Sizwe Hosmed Medical Aid Scheme (🇿🇦 2025*)

 

The medical plans of Sizwe Hosmed have been streamlined and reduced to 8 medical aid plans to help align with market norms and eliminate inefficiencies.

 

Price starting from R2,636 per month on the Access Core plan. Additionally, Sizwe Hosmed offers 24/7 emergency support but does not offer comprehensive gap cover on any policy.

 

Sizwe Hosmed offers 8 medical aid plans:

 

1. ✅ Sizwe Hosmed Access Core Plan
2. ✅ Sizwe Hosmed Value Platinum Core
3. ✅ Sizwe Hosmed Titanium Executive
4. ✅ Sizwe Hosmed Gold Ascend
5. ✅ Sizwe Hosmed Gold Ascend EDO
6. ✅ Sizwe Hosmed Value Platinum Plan
7. ✅ Sizwe Hosmed Essential Copper
8. ✅ Sizwe Hosmed Access Saver

 

 

 

Sizwe Hosmed Review – Analysis of Medical Aids Main Features

 

1. ✅ Sizwe Hosmed at a Glance
2. ✅ Sizwe Hosmed Regulation
3. ✅ Sizwe Hosmed Plan Overview
4. ✅ Sizwe Hosmed – Advantages over Competitors
5. ✅ Sizwe Hosmed Medical Savings Account
6. ✅ How to apply for Medical Aid with Sizwe Hosmed
7. ✅ How to apply for Gap Cover with Sizwe Hosmed
8. ✅ How to Submit a Claim with Sizwe Hosmed
9. ✅ How to Submit a Compliment or Complaint with Sizwe Hosmed
10. ✅ How to Switch my Medical Aid to Sizwe Hosmed
11. ✅ Sizwe Hosmed Customer Support
12. ✅ Sizwe Hosmed vs Platinum Health vs Fedhealth – A Comparison
13. ✅ Sizwe Hosmed Member Reviews
14. ✅ Sizwe Hosmed – Our Verdict
15. ✅ Sizwe Hosmed Pros and Cons
16. ✅ Sizwe Hosmed Frequently Asked Questions

 

 

Medical Aid Sizwe Hosmed at a Glance

 

📌 Date Established	1988 (Hosmed)
📍 Headquartered	Gauteng, South Africa
✒️ Registration Number	FSP 4481
👥 The average number of members	63 577 members 152 421 beneficiaries
✳️ Number of Markets	South Africa
📊 GCR Rating	A+
🚩 Listed on the JSE	No
📈 JSE Stock Symbol	None
📉 The most recent Market Cap reported	None
💙 Average Customer Rating	3.5
🔍 Average Number of Reviews	600+
📌 Market Share	<5%
🔟 The number of plans	8
🏥 Number of Hospitals in Network	300+
🏠 Home care provided	None
🤝 Sponsorships	None
📱 Mobile App	✅ Yes
📖 Sizwe Hosmed Magazine for clients	No
⚙️ Medical Claims Portal	✅ Yes
😷 Information Hub for COVID-19	✅ Yes
⚕️ Chronic Illness Benefits	✅ Yes
📌 Number of PMB Diagnoses	271
📍 Number of PMB Chronic Conditions	27
💻 Screening and Prevention offered	✅ Yes
👶 Maternity Benefit	✅ Yes
💵 Medical Aid Contribution Range (ZAR)	2,636 – 9,788 ZAR
⛔ Average Waiting Period	up to 12 months
✔️ Late-joiner penalties charged	✅ Yes
🌎 Is International Medical Cover offered	✅ Yes
💵 International Travel Benefit (ZAR)	100% Scheme rates

 

👉🏾 Download the SIZWE HOSMED 2025 Member Benefit Guide.

 

 

Sizwe Hosmed Regulation

 

💙 The Council for Medical Schemes regulates Sizwe Hosmed Medical Scheme.  The Council governs South Africa’s medical plan business for Medical Schemes (CMS), a regulating body set up under the Medical Schemes Act, No. 131 of 1998 (the Act). The CMS is responsible for a range of tasks related to the oversight of medical insurance plans, such as:

 

• ➡️ Responsible for registering medical insurance plans and ensuring they comply with the law and other laws.
• ➡️ Making sure healthcare plans have the money to pay claims.
• ➡️ Examining and authorizing proposed price hikes for medical plans.
• ➡️ Accepting and examining member complaints and initiating disciplinary action against medical plans that violate the Act or other applicable rules.
• ➡️ Helping medical insurance plans follow the law and other laws.

 

💙 Furthermore, if a medical scheme is found to violate the law, the CMS has the authority to issue administrative fines and penalties.

 

💙 Discover more about ICD-10 Codes – A Beginner’s Guide to ICD 10 codes

 

 

Sizwe Hosmed Plan Overview

 

 

 

🔎 Plan	💴 Contributions Range (Main)	💵 Contributions Range(+ Adult)	💶 Contributions Range (+ Child)	💷 Medical Savings (Up to) / Out-of-Hospital	💴 Self-Payment Gap	💵 Chronic Conditions
➡️ Essential Copper	R3,023 ZAR	R3,023 ZAR	R 1,046 ZAR	Out-of-Hospital Benefit: Refer to “Essential Copper Guide”	None	27
➡️ Access Saver	R3,371 ZAR	R2,911 ZAR	R676 ZAR	·R10,080 ZAR (Main) ·R8,736 ZAR (Adult) ·R1,992 ZAR (Child)	None	35
➡️ Access CORE	R2,636 ZAR	R2,273 ZAR	R530 ZAR	n/a	None	35
➡️ Gold Ascend	R3,726 ZAR	R3,578 ZAR	R1,029 ZAR	n/a	None	27
➡️Gold Ascend EDO	R3,543 ZAR	R3,400 ZAR	R976 ZAR	n/a	None	27
➡️ Value Platinum	R5,583 ZAR	R5,242 ZAR	R1,528 ZAR	Out-of-Hospital Benefit: ·Member: R15 072 ·Adult: R14 160 ·Child: R4 128	None	45
➡️ Value Platinum Core	R5,306 ZAR	R5,082 ZAR	1,353 ZAR	Out-of-Hospital Benefit: ·Member: R14 328 ·Adult: R13 728 ·Child: R3 660	None	45
➡️ Titanium Executive	R9,788 ZAR	R8,661 ZAR	R2,00 ZAR	Out-of-Hospital Benefit: · Member: R24 432 · Adult: R21 624 · Child: R5 004	· Yes,2025 figures to be finalizes	62

 

👉🏿 Discover: what is the difference between medical aid and medical insurance

 

 

 

Traditional Plans

 

💙 A traditional plan offers daily benefits with a fixed monetary amount for each condition or treatment, which may vary depending on the size of your family.

