ascend. 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:Gold Ascend (2026)
Main member: Adult member: Child member:
Total Cost pm:
  • R4,468
  • R4,291
  • R1234
Savings:
  • 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
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: Gold Ascend
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:
  • Any hospital
Penalty for using other hospital:
  • n/a
 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:
  • 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: 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 Ascend
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)
Specialist consultations:
  • 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
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

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: Gold Ascend
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: .
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
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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