Sizwe Silver Saver medical aid plan: 2020

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View all plans in this scheme.
Always consult with your broker before making final decisions regarding your healthcare cover.

Benefits outlined:

Silver Saver
Total Cost pm:

Main member:

R2,090

Adult:

R1535

Child:

R695
Savings:R4512R3312R1500
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IN HOSPITAL PROCEDURES:
Silver Saver
Scheme Benefits:Notes and Links:
non-Network Specialists:
  • 100% specific scheme tariff
network Specialists:
  • 100% specific scheme tariff
non-Network GPs:
  • 100% specific scheme tariff
network GPs:
  • 100% specific scheme tariff
Hospital Choice:
  • Choose any hospital
Penalty for using other hospital:
  • n/a
  • n/a
Specialised Radiology:
  • R28,060 per family, in and out of hospital.
Supplementary Services: (Physio, etc)
  • 100% scheme rate, limited to physiotherapist, dietician, speech therapy and occupational therapy. Subject to PMB protocols.
  • The Blue Plan gap cover will increase this to 500% scheme rate
Transplants:
  • 100% scheme rate, at DSP and subject to protocols
Co-payments:
  • N/A
Alternatives to hospitals:
  • Private nurse: PMB only
Casualty:2019 Benefits coming soon!
  • Both the Blue Plan and Red Plan gap cover will pay up to R10,000 per person for unpaid casualty costs in event of emergency
Other:2019 Benefits coming soon!
Note:
  • Gap cover is an add-on to your medical aid, not a stand alone product
  • Gap cover has a maximum benefit payout of R165,000 per person per year for all gap benefits (except dread disease and premium waiver benefits which do not count towards the R165,000 limit)
  • Gap only supplements payment for procedures approved or authorised by your medical aid, and does not cover "penalties" (such as if, for example, you choose a non-DSP doctor for your procedure when the plan required a DSP doctor)
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All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme.
The gap benefits listed are for AskAdam gaps, unless otherwise stated. Actual benefits depend on gap choice option.

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OUT OF HOSPITAL PROCEDURES:
Silver Saver
Scheme Benefits:Notes and Links:
Summary:
Main Member:Adult:Child:
General info:
  • Consider getting Primary Health Care (PHC) (medical insurance) that will cover you for all GP visits, some specialist visits, acute meds, minor out of hospital procedures, some radiology and pathology, dentistry, optometry and more. It's an excellent complement to a hospital plan.
  • R370/main | R245/adult | R110/child
  • Read more here
GP consultations:
  • From day-to-day benefit, unless PMB
  • See Primary Health Care benefit above
Childcare:2019 Benefits coming soon!
Specialists consultations:
  • From day-to-day benefit, unless PMB
  • See Primary Health Care benefit above
Pathology:
  • From day-to-day benefit, unless PMB
  • See Primary Health Care benefit above
General radiology:
  • From day-to-day benefit, unless PMB
  • See Primary Health Care benefit above
Specialised radiology:
  • R28,060 per family, in and out of hospital.
Supplementary Services: (Physio, etc)
  • From day-to-day benefit, unless PMB
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MATERNITY BENEFITS:
Silver Saver
Scheme Benefits:Notes and Links:
Hospital stay:
  • 100% scheme rate
  • The Blue Plan gap cover will increase this to 500% scheme rate
Consultations:
  • 9 GP or midwife or specialist consult
  • Additional 2 specialist obstetrician consults
Scans:
  • 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
  • 12 x urine analysis tests
  • 1 x full blood count test
  • Vitamins worth R110
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CANCER (ONCOLOGY):
Silver Saver
Scheme Benefits:Notes and Links:
Overall coverage (in and out of hospital):
  • PMB only
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DENTISTRY:
Silver Saver
Scheme Benefits:Notes and Links:
Standard Dentistry:
  • From day-to-day benefit, unless PMB
  • Consider getting Primary Health Care (medical insurance) that will cover you for a lot of out of hospital claims, including standard dentistry like scaling, polishing, fillings, extractions, root canals and more. It's an excellent complement to a hospital plan.
  • R370/main | R245/adult | R110/child
  • Read more here
Specialised Dentistry:
  • From day-to-day benefit, unless PMB
In-Hospital Dentistry:
  • R2,000 co-payment
  • General anaesthetic for children under 5yrs and removal of impacted teeth
Orthodontics:2019 Benefits coming soon!
Maxillo Facial Surgery:
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MEDICATION:
Silver Saver
Scheme Benefits:Notes and Links:
Chronic:
  • All medical aid plans pay for treatment of the 27 CDL conditions as required by law. This includes medicine as well as GP or specialist consults, tests etc. Find out more
Acute (presrcibed) medication:
  • From day-to-day benefit, unless PMB
  • Consider getting Primary Health Care (medical insurance) that will cover you for all GP visits, some specialist visits, acute meds, minor out of hospital procedures, some radiology and pathology, dentistry, optometry and more. It's an excellent complement to a hospital plan.
  • R370/main | R245/adult | R110/child
  • Read more here
Over-the-counter:
  • From day-to-day benefit, unless PMB
Birth Control:
  • From day-to-day benefit, unless PMB
On Discharge:
  • 7 days supply
Biological:
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OPTOMETRY:
Silver Saver
Scheme Benefits:Notes and Links:
Optometry:
  • From day-to-day benefit
  • Consider getting Primary Health Care (medical insurance) that will cover you for all GP visits, some specialist visits, acute meds, minor out of hospital procedures, some radiology and pathology, dentistry, optometry and more. It's an excellent complement to a hospital plan.
  • R370/main | R245/adult | R110/child
  • Read more here
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MENTAL HEALTH:
Silver Saver
Scheme Benefits:Notes and Links:
In-hospital:
  • 21 days per person, including 6 in-hospital consults with psychologist.
  • Can be substituted with 4 additional consults in lieu of hospitalisation
  • Subject to PMBs and Designated Service Providers
  • Alcoholism/Drug Addiction: 3 days withdrawal treatment plus 21 days rehab at an appropriate facility
Out-of-hospital:
  • From day-to-day benefit
Trauma:
  • PMB conditions are covered for in and out of hospital treatment. For a full list see here.
  • Example of PMB condition: Acute stress disorder accompanied by recent significant trauma, including physical or sexual abuse. Treatment includes hospital admission for psychotherapy / counselling up to 3 days, or up to 12 outpatient psychotherapy / counselling contacts
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OTHER BENEFITS:
Silver Saver
Scheme Benefits:Notes and Links:
General Appliances:
  • From day-to-day benefit
1.1. Hearing Aids:
  • From day-to-day benefit
1.2. Wheelchairs:
  • From day-to-day benefit
Dialysis:
  • PMB only
International Insurance:
Other:2019 Benefits coming soon!
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WELLNESS/ PREVENTATIVE BENEFITS:
Silver Saver
Scheme Benefits:Notes and Links:
Flu vaccination:
Pneumonia vaccines:
Biometric Screening:
Child Immunisation:
Pap Smear:
Mammogram:
PAS Test:
HIV Test:
Other:
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PROSTHETICS:
Silver Saver
Scheme Benefits:Notes and Links:
Overal Limit:2019 Benefits coming soon!
Sub-limits:2019 Benefits coming soon!
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    Important!
  • Unless specified, assume that all benefits are paid 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

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