 

💙 These benefits have a set amount; once used, they cannot be accessed again until the next year. These plans typically allow free choice of service providers and provide peace of mind that even if one benefit is fully used, other benefits may still be available for the family.

 

💙 In addition, unused benefits do not accumulate or carry over to the next year. However, they are renewed at the start of each year.

 

 

Sizwe Hosmed Medical – Gold Ascend

 

 

Gold Ascend introduction:

 

The Sizwe Hosmed Gold Ascend Medical Aid Plan starts from R3,726 ZAR. The plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance, mental health benefits and many more benefits to its members.

Gold Ascend In-Hospital Benefits:

 

🅰️ Hospital Admissions High Care Unit General Ward Theatre Recovery Room	Covered up to 100% of the Negotiated Tariff.
🅱️ 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	Combined In- and Out-of Hospital limit of R24 976.35 per family per annum. 10% co-payment applicable for non-PMB MRI and CT scan.
3️⃣ Oncology	100% of Scheme Tariff Limit R240 786 per beneficiary per annum. Benefits utilisation more than R240 786 beneficiary per annum will be subject to 20% co- payment
4️⃣ Renal Dialysis	Covered up to 100% of the Sizwe Hosmed tariff.
❤️ Organ Transplants	100% Scheme Tariff*
🦷 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* Daily Limit: R1 967.70 per beneficiary per day. Maximum Limit: R41 326.95 per beneficiary per annum 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	Admissions are limited to failed out-patient management as per Managed Care protocols. Physiotherapy and Occupational Therapy during Psychiatric admission subject to sub-limit. Physiotherapy: R2 100 per beneficiary per annum Occupational Therapy: R1 470 per beneficiary per annum
🚑 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 annum. Limit: R6 069 per family per annum.
😮‍💨 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 R19 262.25 per beneficiary per annum.
🟪 Female Sterilisation/Tubal Ligation	100% of Negotiated Tariff. Limited to R19 262.25 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.
📊 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. 100% of Negotiated Tariff* Overall internal and external Prosthesis limit: R34 224.75 per family per annum.
🦾 Internal Prostheses	100% of Negotiated Tariff
🦿 External Prostheses	Limited to PMBs.
⚕️ Cardiac Stents	Limited to three (3) Cardiac Stents per family per annum unless PMB Vascular Stents: Two (2) stents per family per annum unless PMB
🩸 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.

 

💙 READ more about the Gold Ascend Medical Aid Plan

 

 

Sizwe Hosmed Medical – Gold Ascend EDO

 

 

Gold Ascend  EDO introduction:

 

The Sizwe Hosmed Gold Ascend EDO Medical Aid Plan starts from R3,543 ZAR. The plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and cover for in-hospital procedures for its members.

 

Gold Ascend EDO In-Hospital Benefits:

 

🏥 Hospital Admissions High Care Unit General Ward Theatre Recovery Room	Covered up to 100% of the Negotiated Tariff.
🧪 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	Covered up to 100% of the scheme tariff. Subject to pre-authorization and the following programs: Hospital Benefit Management Disease Management PMB Protocols
2️⃣ Specialized Radiology	Limited to two scans per beneficiary yearly for MRI, CAT, and Angiogram scans. Subject to the overall combined in and out-of-hospital limit of R22,654 per family per year. Managed care protocols apply, and pre-approval is required. Interventional Radiology falls within the hospital limit and is subject to clinical protocols and pre-approval.
3️⃣ Oncology	The benefit is limited to requirements set out in PMBs covered at a DSP.
4️⃣ Renal Dialysis	Covered up to 100% of the Sizwe Hosmed tariff.
❤️ Organ Transplants	Covered up to 100% of the scheme tariff.
🦷 Dental Hospitalisation	Covered up to 100% of the scheme tariff. Limited to PMBs. Children under seven can receive general anesthesia benefits once per year for intensive dental treatment. Symptomatic wisdom tooth removal is covered solely as Day Case. Subject to pre-approval. Treatment protocols will apply.
🥰 Maxillo-facial and Oral Surgery	Covered up to 100% of the Sizwe Hosmed tariff. Subject to managed care protocols. Benefits for Temporo-Mandibular Joint (TMJ) are limited to non-surgical interventions or treatments.
💟 Drug and Alcohol Rehabilitation	Treatment Protocols and PMBs are subject to pre-approval. On pre-authorization, 3 days of withdrawal treatment + 21 days of rehabilitation at an appropriate facility
🧠 Psychiatric Treatment Consultations Ward Fees Medicines Psychiatry/psychology therapy sessions	Each beneficiary is only allowed 21 days per year. This benefit provides six (6) in-hospital consultations with a clinical psychologist and six (6) psychiatrist consultations – subject to PMBs. Limited to 1,785 daily per beneficiary, with a maximum value of R37,485. Subject to managed care rules Four (4) additional out-of-hospital visits/consultations are permitted instead of hospitalization.
🚑 Hospitalisation Alternatives	Subject to PMBs Pre-authorization required. Subject to relevant protocols
⬇️ Step-down Facilities	Subject to the Management Program and Disease Management Program. Sizwe Hosmed prices apply to all services provided at registered step-down institutions and nursing homes. Hospice care is covered by up to 100% of the cost. 100% of the Sizwe Hosmed rates apply for Home Care services instead of Hospitalisation.
🏡 Home-Based Care	Benefits are subject to Sizwe Hosmed Private Nurse fees and Pre-Authorisation. There is a limit of R5,505 per year per family. Frail care is not covered under this benefit. PMB is applicable.
😮‍💨 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	Covered up to 100% of the negotiated tariff. Sterilization is limited to R17,472 per beneficiary per year. Subject to pre-approval and PMBs.
🅱️ Female Sterilisation/Tubal Ligation	Covered up to 100% of the negotiated tariff. Sterilization is limited to R17,472 per beneficiary per year. Subject to pre-approval and PMBs.
🧬 Back and Neck Surgery	Spinal surgery authorization for treating chronic back or neck pain is subject to managed care guidelines. Before authorizing surgery, managed care may require adherence to conservative clinical treatment.
🔴 Stereotactic Radiosurgery	Covered up to 100% of the scheme tariff. Only covers Primary Central Nervous System tumors.
🟠 Age-related Muscular Degeneration Treatment	Covered up to 100% of the negotiated tariff. Pre-authorization required.
🟡 Laparoscopic Hospitalisation and Associated Costs	Pre-authorization required. Subject to PMBs.
🟢 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. Overall prostheses limit of R31,043 per family per year within the hospital limit.
🦾 Internal Prostheses	Subject to the benefit limit unless it is a PMB. The following are covered: Pacemakers Defibrillators Spinal Fusion – only one spine level per beneficiary, and if more is required, managed care protocols will apply. Grafts Joints – Hip and Knee (partial and total), limited to one joint per beneficiary yearly. Other clinically appropriate unspecified prosthetic items
🦿 External Prostheses	Subject to the benefit limit unless it is a PMB. This benefit includes the following: Artificial Limbs Prosthetic Breasts Ocular Taylor Spatial Frame External Fixator Mesh Other clinically appropriate unspecified prosthetic items.
🫀 Cardiac Stents	Cardiac Stents are limited to 3 unless it is a PMB. Vascular Stents are limited to 2 stents per family per year.
🩸 Blood Transfusions	Covered up to 100% of the 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.

