Sizwe Hosmed Access Core Plan (🇿🇦 2026)
Overall, the Sizwe Hosmed Access Core Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and appliance benefits to its members. The Sizwe Hosmed Access Core Medical Aid Plan starts from R3,161 ZAR.| 👤 Main Member Contribution | R3,161 |
| 👥 Adult Dependent Contribution | R2,726 |
| 🍼 Child Dependent Contribution | R636 |
| 🔁 Gap Cover | None |
| 📉 Annual Limit | Unlimited Hospital Cover |
| 💙 Hospital Cover | Unlimited for PMBs |
| ➡️ Prescribed Minimum Benefits | ☑️ Yes |
| 🟦 Screening and Prevention | ☑️ Yes |
Sizwe Hosmed Access Core Plan - 7 Key Point Quick Overview
- ✅ Sizwe Hosmed Access Core Plan Overview
- ✅ Sizwe Hosmed Access Core Plan Contributions
- ✅ Access Core Plan Benefits and Cover Comprehensive Breakdown
- ✅ Access Core Plan Exclusions and Waiting Periods
- ✅ Sizwe Hosmed Access Core Plan vs. Similar Plans from other Medical Schemes
- ✅ Our Verdict on The Access Core Plan
- ✅ Access Core Plan Frequently Asked Questions
Sizwe Hosmed Access Core Plan Overview
💙 The Sizwe Hosmed Access Core medical aid plan is one of 8, starting from R3,161 and includes maternity coverage up to 100% of the medical aid rate, higher prostheses limits, dental care, chiropractor benefit, and more.
💙 Gap Cover is not available on the Sizwe Hosmed Access Core Plan. However, Sizwe Hosmed offers 24/7 medical emergency assistance. According to the Trust Index, Sizwe Hosmed has a trust rating of 3.9.
Sizwe Hosmed offers 8 medical aid plans:
- ✅ Sizwe Hosmed Access Core Plan
- ✅ Sizwe Hosmed Value Platinum Core
- ✅ Sizwe Hosmed Titanium Executive
- ✅ Sizwe Hosmed Gold Ascend
- ✅ Sizwe Hosmed Gold Ascend EDO
- ✅ Sizwe Hosmed Value Platinum Plan
- ✅ Sizwe Hosmed Essential Copper
- ✅ Sizwe Hosmed Access Saver
Sizwe Hosmed Access Core Plan Contributions
| 👤 Main Member | 👥 Adult Dependent | 🍼 Child Dependent |
| R3,161 | R2,726 | R636 |
Access Core Plan Benefits and Cover Comprehensive Breakdown
Access Core Plan In-Hospital Benefits
Hospital admissions- ☑️ Unlimited benefits for Specified Minimum Benefit circumstances.
- ☑️ Hospital admissions—including PMBs—require pre-authorization and case management.
- ☑️ Emergency admissions require 48-hour notification of the Scheme.
- ☑️ Claims will be denied if admissions are not pre-authorized or reported within 48 hours.
- ☑️ Access Core Plan hospital benefits are only available at Authorized Service Providers.
- ☑️ There is a 10% co-payment for non-DSP hospital use.
- ☑️ PMB and case management protocols apply.
- ☑️ All procedures must be approved in advance.
