• Benefits, prosthetics, Scheme Plans, Sizwe Plan

Sizwe Gold Ascend:
prosthetic benefits (2025)

Contents:

This page has information on: Costs and Prosthetics for Sizwe Gold Ascend

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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Prosthetics benefits (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
Overall Limit:
  • Internal and External: R34,224 per family
  • Prosthetics required for PMB conditions are always paid in full by scheme, with no co-payment, if you follow the protocols. More info here
 Gap Cover:
Can cover most co-payments and increase sublimits
(Plans coming soon)
Sub-limits:
  • Joints - hip and knee (partial and total): 1 per person
  • Spine: one levels per person, or by authorisation.
  • Vascular stents: 2 stents per family
  • Cardiac stents: 3 stents per family
 Gap Cover:
Can cover most co-payments and increase sublimits
(Plans coming soon)
Note:
  • PMBs: Prescribed Minimum Benefits. PMBs cannot have sublimits or co-payments if protocols are followed. You can read more about PMBs here.
  • 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.
    Important!
  • Unless specified, assume that all benefits 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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