 

💙 READ more about the Gold Ascend EDO Medical Aid Plan

 

 

Sizwe Hosmed Medical – Value Platinum

 

 

Value Platinum introduction:

 

The Sizwe Hosmed Value Platinum Medical Aid Plan starts from R5,583 ZAR. The plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and unlimited hospital cover to its members.

 

Value Platinum In-Hospital Benefits:

 

☑️ Hospital Admissions High Care Unit General Ward Theatre Recovery Room	Covered up to 100% of the Negotiated Tariff.
✅ 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.
1️⃣ Consultations and Procedures	Covered up to 100% of the negotiated tariff.
2️⃣ Basic Radiology and Pathology	Covered up to 100% of the scheme tariff.
3️⃣ Specialized Radiology	Limited to two scans per beneficiary yearly. There is a 10% co-payment for non-PMB MRI and CT scans. Overall combined In- and Out-of-Hospital Specialised Radiology limit of R37 963.80 per family per annum. R1 653.75 co-payment per scan event except for PMBs.
4️⃣ Oncology	100% of DSP Tariff* Oncology limit: R601 965 per beneficiary per annum. Benefits utilisation more than R601 965 per beneficiary per annum will be subject to 20% co-payment
5️⃣ Renal Dialysis	Covered up to 100% of the negotiated tariff.
❤️ Organ Transplants	Covered up to 100% of the scheme tariff.
🦷 Dental Hospitalisation	Covered up to 100% of the scheme tariff. Limited to PMBs. Children under seven can receive general anesthesia benefits once per year for intensive dental treatment. Symptomatic wisdom tooth removal is covered solely as Day Case. Subject to pre-approval. Treatment protocols will apply.
😊 Maxillo-facial and Oral Surgery	Covered up to 100% of the scheme tariff. Subject to managed care protocols. Only symptomatic wisdom teeth and surgical exposure are allowed. All other operations are subject to PMB approval alone. Only symptomatic impacted wisdom teeth are removed on a day-to-day basis.
🩺 Drug and Alcohol Rehabilitation	Covered up to 100% of the scheme tariff. Limited to R21,131 per family per year.
🧠 Psychiatric Treatment (PMB) Consultations Ward Fees Medicines Psychiatry/psychology therapy sessions	Covered up to 100% of the scheme tariff. Subject to available benefits of R48 620.25 per beneficiary per admission at R2 315.25 per day.
✔️ Non-PMB Psychiatric Treatment	Sub-limits (non-PMB) Physiotherapy: R2 100 per beneficiary annum.
⬇️ Step-down Facilities	Covered up to 100% of the negotiated tariff. Limited to 14 days per beneficiary per year.
🏡 Home-Based Care	Covered up to 100% of the negotiated tariff. Limited to 14 days per beneficiary per year.
🩹 Negative Pressure Wound Therapy	Covered up to 100% of the negotiated tariff.
😮‍💨 Hyperbaric Oxygen Therapy	100% of Negotiated Tariff. Limited to PMBs.
🅰️ Male Sterilisation/Vasectomy	Covered up to 100% of the negotiated tariff. Sterilization is limited to R19 263.30 per beneficiary per year. Subject to pre-approval and PMBs.
🅱️ Female Sterilisation/Tubal Ligation	Covered up to 100% of the negotiated tariff. Sterilization is limited to R19 263.30 per beneficiary per year. Subject to pre-approval and PMBs.
🧬 Back and Neck Surgery	Spinal surgery authorization for treating chronic back or neck pain is subject to managed care guidelines. Before authorizing surgery, managed care may require adherence to conservative clinical treatment.
↪️ Stereotactic Radiosurgery	Covered up to 100% of the scheme tariff. Only covers Primary Central Nervous System tumors.
📌 Age-related Muscular Degeneration Treatment	Covered up to 100% of the negotiated tariff. Pre-authorization required.
📍 Laparoscopic Hospitalisation and Associated Costs	Pre-authorization required. Subject to PMBs.
🧪 PMB Laparoscopic Procedures	PMBs are covered in DSP facilities. Subject to clinical protocols. In-hospital procedures will incur an R5,250 co-payment, except for diagnostic laparoscopy, aspiration/excision ovarian cyst, lap-appendicectomy, and treatment of recurrent or bilateral inguinal hernias. A co-payment does not apply if procedures are done at a day hospital or as a day case.
🦾 Internal and External Prostheses	Covered up to 100% of the negotiated tariff. Subject to PMBs and pre-approval. Overall Surgical and non- surgical Prosthesis limit R57 015 per family per annum.
🦿 Instrumentation and disc prostheses, including components and fixation devices for the back or spine.	Two (2) levels per year done in one procedure.
🦵 Internal Prostheses	Joints – hip and knee (partial and total), only one (1) Prosthesis and only one (1) joint per annum.
✴️ Aphakic Lenses	Limited to R8 439.90
🔁 Cardiac Stents	Cardiac Stents – One (1) stent per Lesion, maximum three (3) stents per family per annum. • Vascular Stents – Two (2) stents per family per annum.
⚗️ Internal sphincters and stimulators	Limited to PMBs.
☑️ Neurostimulators/Internal nerve stimulators for Parkinson’s disease	Subject to the overall prostheses limit.
✅ Unlisted prostheses, artificial limbs, and external prostheses	Subject to overall Prosthesis limit. Subject to PMBs
🩸 Blood Transfusions	Covered up to 100% of the 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.
❎ Deductibles – Applied for In-hospital procedures	Joint Replacement Umbilical Hernia Repair Hysterectomy Functional Nasal Surgery Elective Caesarean Section

 

💙 READ more about the Value Platinum Medical Aid Plan

 

 

 

Sizwe Hosmed Medical – Value Platinum Core

 

 

Value Platinum Core introduction:

 

The Sizwe Hosmed Value Core Medical Aid Plan starts from R5,306 ZAR. It is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and appliance benefits to its members

 

Value Platinum Core In-Hospital Benefits:

 