| 🅰️ Hospital Admissions High Care Unit General Ward Theatre Recovery Room | Covered up to 100% of the Negotiated Tariff. Admissions for elective procedures must be pre-authorised at least 72 hours before the admission date. 30% penalty will be imposed for non-emergency late pre-authorisations as well as voluntary use of non-DSP* hospital . Emergency admissions must be notified to the Scheme within 48 hours of admission. |
| 🅱️ Medicines and consumables used in hospital and theatre | Covered up to 100% of the negotiated tariff. |
| 💊 Medicine to take home after discharge | Paid from the hospital benefit. Limited to 7 days’ medicine. |
| 👨⚕️ Consultations and Procedures | Covered up to 100% of the negotiated tariff. |
| 1️⃣ Basic Radiology and Pathology | 100% of Scheme Tariff* |
| 2️⃣ Specialized Radiology | 100% of Scheme Tariff* |
| 3️⃣ Oncology | 100% of DSP Tariff* Limited to PMBs |
| 4️⃣ Renal Dialysis | 100% of Negotiated Tariff* Limited to PMBs |
| ❤️ Organ Transplants | 100% Scheme Tariff* Limited to R267 282.38 per family per year. |
| 🦷 Dental Hospitalisation | 100% of Scheme Tariff Limited to PMBs |
| 😊 Maxillo-facial and Oral Surgery | 100% of Scheme Tariff* Limited to PMBs |
| 💗 Drug and Alcohol Rehabilitation | 100% of Scheme Tariff* Maximum of three (3) days admission for withdrawal treatment and up to 21 days admission for rehabilitation at an appropriate facility. |
| 🧠 Psychiatric Treatment Consultations Ward Fees Medicines Psychiatry/psychology therapy sessions | 100% of Scheme Tariff* Subject to PMB, pre-authorisation and clinical protocols and Scheme rules. 21 days In-Hospital or 15 out-of-hospital sessions per beneficiary per annum (includes Psychiatrist consultations and six (6) In-Hospital consultations by Clinical Psychologist). Limited to a maximum of three (3) day’s hospitalisation if admitted by a GP or a Specialist Physician. |
| 🧠 Non-PMB Psychiatric Treatment | No benefit. |
| 🚑 Hospitalisation Alternatives | 100% of Negotiated Tariff |
| ⬇️ Step-down Facilities | 100% of Negotiated Tariff |
| 🏡 Home-Based Care | 100% of Negotiated Tariff* Limited to 14 days per year. |
| 😮💨 Hyperbaric Oxygen Therapy | Covered up to 100% of the negotiated tariff. Pre-authorization required. Limited to PMBs. Public sector protocols will apply. |
| 🟦 Male Sterilisation/Vasectomy | 100% of Negotiated Tariff. Limited to R20 225.36 per beneficiary per annum. |
| 🟪 Female Sterilisation/Tubal Ligation | 100% of Negotiated Tariff. Limited to R20 225.36 per beneficiary per annum. |
| 🧬 Back and Neck Surgery | 100% of Scheme Tariff* Subject to PMBs, pre-authorisation, clinical protocols, and Scheme rules. Subject to adherence to conservative treatment. A co-payment of R5 000 is applicable to all non-PMB back surgeries |
| 📈 Stereotactic Radiosurgery | Covered up to 100% of the scheme tariff. Subject to PMBs, pre-authorisation, Managed Care Protocols and Scheme rules. Primary Central Nervous System Tumours only. |
| 📉 Age-related Muscular Degeneration Treatment | Covered up to 100% of the negotiated tariff. Pre-authorization required. Applicable to members 55 years and above. |
| 📊 Laparoscopic Hospitalisation and Associated Costs | Pre-authorization required. Subject to PMBs. No co-payment applicable when procedure performed in a Day Hospital or as a Day Case. Procedures done In-Hospital will attract a 20% co-payment with exception of Diagnostic laparoscopy, Aspiration/excision Ovarian Cyst, Lap-appendicectomy and repair of recurrent or Bilateral Inguinal Hernias. |
| 📌 PMB Laparoscopic Procedures | PMBs are covered in DSP facilities. Subject to clinical protocols. |
| 📍 Internal and External Prostheses | Covered up to 100% of the negotiated tariff. Subject to PMBs and pre-approval. |
| 🦾 Internal Prostheses | 100% of Negotiated Tariff. |
| 🦿 External Prostheses | Limited to PMBs. |
| ⚕️ Cardiac Stents | Cardiac Stents: Maximum three (3) per family per year, limited to: - Bare metal stents: R13 335 per stent - Drug eluting stents: R16 170 per stent No benefit for unstable angina or NSTEMI unless there is evidence of failed conservative medical treatment. Public sector protocols for STEMI apply. |
| 🩸 Blood Transfusions | 100% Scheme Tariff* |
