This page has information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Sizwe Value Platinum Core.
In-hospital Procedures ():
(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)
Assume scheme pays all these costs, unless otherwise stated
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non-Network Specialists: |
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network Specialists: |
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non-Network GPs: |
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network GPs: |
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Hospital Choice: |
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Day Hospitals: |
- Some minor procedures are only paid if done in day hospitals or doctor's rooms
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Penalty for using other hospital: |
- 10% co-payment if you voluntarily choose another hospital
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Other Co-payments: |
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Specialised Radiology: |
- 2 scans per person, in and out of hospital, with a 10% co-payment
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Scopes: |
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Supplementary Services: (Physio, etc) |
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Transplants: |
- 100% scheme rate , at DSP and from protocols
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Dialysis: |
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Exclusions: |
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Alternatives to hospitals: |
- Rehab facilities: 14 days per person
- Private nursing: 14 days per person
- Step-down facilities: 14 days per person
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Casualty: |
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Other: |
- All benefits fromPMBs
- Back and neck surgery: R2,500 co-payment
- Laparoscopic hospitalisation: R5,000 co-payments may apply if done outside day hospital
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Note: |
- 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
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View all the 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.
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Out-of-hospital Procedures ():
(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)
Assume scheme pays all these costs, unless otherwise stated |
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Main Member: |
Adult: |
Child: |
- No savings account option on this plan
- The scheme might still cover some or all day-to-day claims. See below, and see benefits.
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- All medical aids 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
- The benefit is paid by the scheme, and not out of your savings account
- If you have no day-to-day funds, you still have cover for PMBs
- 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.
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- DSP Network: Unlimited
- Outside DSP network: 30% co-payment
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- Require GP referral
- M =3 consults
- M1 =5 consults
- M2 =7 consults
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- R3,725 per person for radiology and pathology
- Strong>R2,890 per person sub limit
- From day-to-day benefit
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- R3,725 per person for radiology and pathology
- Strong>R2,255 per person sub limit
- From day-to-day benefit
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- MRI, PET, CT Scan: 2 scans per person
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Scopes: |
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- Homeopathy, Naturopathy, Chiropractor and Podiatry fromPMBs and Protocols: R3,910 per family
- Audiology, Speech therapy, Dieticians, Hearing Aid Acousticians, Occupational Therapy, Orthotics, Social Workers, and Speech Therapy: R3,770 per family
- Biokinetics & Physiotherapy: R1,780 per person and R2,930 per family
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- PMBs: Prescribed Minimum Benefits. To read more about PMBs click here
- 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
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View all the 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.
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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 ():
(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)
Assume scheme pays all these costs, unless otherwise stated |
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Main Member: |
Adult: |
Child: |
- No savings account option on this plan
- The scheme might still cover some or all day-to-day claims. See below, and see benefits.
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Chronic: |
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- Schemes have very strict rules about where you can get your medicine to get full benefit. We do not list the requirements here, so confirm with your scheme before you collect your medicine.
- Formulary: A pre-defined list of approved medicines. Each plan has a different list, and might not pay for non-listed medicine. Confirm with your scheme whether your required medicine is covered by them.
- PMBs: Prescribed Minimum Benfits. To read more about PMBs click here
- 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
|
View all the 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.
|
. |
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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