☑️ Hospital Admissions High Care Unit General Ward Theatre Recovery Room	Covered up to 100% of the Negotiated Tariff.
✅ 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.
1️⃣ Consultations and Procedures	Covered up to 100% of the negotiated tariff.
2️⃣ Basic Radiology and Pathology	Covered up to 100% of the scheme tariff.
3️⃣ Specialized Radiology	Limited to two scans per beneficiary yearly. There is a 10% co-payment for non-PMB MRI and CT scans. Overall combined In- and Out-of-Hospital Specialised Radiology limit of R37 963.80 per family per annum. R1 653.75 co-payment per scan event except for PMBs.
4️⃣ Oncology	100% of DSP Tariff* Oncology limit: R601 965 per beneficiary per annum. Benefits utilisation more than R601 965 per beneficiary per annum will be subject to 20% co-payment
5️⃣ Renal Dialysis	Covered up to 100% of the negotiated tariff.
❤️ Organ Transplants	Covered up to 100% of the scheme tariff.
🦷 Dental Hospitalisation	Covered up to 100% of the scheme tariff. Limited to PMBs. Children under seven can receive general anesthesia benefits once per year for intensive dental treatment. Symptomatic wisdom tooth removal is covered solely as Day Case. Subject to pre-approval. Treatment protocols will apply.
😊 Maxillo-facial and Oral Surgery	Covered up to 100% of the scheme tariff. Subject to managed care protocols. Only symptomatic wisdom teeth and surgical exposure are allowed. All other operations are subject to PMB approval alone. Only symptomatic impacted wisdom teeth are removed on a day-to-day basis.
🩺 Drug and Alcohol Rehabilitation	Covered up to 100% of the scheme tariff. Limited to R21,131 per family per year.
🧠 Psychiatric Treatment (PMB) Consultations Ward Fees Medicines Psychiatry/psychology therapy sessions	Covered up to 100% of the scheme tariff. Subject to available benefits of R48 620.25 per beneficiary per admission at R2 315.25 per day.
✔️ Non-PMB Psychiatric Treatment	Sub-limits (non-PMB) Physiotherapy: R2 100 per beneficiary annum.
⬇️ Step-down Facilities	Covered up to 100% of the negotiated tariff. Limited to 14 days per beneficiary per year.
🏡 Home-Based Care	Covered up to 100% of the negotiated tariff. Limited to 14 days per beneficiary per year.
🩹 Negative Pressure Wound Therapy	Covered up to 100% of the negotiated tariff.
😮‍💨 Hyperbaric Oxygen Therapy	100% of Negotiated Tariff. Limited to PMBs.
🅰️ Male Sterilisation/Vasectomy	Covered up to 100% of the negotiated tariff. Sterilization is limited to R19 263.30 per beneficiary per year. Subject to pre-approval and PMBs.
🅱️ Female Sterilisation/Tubal Ligation	Covered up to 100% of the negotiated tariff. Sterilization is limited to R19 263.30 per beneficiary per year. Subject to pre-approval and PMBs.
🧬 Back and Neck Surgery	Spinal surgery authorization for treating chronic back or neck pain is subject to managed care guidelines. Before authorizing surgery, managed care may require adherence to conservative clinical treatment.
↪️ Stereotactic Radiosurgery	Covered up to 100% of the scheme tariff. Only covers Primary Central Nervous System tumors.
📌 Age-related Muscular Degeneration Treatment	Covered up to 100% of the negotiated tariff. Pre-authorization required.
📍 Laparoscopic Hospitalisation and Associated Costs	Pre-authorization required. Subject to PMBs.
🧪 PMB Laparoscopic Procedures	PMBs are covered in DSP facilities. Subject to clinical protocols. In-hospital procedures will incur an R5,250 co-payment, except for diagnostic laparoscopy, aspiration/excision ovarian cyst, lap-appendicectomy, and treatment of recurrent or bilateral inguinal hernias. A co-payment does not apply if procedures are done at a day hospital or as a day case.
🦾 Internal and External Prostheses	Covered up to 100% of the negotiated tariff. Subject to PMBs and pre-approval. Overall Surgical and non- surgical Prosthesis limit R57 015 per family per annum.
🦿 Instrumentation and disc prostheses, including components and fixation devices for the back or spine.	Two (2) levels per year done in one procedure.
🦵 Internal Prostheses	Joints – hip and knee (partial and total), only one (1) Prosthesis and only one (1) joint per annum.
✴️ Aphakic Lenses	Limited to R8 439.90
🔁 Cardiac Stents	Cardiac Stents – One (1) stent per Lesion, maximum three (3) stents per family per annum. • Vascular Stents – Two (2) stents per family per annum.
⚗️ Internal sphincters and stimulators	Limited to PMBs.
☑️ Neurostimulators/Internal nerve stimulators for Parkinson’s disease	Subject to the overall prostheses limit.
✅ Unlisted prostheses, artificial limbs, and external prostheses	Subject to overall Prosthesis limit. Subject to PMBs
🩸 Blood Transfusions	Covered up to 100% of the 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.
❎ Deductibles – Applied for In-hospital procedures	Joint Replacement Umbilical Hernia Repair Hysterectomy Functional Nasal Surgery Elective Caesarean Section

 

💙 READ more about the Value Platinum Core Medical Aid Plan

 

 

Sizwe Hosmed Medical – Titanium Executive

 

 

Titanium Executive introduction:

 

The Sizwe Hosmed Titanium Executive Medical Aid Plan starts from R9,788 ZAR. The plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance, mental health benefits to its members and so much more.

 

Titanium Executive In-Hospital Benefits:

 