| 🩺 Physiotherapy and Biokinetics | Covered up to 100% of the scheme tariff. |
| 🍎 Dietician and Occupational Therapy | Covered up to 100% of the scheme tariff. |
Access Core Plan Day-to-Day Benefits
💙 Access Core Plan offers the following Day-to-Day Limits:| 🟥 Day Hospital Procedures using a DSP hospital Network | 100% Negotiated Tariff. Co-Payment applicable to defined conditions. Subject to PMB conditions only. Refer to Sizwe medical brochure for 2026 for finer detail. |
| 🟧 Co-payments on day procedures | 100% Scheme Tariff Limited to PMBs at DSP. Voluntary use of non-DSP* will result in a 30% co-payment. |
| 🟨 Out-of-Hospital Consultations General Practitioners Specialists Outpatient Facilities | 100% Scheme Tariff Limited to PMBs at DSP |
| 🟩 Medicines | 100% of Reference Price. Limited to CDL (Chronic Disease List). Subject to formulary, protocol and reference pricing. |
| 🟦 Ambulance and Emergency Services | Benefit applicable to members who utilise the Scheme’s DSP network only. The Scheme’s preferred provider must be contacted should you require an ambulance. Authorisation for emergency transportation should be obtained within 72 hours. If services are not pre-authorised through the preferred provider, claims will not qualify for payment. |
| ⬛ Non-Emergency Air/Road services. | 100% Negotiated Tariff* Must be pre authorized. |
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Access Core Plan Optical Benefits
💙 No benefits on this plan.Access Core Plan Dentistry Benefits
💙 No Benefits on this plan.Access Core Plan Other Benefits
| ✈️ Air/Road Ambulance and Emergency Services | The contractual service provider authorizes 100% of the Negotiated Tariff*. Emergency transportation authorization should be obtained within 72 hours. Claims will not be paid if services are not pre-authorized through the selected provider. |
| 🧠 Mental health (including consultation, ward fees, related medicines, therapy session with Psychiatrist and Psychologist, etc.) | Covered up to 100% of the scheme tariff. Subject to PMB, pre - authorisation and clinical protocols and Scheme rules. 21 days In-Hospital or 15 out-of-hospital sessions per beneficiary per annum (includes Psychiatrist consultations and six (6) In-Hospital consultations by Clinical Psychologist). Limited to a maximum of three (3) day’s hospitalisation if admitted by a GP or a Specialist Physician. |
| 🤍 Infertility | Subject to PMBs, pre-authorisation and Protocols. Department of Health protocols apply. 100% of Scheme Tariff |
| 👩⚕️ Hospice and Private Nursing | No Benefit |
Access Core Plan: Sizwe Hosmed Bambino Benefits
💙 Sizwe Hosmed is concerned about its maternity mothers. This program offers information and advantages to help them during their pregnancy.
💙 In addition, pregnant women enrolled in the Bambino Programme are eligible for a complimentary maternity bag filled with baby goods at 24 weeks of pregnancy.
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Access Core Plan Preventative Care Benefits
| 🍼 Sizwe Hosmed Bambino Program | Covered up to 100% of the scheme tariff. |
| 💙 Hospital Confinement | Admissions can only be done to a DSP Hospital Network. Natural Delivery – Limited to 2 days Cesarean – Limited to 3 days. |
| 👩🍼 Home Delivery | Covered up to 100% of the negotiated tariff. A registered Midwife, GP, or medical specialist can only do it. Materials included in benefit. |
| 🥰 Maternity Ultrasounds | Limited to two 2D ultrasounds in and out-of-hospital. Covered up to 100% of the negotiated tariff. |
| 💗 Maternity Visits/Consultations | Covered up to 100% of the scheme tariff. Additional ten (10) antenatal visits at either a midwife, GP or Specialist per pregnancy, six (6) either with a GP, Midwife and four (4) with a Specialist Obstetrician. |
| 👶🏻 Antenatal Pathology Screening and Vitamins. Haemoglobin Syphilis Chlamydia Bacteriuria Hepatitis B Rhesus incompatibility | Limited to: • Two (2) Haemoglobin Measurement test. • One (1) Blood Grouping test. One (1) Rhesus Factor. • One (1) VDRL test for Syphilis. • Two (2) HIV blood tests. • 12 urine analysis tests. • One (1) Full blood count (FBC) test. • One (1) Hepatitis S Ag test. • One (1) Toxoplasmosis test. • One (1) Rubella test. Vitamins Limit: R297.68 perpregnancy paid from Risk |
