Sizwe Value Platinum Core:
in-and-out of hospital benefits (2025)

What's on this page:

This page has overview information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Sizwe Value Platinum Core. 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 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.

Monthly Costs (2025)

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Sizwe:Value Platinum Core (2025 prices)
Main member: Adult member: Child member:
Total Cost pm:
  • R5,306
  • R5,082
  • R1,353
  • Only pay for 3 children
Self Payment Gap:
(What you need to pay out of pocket before you can access the "Above Threshold" benefit)
  • R2345
  • R1986
  • R512
"Above Threshold" benefit (ATB):
Additional cover the scheme makes available to you, once you've paid the self payment gap.
  • 6197
  • 3645
  • 1585
Children Rates:
  • Up to age 26
  • Only pay for 3 children
Income band:

In-hospital Procedures (2025):

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Sizwe: Value Platinum Core
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
GPs and Specialists:
  • 100% scheme tariff
Hospital Choice:
  • Network Hospital
Penalty for using other hospital:
  • 10% penalty if you voluntarily choose another hospital
Co-payments:
  • Back surgery: R5,000 co-payment
  • MRIs, CT scans etc: R1,654 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.
Specialised Radiology:
  • MRI, CT Scan, Angiogram: R37,964 per family, in and out of hospital
    • with a R1,654 co-payment
Scopes:
  • If done in hospital, 20% co-payment (with some exceptions)
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!
Alternatives to hospitals:
  • Rehab facilities, home care: R6,069 per family
  • Private nursing: R9,059 per family
  • Step-down facilities: 100% scheme rate
Casualty/ER:
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: Value Platinum Core
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
Main Member: Adult: Child:
Self Payment Gap:
(What you need to pay out of pocket before you can access the "Above Threshold" benefit)
  • R2345
  • R1986
  • R512
"Above Threshold" benefit (ATB):
Additional cover the scheme makes available to you, once you've paid the self payment gap.
  • 6197
  • 3645
  • 1585
PMBs out of hospital:
GP consultations:
  • From day to day benefit
Childcare:
  • Heart screening test
  • Newborn hearing test
  • Immunisations
Specialists consultations:
  • From day to day benefit
Pathology:
  • From day to day benefit
  • Above Threshold Benefit limited to R16,537 per family
General radiology:
  • From day to day benefit
Specialised radiology:
  • MRI, CT Scan, Angiogram: R37,964 per family, in and out of hospital
    • with a R1,654 co-payment
Scopes:
  • If done in hospital, 20% co-payment (with some exceptions)
Supplementary Services: (Physio, etc)
  • Homeopathy, Naturopathy, Chiropractor and Podiatry: from day to day benefit, with Above Threshold limited to R1,737 per person
  • Audiology, Speech therapy, Dieticians, Occupational Therapy, Prosthetist, Educational Psychologist, Orthotics, Social Workers and registered counsellors: from day to day benefit, with Above Threshold limited to R2,013 per person and R3,533 per family
  • Biokinetics & Physiotherapy: from day to day benefit
General Appliances:
  • Callipers, Nebulizer, Glucometer, Insulin Pump, Morphine pump, C-PAP machine: R2,103 per person and R3,533 per family
  • Paid from day to day benefit
1.1. Hearing Aids:
  • R16,042 per family . One unit per person every 3 years
  • Paid by scheme
1.2. Wheelchairs:
  • R4,207 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: Value Platinum Core
Assume scheme pays all these costs, unless otherwise stated
Main Member: Adult: Child:
Self Payment Gap:
(What you need to pay out of pocket before you can access the "Above Threshold" benefit)
  • R2345
  • R1986
  • R512
"Above Threshold" benefit (ATB):
Additional cover the scheme makes available to you, once you've paid the self payment gap.
  • 6197
  • 3645
  • 1585
Chronic:
  • 26 additional conditions
  • R8,334 per person and R16,808 per family
Acute (prescribed) medication:
  • From day to day benefit
Over-the-counter:
  • From day to day benefit, but not from Above Threshold
Birth Control:
  • R3,497
  • Includes Mirena device
  • From day to day benefit
On Discharge:
  • 7 days supply
Biological:
  • Oncology drugs: Part of oncology limit
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

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.


What does a “PMBs only” restriction mean?
In this case, the scheme will only pay for diagnosis, treatment and management of a claim for one of 270 pre-defined conditions (PMBs). Read more, and see full list of PMB conditions. 

What does “From Risk” mean?
The scheme will pay for this claim from its own funds, not from your savings or other day-to-day benefits. 

What is a DSP?
A Designated Service Provider. The scheme has a network of providers, and will often only pay claims in full if you use a DSP. If you choose another provider, you might have a co-payment, or even no cover.