🔍 Hospital Admissions High Care Unit General Ward Theatre Recovery Room	Covered up to 100% of the Negotiated Tariff.
📌 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.
✅ Basic Radiology and Pathology	Covered up to 100% of the scheme tariff. Paid from risk.
1️⃣ Specialized Radiology	Overall combined In- and Out-of Hospital Specialised Radiology limit of R49 936.95 per family per annum.
2️⃣ Oncology	Covered up to 100% of the DSP tariff. Enhanced oncology DSP protocols will apply. Unlimited Oncology treatment is available. Benefits over R752 456.25 are subject to a 20% co-payment on non-PMBs.
3️⃣ Non-Cancer Specialised Drugs Benefits (including biological medicine)	Subject to PMBs and pre-authorization. Managed care and treatment guidelines will apply. Limited to R150 491.25 per beneficiary per annum.
4️⃣ Renal Dialysis	Covered up to 100% of the negotiated tariff. Subject to pre-authorisation, clinical guidelines, medicine formulary and registration on the Disease management programme.
❤️ Organ Transplants	Covered up to 100% of the negotiated tariff.
🦷 Dental Hospitalisation	Covered up to 100% of the scheme tariff. Children under seven can receive general anesthesia benefits once per year for intensive dental treatment. Symptomatic wisdom tooth removal is covered solely as Day Case. Subject to pre-approval. Treatment protocols will apply.
🥰 Maxillo-facial and Oral Surgery	Covered up to 100% of the scheme tariff. The benefits of TMJ therapy are restricted to non-surgical interventions/treatments. Subject to managed care protocols. Only symptomatic wisdom teeth and surgical exposure are allowed. All other operations are subject to PMB approval. Only symptomatic impacted wisdom teeth are removed on a day-to-day basis. Claims for oral pathology procedures (cysts and biopsies, surgical treatment of jaw tumors, and soft tissue tumors) will be covered only if accompanied by a laboratory report confirming the diagnosis.
💊 Drug and Alcohol Rehabilitation	Covered up to 100% of the scheme tariff. Limited to 3 days of withdrawal treatment + 21 days of rehabilitation at an approved facility.
🧠 Psychiatric Treatment (PMB) Consultations Ward Fees Medicines Psychiatry/psychology therapy sessions	Covered up to 100% of the scheme tariff. 100% of Negotiated Tariff* Subject to available benefits of R55 913.55 per beneficiary per admission limited to R2 662.80 per day.
💛 Non-PMB Psychiatric Treatment	Subject to managed care rules, four (4) additional out-of-hospital consultations in place of hospitalization are permitted.
⬇️ Step-down Facilities	Covered up to 100% of the negotiated tariff.
🏡 Home-Based Care	100% of Negotiated Tariff Limit: R12 139.05 family per annum
👩‍⚕️Private Nurse	Limit R12 139.05 family per annum
😮‍💨 Hyperbaric Oxygen Therapy	Covered up to 100% of the negotiated tariff.
🩹 Negative Pressure Wound Therapy	100% of Negotiated Tariff
👴🏾Frail care	Not covered
🅰️ Male Sterilisation/Vasectomy	Covered up to 100% of the scheme tariff.
🅱️ Female Sterilisation/Tubal Ligation	Covered up to 100% of the scheme tariff.
🧬 Back and Neck Surgery	Spinal surgery authorization for treating chronic back or neck pain is subject to managed care guidelines. Before authorizing surgery, managed care may require adherence to conservative clinical treatment.
🟥 Stereotactic Radiosurgery	Covered up to 100% of the scheme tariff.
🟧 Age-related Muscular Degeneration Treatment	Covered up to 100% of the negotiated tariff.
🟨 Laparoscopic Hospitalisation and Associated Costs	Covered up to 100% of the scheme tariff.
🟩 Internal and External Prostheses	Surgical and non-surgical prostheses are covered by up to 100% of the cost. 100% Negotiated Tariff* Overall annual limit of R75 306 per family per annum
🟦 Internal Prostheses	Hip and knee (partial and total), only one prosthesis, and one joint every year. Spine – two (2) levels per year performed in a single surgery.
⬛ External Prostheses	100% Negotiated Tariff
🔲 Refractive Surgery Including Radial Keratotomy	100% of Scheme Rate Limit: R23 034.90 per family per annum.
🟪 Cardiac Stents	Cardiac – pacemaker, internal defibrillators, grafts, valves Vascular Stents are limited to 2 stents per family per year. Cardiac stents include three stents per family per year.
🩸 Blood Transfusions	Covered up to 100% of the 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.

 

 

Out-of-Hospital Medical Benefits:

 

•  ➡️ Benefits Out-of-Hospital is subject to MSA, Self-Payment Gap, and Above Threshold Benefit.
•  ➡️ Main – R24,432 ZAR
•  ➡️ Dependent – R21,624 ZAR
•  ➡️ Child – R5,004 ZAR

 

Above Threshold Benefits sub-limit:

 

•  ➡️ Physiotherapy – 16,425 ZAR per family per year.
•  ➡️ Pathology and Radiology – 16,425 ZAR per family per year.

 

Acute medicine:

 

•  ➡️R33 819 per family per annum
•  ➡️ Sub-limit R 17 688 pb

 

 

💙 READ more about the Titanium Executive Medical Aid Plan

 

 

New Age Hybrid Network Savings Plan

 

💙 A Savings plan offers a set monetary amount, based on a percentage of your total contribution, allocated to a Members’ Savings Account (MSA) annually. For example, Sizwe Hosmed members can set aside 15% or 25% of their monthly contribution towards their MSA.

 

💙The MSA is intended for the family’s out-of-hospital (day-to-day) healthcare needs. At the same time, the Scheme also offers additional specific, out-of-hospital benefits to help preserve the MSA.  The MSA belongs to the member, and unused funds accumulate yearly.

 

💙 Furthermore, it can be transferred to another savings type plan. If a member resigns from a savings-type plan, any unused funds will be refunded to the member after four months.

 

💙 In the case of the Sizwe Hosmed Access Saver Plan, the Scheme will cover the following out-of-hospital benefits, meaning they will not be drawn from the member’s MSA account. This is an excellent offering for the member and their family.

 

 

Sizwe Hosmed Medical – Access Saver

 

 

 

💙 Members of the Sizwe Hosmed Savings Plan can choose a certain annual percentage of their payments to be placed in a separate account called the Members Savings Account (MSA).

 

💙 Each member can contribute 15% or 25% of their monthly contributions to their MSA.  This MSA is set aside to cover non-hospital medical expenses incurred by the family, and the Scheme provides additional non-hospital benefits to help keep the MSA intact.

 

💙  If a member decides to leave the MSA before the end of the year, they will retain ownership of the MSA and any accumulated funds from the previous year, which can be rolled over into another savings plan or repaid to them after four months.

 

 💙 Sizwe Hosmed Access Saver Plan is a good option for families because the Scheme provides coverage for a wide range of non-hospital benefits without depleting the member’s MSA.

 

Access Saver In-Hospital Benefit:

 

