• Scheme Plans, Sizwe Plan

Sizwe Value Platinum Core:
prosthetic benefits (2025)

Contents:

This page has information on: Costs and Prosthetics for Sizwe Value Platinum Core

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:Value Platinum Core (2026)
Main member: Adult member: Child member:
Total Cost pm:
  • R6,363
  • R6,094
  • R1,624
Self Payment Gap:
(What you need to pay out of pocket before you can access the "Above Threshold" benefit)
  • R2462
  • R2085
  • R538
"Above Threshold" benefit (ATB):
Additional cover the scheme makes available to you, once you've paid the self payment gap.
  • 6507
  • 3827
  • 1664
Children Rates:
  • Up to age 26
  • Only pay for 3 children
medicalaid_guide
FREE GUIDE!
How to choose the right Medical Aid plan
Instant download when you subscribe

Prosthetics benefits (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
Overall Limit:
  • Internal and External: R57,015 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: two 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.
medicalaid_guide
FREE GUIDE!
How to choose the right Medical Aid plan
Instant download when you subscribe

More Information