Access Core Plan Chronic Diseases Benefit
💙 Sizwe Hosmed Access Core Plan covers the following chronic conditions on the CDL list:- ☑️ Addison’s Disease
- ☑️ Epilepsy
- ☑️ Asthma
- ☑️ Glaucoma
- ☑️ Bipolar Mood Disorder
- ☑️ Hemophilia
- ☑️ Bronchiectasis
- ☑️ HIV/AIDS
- ☑️ Cardiac Failure
- ☑️ Hyperlipidemia
Access Core Plan Exclusions and Waiting Periods
Access Core Plan Exclusions
Sizwe Hosmed indicates that the following are excluded. However, these are only a few items; the complete list can be viewed on the Sizwe Hosmed website.- ☑️ Costs that exceed the annual or biennial maximum allowed for the category
- ☑️ Operations, medicines, treatments, and procedures for cosmetic purposes or personal reasons
- ☑️ Medical service not deemed necessary by the medical advisor for the management of the medical condition
- ☑️ Treatment with no proven efficacy and safety
- ☑️ Services rendered by unregistered persons or institutions not registered in terms of any law
- ☑️ Abdominoplasties and repair of divarication of abdominal muscles
- ☑️ Geriatric hospital, nursing home, frail care facility, or similar accommodations and services
- ☑️ Alternative therapists, such as art therapists, aromatherapists, massage therapists, reflexologists, and Chinese medicine practitioners
- ☑️ Anabolic steroids and immunostimulants, excluding immunoglobulins and growth hormones
- ☑️ Ante- and postnatal exercises
Access Core Plan Waiting Periods
💙 When new members join the plan, they may be subject to a three-month general waiting period during which they cannot receive benefits. 💙 Except in the case of Specified Minimum Benefits, if the new member has a pre-existing ailment, they may be subject to a one-year condition-specific waiting period. 👉🏿 You might also like Best Gap Cover with No Waiting Period
Sizwe Hosmed Access Core Plan vs. Similar Plans from other Medical Schemes
| 🔎 Medical Aid Plan | 🥇 Sizwe Hosmed Access Core (2026) | 🥈 Medshield MediCore (2026*) | 🥉 Bestmed Rhythm 1 (2026) |
| 🌎 International Cover | Covered up to 100% of the scheme rates | Yes | R1 million in USA – Other countries R5 million |
| 👤 Main Member Contribution | R3,161 | R4 278 | R1,736 – R3,615 |
| 👥 Adult Dependent Contribution | R2,726 | R3 618 | R1,615 – R3 363 |
| 🍼 Child Dependent Contribution | R636 | R987 | R715 – R1,873 |
| 📉 Annual Limit | Unlimited Hospital Cover | Unlimited Hospital Cover | Several limits and sub-limits |
| 💙 Hospital Cover | Unlimited for PMBs | Unlimited | Unlimited at Rhythm DSPs |
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Our Verdict on The Access Core Plan
💙 Sizwe Hosmed Access Core Plan is a medical aid scheme offering members comprehensive healthcare coverage. The plan is designed for individuals and families who require extensive medical care and are willing to pay higher premiums to access top-quality healthcare services.
💙 Furthermore, the plan has many unique features and benefits that make it stand out from other medical aid plans in South Africa. One of the key benefits of the Sizwe Hosmed Core Plan is its extensive hospital coverage.
💙 Members of the plan can access care from a network of private hospitals across South Africa, including many of the country’s leading medical facilities. This coverage includes in-hospital and out-of-hospital care, ensuring that members can receive the care they need when needed.
💙 Another unique feature of the Sizwe Hosmed Access Core Plan is its chronic medication cover. The plan covers the cost of medication for chronic conditions such as diabetes, hypertension, and HIV/AIDS. This is a significant benefit for individuals and families who require ongoing medication to manage their health conditions. However, one of the plan’s drawbacks is that it can be quite expensive.
💙 In addition, the Access Core Plan has higher premiums compared to other medical aid plans, making it less accessible to low-income individuals and families. Additionally, the plan has limits on certain medical procedures, which can be a burden for members who require frequent medical care.
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