🔎 Hospital Admissions High Care Unit General Ward Theatre Recovery Room	Covered up to 100% of the DSP Tariff. Non-PMB benefits are subject to benefit availability.
💉 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	Covered up to 100% of the scheme tariff. The unlimited cover is in-hospital.
2️⃣ Specialized Radiology	Limited to two scans per beneficiary yearly for MRI, PET, and CT scans. There is a 10% co-payment for non-PMB CT, MRI, or PET scans. Mutual benefit in and out-of-hospital. Subject to pre-approval and specialist referral. Limited to two (2) scans per beneficiary per annum, subject to R20 000 per family per annum. Limited to R3 500 per scan event in or Out-of-Hospital.
3️⃣ Oncology	Covered up to 100% of the DSP tariff. Unlimited treatment. Benefits that exceed R282 932.55 are subject to a 20% co-payment for non-PMBs. Subject to using a DSP. Member must register on the Disease Management Program. Standard oncology DSP protocols will apply.
4️⃣ Renal Dialysis	Covered up to 100% of the negotiated tariff. Peritoneal and hemodialysis are included. Department of Health Protocols apply Subject to pre-approval. PMBs have unlimited benefits. Pre-authorization, clinical recommendations, drug formulary, and registration on the Disease management program are all subject to approval.
❤️ Organ Transplants	Covered up to 100% of the scheme tariff. Unlimited PMB benefits. Clinical guidelines, pre-authorization, and DMP registration are required. Medical protocols apply. Donations to non-Sizwe Hosmed members are not covered.
🦷 Dental Hospitalisation	Covered up to 100% of the scheme tariff. Limited to PMBs. Children under seven can receive general anesthesia benefits once per year for intensive dental treatment. Symptomatic wisdom tooth removal is covered solely as Day Case. Subject to pre-approval. Treatment protocols will apply.
😊 Maxillo-facial and Oral Surgery	Only PMBs are covered. Subject to pre-approval and treatment protocols.
🎗️ Drug and Alcohol Rehabilitation	Limited to R14,880 per family yearly. Covered up to 100% of the scheme tariff.
🧠 Psychiatric Treatment Consultations Ward Fees Medicines Psychiatry/psychology therapy sessions	Covered up to 100% of the scheme tariff. Limited to 21 days per beneficiary or 15 outpatient consultations per year. Pre-authorization is needed. Managed care protocols apply.
➡️ Hospitalisation Alternatives	Subject to PMBs Pre-authorization required. Subject to relevant protocols
⬇️ Step-down Facilities	Covered up to 100% of the negotiated tariff. Limited to 14 days per year per beneficiary.
🏠 Home-Based Care	Covered up to 100% of the negotiated tariff. Limited to 14 days per year per beneficiary.
🩹 Negative Pressure Wound Therapy	Covered up to 100% of the negotiated tariff. Pre-authorization required. Subject to PMBs. Relevant protocols will apply.
😮‍💨 Hyperbaric Oxygen Therapy	Covered up to 100% of the negotiated tariff. Pre-authorization required. Subject to PMBs. Relevant protocols will apply.
🅰️ Male Sterilisation/Vasectomy	Limited to R R19 262.25 per beneficiary yearly. Covered up to 100% of the negotiated tariff. Pre-authorization required. Relevant protocols will apply.
🅱️ Female Sterilisation/Tubal Ligation	Limited to R R19 262.25 per beneficiary yearly. Covered up to 100% of the negotiated tariff. Pre-authorization required. Relevant protocols will apply.
⚕️ Back and Neck Surgery	Covered up to 100% of the scheme tariff. Pre-authorization required. Subject to PMBs. Subject to the conservative back and neck treatment protocol. Spinal surgery authorization for treating chronic back or neck pain is subject to managed care guidelines. Before authorizing surgery, managed care may require adherence to conservative clinical treatment.
📈 Stereotactic Radiosurgery	Pre-authorization required. Only PMBs are covered.
📉 Age-related Muscular Degeneration Treatment	Covered up to 100% of the negotiated tariff. Pre-authorization required.
📊 Laparoscopic Hospitalisation and Associated Costs	Pre-authorization required. Subject to PMBs.
🧪 PMB Laparoscopic Procedures	Covered up to 100% of the scheme tariff. There is no co-payment if the procedures are performed at a day hospital or treated as a day case.
🦵 Internal and External Prostheses	Covered up to 100% of the negotiated tariff. Subject to PMBs and pre-approval. Overall prostheses limit of R37,188.90 per family per year.
🦾 Instrumentation and Disc Prostheses Components Fixation Devices for back/spine	Limited to 1 event per beneficiary yearly. Limited to PMBs.
🦿 Internal Prostheses	Limited to the equivalent in the state. This benefit does not include cement.
External Prostheses	Limited to PMBs.
🟥 Aphakic Lenses	Limited to R6 204.45 per lens.
🟧 Cardiac Stents	Limited to PMBs. One (1) per Lesion- maximum of three (3) Lesions. • Bare metal stents: R12 700 per stent • Drug eluting stents: R15 400 per stent
🟨 Internal Sphincters and Stimulators	Subject to the overall prostheses limit. Only PMBs are treated.
🟩 Unlisted Prostheses such as artificial limbs, artificial eyes, etc.	There is a limit of R12,731, which is subject to the overall prostheses limit.
🟦 Blood Transfusions	Covered up to 100% of the scheme tariff. Only PMBs are treated.
🟪 Physiotherapy and Biokinetics	Covered up to 100% of the scheme tariff.
🍎 Dietician and Occupational Therapy	Only PMBs are treated.
✔️ Deductible for in-hospital procedures	Skin disorders Arthroscopy Bunionectomy Removal of varicose veins Refractive eye surgery, Aphakic lenses Infertility treatment Non-cancerous breast conditions

 

Outpatient Medical Benefits:

 

💙 MSA pays for benefits outside the hospital, such as GP and specialist consultations, pathology, radiology, and chronic medicine.  Annual Member Savings Account: For members who have 25% of their payments allocated to personal medical savings accounts:

 

• ➡️ Main Member – R10,080 ZAR
• ➡️ Adult Dependent – R8,736 ZAR
• ➡️ Child Dependent – 1,992 ZAR

 

Extra Benefits:

•  ➡️ Outpatient care is subject to sub-limit and MSA*
•  ➡️ No Overall Annual Limit
•  ➡️ Statutorily Prescribed Minimum Benefits (PMBs) Unlimited.
•  ➡️ Cover for medical emergencies while traveling outside South Africa:
•  ➡️ 100% of Scheme rates are paid in ZAR.
•  ➡️ Subject to documentation completion before departure from RSA.
•  ➡️ Subject to Scheme’s approval.

 

 

👉🏿 READ more about the Access Saver Plan

 

 

Sizwe Hosmed Medical – Access Core

 

 

Access Core Introduction:

 

The Sizwe Hosmed Access Core Medical Aid Plan starts from R2,636 ZAR. The plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and appliance benefits to its members.

 

 

In-Hospital Benefit:

 

🅰️ Hospital Admissions High Care Unit General Ward Theatre Recovery Room	Covered up to 100% of the Negotiated Tariff.
🅱️ 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	Combined In- and Out-of Hospital limit of R24 976.35 per family per annum. 10% co-payment applicable for non-PMB MRI and CT scan.
3️⃣ Oncology	100% of Scheme Tariff Limit R240 786 per beneficiary per annum. Benefits utilisation more than R240 786 beneficiary per annum will be subject to 20% co- payment
4️⃣ Renal Dialysis	Covered up to 100% of the Sizwe Hosmed tariff.
❤️ Organ Transplants	100% Scheme Tariff*
🦷 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* Daily Limit: R1 967.70 per beneficiary per day. Maximum Limit: R41 326.95 per beneficiary per annum 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	Admissions are limited to failed out-patient management as per Managed Care protocols. Physiotherapy and Occupational Therapy during Psychiatric admission subject to sub-limit. Physiotherapy: R2 100 per beneficiary per annum Occupational Therapy: R1 470 per beneficiary per annum
🚑 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 annum. Limit: R6 069 per family per annum.
😮‍💨 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 R19 262.25 per beneficiary per annum.
🟪 Female Sterilisation/Tubal Ligation	100% of Negotiated Tariff. Limited to R19 262.25 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.
📊 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. 100% of Negotiated Tariff* Overall internal and external Prosthesis limit: R34 224.75 per family per annum.
🦾 Internal Prostheses	100% of Negotiated Tariff
🦿 External Prostheses	Limited to PMBs.
⚕️ Cardiac Stents	Limited to three (3) Cardiac Stents per family per annum unless PMB Vascular Stents: Two (2) stents per family per annum unless PMB
🩸 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.

