Note: We are updating 2024 benefits as they are released. Some plans show old benefits until schemes release new plans.

Sizwe Value Core:
in-and-out of hospital benefits (2022)


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Monthly Costs:

Value Core Edo 2024 prices
Main member: Adult member: Child member:
Total Cost pm:
  • R4,051
  • R3,887
  • R1,079
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= R10,300
  • Main+1= R21,750
  • Main+2= R23,660
  • Main+3= R26,210
Children Rates:
Income band:
Note:
  • Exclusions: Note that all schemes have extensive exclusions. We've tried to list the major ones, but you must consult with your scheme to get the full list.
  • All treatments and procedures are subject to authorisation and protocols
  • All benefits are listed as an indication only. Please verify with your broker and scheme
♦️View all the other benefits for this plan:♦️
Inhospital | 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
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In-hospital Procedures for :

Sizwe: Value Core Edo
Assume scheme pays all these costs, unless otherwise stated
non-Network Specialists:
  • 100% scheme tariff
network Specialists:
  • 100% scheme tariff
non-Network GPs:
  • 100% scheme tariff
network GPs:
  • 100% scheme tariff
Hospital Choice:
  • Network Hospital
Day Hospitals:
  • Some minor procedures are only paid if done in day hospitals or doctor's rooms
Penalty for using other hospital:
  • 10% co-payment if you voluntarily choose another hospital
Other Co-payments:
Specialised Radiology:
  • 2 scans per person, in and out of hospital, with a 10% co-payment
Supplementary Services: (Physio, etc)
  • 100% scheme rate
Transplants:
  • 100% scheme rate , at DSP and from protocols
Dialysis:
  • Covered
Exclusions:
Alternatives to hospitals:
  • Rehab facilities: 14 days per person
  • Private nursing: 14 days per person
  • Step-down facilities: 14 days per person
Casualty:
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
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
♦️View all the other benefits for this plan:♦️
Inhospital | 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
.
.
.

Out-of-hospital Procedures for :

Sizwe: Value Core Edo
Assume scheme pays all these costs, unless otherwise stated
Summary of day-to-day benefits:
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= R10,300
  • Main+1= R21,750
  • Main+2= R23,660
  • Main+3= R26,210
PMBs out of hospital:
  • 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.
General info:
GP consultations:
  • DSP Network: Unlimited
  • Outside DSP network: 30% co-payment
Childcare:
Specialists consultations:
  • Require GP referral
  • M =3 consults
  • M1 =5 consults
  • M2 =7 consults
Pathology:
  • R3,725 per person for radiology and pathology
  • Strong>R2,890 per person sub limit
  • From day-to-day benefit
General radiology:
  • R3,725 per person for radiology and pathology
  • Strong>R2,255 per person sub limit
  • From day-to-day benefit
Specialised radiology:
  • MRI, PET, CT Scan: 2 scans per person
Supplementary Services: (Physio, etc)
  • 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
General Appliances:
1.1. Hearing Aids:
1.2. Wheelchairs:
Note:
  • 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
♦️View all the other benefits for this plan:♦️
Inhospital | 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
.

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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Medication Benefit for :

Sizwe: Value Core Edo
Assume scheme pays all these costs, unless otherwise stated
Summary of day-to-day benefits:
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= R10,300
  • Main+1= R21,750
  • Main+2= R23,660
  • Main+3= R26,210
Chronic:
Acute (presrcibed) medication:
Over-the-counter:
Birth Control:
On Discharge:
  • 7 days supply
Biological:
  • PMBs only
Note:
  • 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:♦️
Inhospital | 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
.

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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