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

Sizwe Titanium Executive:
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 Titanium Executive. 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:Titanium Executive (2026)
Main member: Adult member: Child member:
Total Cost pm:
  • R11,737
  • R10,385
  • R2,399
Savings:
  • R29296
  • R25921
  • R5988
Self Payment Gap:
(What you need to pay out of pocket before you can access the "Above Threshold" benefit)
  • R5602
  • R4643
  • R2124
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: Titanium Executive
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
GPs and Specialists:
  • GP and Specialist: 100% scheme tariff
  • Anaesthetist: 300% scheme tariff
 Gap Cover:
Can push payout up to 700% scheme rate
(Plans coming soon)
Hospital Choice:
  • Choose 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: R1,654 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: R49,937 per family, in and out of hospital
    • with a R1,654 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:
  • 100% scheme rate, at DSP and from protocols
Exclusions:
  • NB: See scheme's rules for all exclusions. All schemes have plenty!
 Gap Cover:
Coming soon
Alternatives to hospitals:
  • Rehab facilities, home care: R12,139 per family
  • Private nursing: R12,139 per family
  • Step-down facilities: 100% scheme rate
Casualty/ER:
  • 2 x 2D scans, paid by scheme
  • 2 x haemoglobin tests
  • 1 x blood group test
  • 1 x VDRL test for syphillis
  • 1 x HIV Elisa test
 Gap Cover:
Can cover ER claims
(Plans coming soon)
Other:
  • M =12 consults
  • M1 =20 consults
  • M2 =25 consults
  • M3 =29 consults
  • M4 =30 consults
  • M5 =31 consults
  • M6 =32 consults
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: Titanium Executive
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
Main Member: Adult: Child:
Savings:
  • R29296
  • R25921
  • R5988
Self Payment Gap:
(What you need to pay out of pocket before you can access the "Above Threshold" benefit)
  • R5602
  • R4643
  • R2124
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
Childcare:
  • Heart screening test
  • Newborn hearing test
  • Immunisations
 Gap Cover:
Can pay for child ER visits
(Plans coming soon)
Specialist consultations:
  • From day to day benefit
Pathology:
  • From day to day benefit
  • Above Threshold Benefit limited to R16,700 per family
General radiology:
  • From day to day benefit
Specialised radiology:
  • MRI, CT Scan, Angiogram: R49,937 per family, in and out of hospital
    • with a R1,654 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: from day to day benefit, limited to R2,673 per person
  • Audiology, Speech therapy, Dieticians, Occupational Therapy, Prosthetist, Educational Psychologist, Orthotics, Social Workers and registered counsellors: from day to day benefit, limited to R3,700 per person and R6,233 per family
  • Biokinetics & Physiotherapy: from day to day benefit
General Appliances:
  • Callipers, Nebulizer, Glucometer, Insulin Pump, Morphine pump, C-PAP machine: R3,529 per person and R5,878 per family
  • Paid from day to day benefit
1.1. Hearing Aids:
  • R48,123 per family . One unit per person every 3 years
  • Paid by scheme
1.2. Wheelchairs:
  • R5,866 per family . One every 4 years
  • Paid by scheme
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: Titanium Executive
Assume scheme pays all these costs, unless otherwise stated
Main Member: Adult: Child:
Savings:
  • R29296
  • R25921
  • R5988
Self Payment Gap:
(What you need to pay out of pocket before you can access the "Above Threshold" benefit)
  • R5602
  • R4643
  • R2124
Other Day-to-Day Funds:
Chronic:
  • 35 additional conditions
  • R17,688 per person and R33,819 per family
Acute (prescribed) medication:
  • From day to day benefit
  • Above threshold limit: R7,800 per adult and R2,442 per child
Over-the-counter:
  • From day to day benefit and Acute Medicine limit
Birth Control:
  • R3,497
  • Includes Mirena device
  • From day to day benefit
On Discharge:
  • 7 days supply
Biological:
  • Oncology drugs: Part of oncology limit
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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