 

Outpatient Medical Benefits:

 

💙 MSA pays for benefits Out-of-Hospital, such as GP and specialist consultations, pathology, radiology, and chronic medicine. Annual Member Savings Account: For members who have 25% of their payments allocated to personal medical savings accounts:

 

•  ➡️ Main Member – 7,260 ZAR
•  ➡️ Adult Dependent – 6,252 ZAR
•  ➡️ Child Dependent – 1,464 ZAR

 

More Benefits:

 

•  ➡️ Outpatient care is subject to sub-limit and MSA*
•  ➡️ Overall Annual Limit
•  ➡️ Statutorily Prescribed Minimum Benefits (PMBs) Unlimited.
•  ➡️ Cover for medical emergencies while traveling outside South Africa:
•  ➡️ 100% of Scheme rates are paid in ZAR.
•  ➡️ Subject to documentation completion before departure from RSA.
•  ➡️ Subject to Scheme’s approval.

 

 

👉🏿 READ more about the Access Core Plan

 

 

Sizwe Hosmed Medical – Essential Copper

 

 

Essential Copper Introduction:

 

The Sizwe Hosmed Essential Copper Medical Aid Plan starts from R3,023 ZAR. The plan is a trustworthy and comprehensive medical aid plan that offers international and 100% specialist coverage to its members.

 

In-Hospital Benefit:

 

🏥 Hospital Admissions High Care Unit General Ward Theatre Recovery Room	Covered up to 100% of the DSP Tariff. The benefit is limited to PMBs
💊 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.
📈 Basic Radiology and Pathology	Covered up to 100% of the scheme tariff.
📉 Specialized Radiology	Mutual benefit in and out-of-hospital. Subject to pre-approval and specialist referral. Limited to two scans per beneficiary per year. Limited to PMBs.
📊 Oncology	Subject to using a DSP. Member must register on the Disease Management Program. Standard oncology DSP protocols will apply. The cover is limited to PMBs. Unlimited cover for PMBs, including the following: Consultations Investigations Treatment
➡️ Renal Dialysis	Covered up to 100% of the negotiated tariff. Peritoneal and hemodialysis are included. Department of Health Protocols apply Subject to pre-approval. PMBs have unlimited benefits. Pre-authorization, clinical recommendations, drug formulary, and registration on the Disease management program are all subject to approval.
❤️ Organ Transplants	Covered up to 100% of the scheme tariff. Unlimited PMB benefits. Clinical guidelines, pre-authorization, and DMP registration are required. Medical protocols apply.
🦷 Dental Hospitalisation	Covered up to 100% of the scheme tariff. Limited to PMBs. Children under seven can receive general anesthesia benefits once per year for intensive dental treatment. Symptomatic wisdom tooth removal is covered solely as Day Case. Subject to pre-approval. Treatment protocols will apply.
😊 Maxillo-facial and Oral Surgery	No Benefit
🥰 Drug and Alcohol Rehabilitation	100% Scheme Tariff Limited to R14 881.65 per family per annum
🧠 Psychiatric Treatment Consultations Ward Fees Medicines Psychiatry/psychology therapy sessions	Covered up to 100% of the scheme tariff. Limited to 21 days per beneficiary or 15 outpatient consultations per year. Pre-authorization is needed. Managed care protocols apply.
🧬 Hospitalisation Alternatives	Subject to PMBs Pre-authorization required. Subject to relevant protocols
⬇️ Step-down Facilities	Covered up to 100% of the negotiated tariff. Limited to PMBs.
🏡 Home-Based Care	Covered up to 100% of the negotiated tariff. Limited to 14 days per year. Only PMBs are covered.
😮‍💨 Hyperbaric Oxygen Therapy	Covered up to 100% of the negotiated tariff. Pre-authorization required. Subject to PMBs. Relevant protocols will apply.
Male Sterilisation/Vasectomy	Covered up to 100% of the negotiated tariff. Pre-authorization required. Subject to PMBs. Relevant protocols will apply.
☑️ Female Sterilisation/Tubal Ligation	Covered up to 100% of the negotiated tariff. Pre-authorization required. Subject to PMBs. Relevant protocols will apply.
⚕️ Back and Neck Surgery	Covered up to 100% of the scheme tariff. Pre-authorization required. Subject to PMBs. Subject to the conservative back and neck treatment protocol.
✳️ Stereotactic Radiosurgery	Pre-authorization required. Only PMBs are covered.
🩺 Age-related Muscular Degeneration Treatment	Only PMBs will be covered. Covered up to 100% of the negotiated tariff. Pre-authorization required.
🧪 Laparoscopic Hospitalisation and Associated Costs	Pre-authorization required. Subject to PMBs. Because of this reason, a 20% co-payment where laparoscopic procedure is voluntarily accessed at an acute hospital instead of a day hospital. No co-payment is applicable for the following laparoscopic procedures: • Diagnostic laparoscopy, • Aspiration/excision Ovarian Cyst, • Lap- appendicectomy, and • Repair of recurrent or Bilateral Inguinal Hernias.
🅰️ PMB Laparoscopic Procedures	Covered up to 100% of the scheme tariff. There is no co-payment if the procedures are performed at a day hospital or treated as a day case.
🦾 Internal and External Prostheses	100% of Negotiated Tariff. Limited to PMBs Overall Prosthesis limit: R23 656.50 per family per annum
🦿 Instrumentation and Disc Prostheses Components Fixation Devices for back/spine	Limited to 1 event per beneficiary yearly. Limited to PMBs.
🦵 Joints Prostheses	Limited to the equivalent in the state. This benefit does not include cement.
1️⃣ Aphakic Lenses	Limited to PMBs at R6 204.45 per lens.
2️⃣ Cardiac Stents	Limited to PMBs. Limited to 1 lesion and a maximum of 3. Public sector protocols for STEMI will apply. There is no benefit for unstable angina or NSTEMI unless evidence can be provided that conservative treatment failed.
3️⃣ Internal Sphincters and Stimulators	Subject to the overall prostheses limit. Only PMBs are treated.
4️⃣ Unlisted Prostheses such as artificial limbs, artificial eyes, etc.	There is a limit of R11,235, and it is subject to the overall prostheses limit.
🩸 Blood Transfusions	Covered up to 100% of the scheme tariff. Only PMBs are treated.
🙂 Physiotherapy and Biokinetics	Covered up to 100% of the scheme tariff.
🍎 Dietician and Occupational Therapy	Only PMBs are treated.

 

Outpatient Medical Benefits:

 

•  ➡️ GP and Specialist consultations, Pathology, Radiology, and Chronic Medicine, are restricted to PMBs.
•  ➡️ PMB benefits, subject to DSP.

 

Statutorily Prescribed Minimum Benefits (PMBs) Unlimited.  Cover for medical emergencies while traveling outside South Africa:

 

•  ➡️ 100% of Scheme rates are paid in ZAR.
•  ➡️ Subject to documentation completion before departure from RSA.
•  ➡️ Subject to Scheme’s approval.

 

 

👉🏿 Read more about Essential Copper Plan

 

 

Sizwe Hosmed – Advantages over Competitors

 

•  ➡️ Employers – Sizwe Hosmed provides the chance for you, as an employer, to assist your employees in obtaining medical coverage.
•  ➡️ Network choices – Sizwe Hosmed has a vast network of medical professionals who will provide you with the highest quality care at the most affordable rates.
•  ➡️ Hospitalization and all-inclusive coverage – You can rest assured that you will be covered for routine and emergency medical care and procedures.
•  ➡️ Sizwe Hosmed is prepared to explain their programs and assist you in determining which plan meets your income and healthcare requirements.
•  ➡️ Sizwe Hosmed is committed to serving its members with patience, understanding, and skill, expanding the scheme, and ensuring that its members benefit from the plan’s rising financial stability and various advantages.
•  ➡️ Sizwe Hosmed offers a dedicated back and neck program to assist people with chronic back and neck pain in managing their condition and enhancing their quality of life.
•  ➡️ There is a special maternity benefit offered. The Sizwe Hosmed Bambino Program is intended to aid pregnant mothers and their partners in navigating this joyful period. The program is chock-full of helpful information, support, and perks to aid parents during their pregnancy.
•  ➡️ The Sizwe Hosmed Disease Risk Management Program aims to improve your general health, well-being, and quality of life using an interdisciplinary approach. By enrolling in the program, you are taught about your disease so that you may manage it more effectively.

 

Poll 1: 5 Best Student Medical Aids for Foreigners

Poll 2: 5 Best Medical Aids for Students

 

 

 

Sizwe Wellness and Health screening

 

Sizwe Hosmed has a very rich Wellness, Screening Benefit AND this benefit is available to the entire family on ALL plans.

 

 

 

 

Bambino Maternity programme

This programme provides additional benefits specifically for mom-to-be on all plans. Register as soon as possible to receive additional benefits on the programme.

 

 

 

 

💙 Receive a fully stocked maternity bag and educational materials provided at 24 weeks of pregnancy.

 

 

 

How to apply for Medical Aid with Sizwe Hosmed

Medical Aid Quote Sizwe Hosmed Medical Scheme process explained

 

The process for applying for medical aid with Sizwe Hosmed in South Africa can vary depending on the specific plan and options you choose. However, generally, the following steps can be expected:

 

•  ➡️ Gather the necessary documentation: This may include proof of identity (such as a copy of your ID or passport), proof of income (such as your payslip or a letter from your employer), and any other relevant information (such as a letter from a doctor if you have a pre-existing medical condition).
•  ➡️ Choose a plan: Sizwe Hosmed offers a variety of medical aid plans, so it’s important to research and compares the different options to find the one that best suits your needs.
•  ➡️ Complete the application form: The application form can be found on the Sizwe Hosmed website or obtained from one of the company’s branches. The form must be completed and submitted along with the necessary documentation.
•  ➡️ Wait for approval: Once the application is received, it will be reviewed by Sizwe Hosmed. If the application is approved, you will receive confirmation of acceptance and instructions on how to make your first payment.
•  ➡️ Make your first payment: Once your application is approved, you will need to make your first payment to activate your medical aid.
•  ➡️ Wait for your membership card: After receiving your first payment, Sizwe Hosmed will send you a membership card, which you will need to present when visiting a medical provider.
•  ➡️ Sizwe Hosmed if you have any questions or concerns: Sizwe Hosmed has a call center available to answer any questions about your medical aid or concerns about your application or coverage.
•  ➡️ New Members 35 years or older may be subject to late-joiner penalties on Sizwe Hosmed Medical Aid Plans.

 

👉🏿 Get a Sizwe Hosmed Medical Aid quote from our Dedicated Medical Aid Specialists Broker

 

 

How to apply for Gap Cover with Sizwe Hosmed

 

💙 Sizwe Hosmed does not currently offer its own gap cover. However, the typical guideline to apply for gap cover from a third party in 2025 can involve the following steps, subject to the provider:

 

•  ➡️ Research different gap covers providers and compares their  policies and benefits to determine which best suits your needs.
•  ➡️ Contact your chosen provider by visiting their website or calling their customer service number.
•  ➡️ Provide the provider with your personal and financial information, including your ID number, income, and current medical aid scheme details.
•  ➡️ Review and sign the gap cover contract, ensuring you understand the terms and conditions before submitting it.
•  ➡️ Make the initial payment or arrange for automatic monthly payments.
•  ➡️ Keep all documentation safe and ensure you know the terms and conditions of the gap cover.
•  ➡️ Contact the provider if you have any questions or concerns.

 

👉🏿 Read more:

5 Best Gap Cover Options for Under R2000

10 Best Gap Covers in South Africa

 

 

How to Submit a Claim with Sizwe Hosmed

 

Your account should indicate if a consultation or treatment with a healthcare professional was filed directly to the Scheme following the consultation or treatment. Please consult with your healthcare provider if uncertain. Please follow the below steps if the account has not been submitted.

 

•  ➡️ Send only the account’s original receipt.
•  ➡️ Do not send duplicate statements or bills.
•  ➡️ If you have already paid the bill, including your receipt, identify the account as a “refund member,” as some physicians give a discount if you pay the bill immediately.
•  ➡️ All accounts must contain complete membership information.

 

 

How to Submit a Compliment or Complaint with Sizwe Hosmed

 

💙 Sizwe Medical Fund provides its members with the highest standard of service and communication.  Despite this commitment, there may be instances where errors occur, or dissatisfaction arises.

 

💙 In such cases, members are encouraged to submit queries or complaints, which the scheme will promptly and efficiently address.  Sizwe Medical Fund has implemented an enhanced query and escalation process to improve communication with its valued members.

 

•  ➡️ Phase 1 – If a member is unhappy with the service they received from the Help Desk, each member is assigned a unique reference number that must be included in future correspondence. Furthermore, it can take up to 72 hours to get a response to a member’s inquiry.
•  ➡️ Phase 2 – either the Member’s question has been answered, or the Member has followed up with the Call Center using the reference number provided.
•  ➡️ Phase 3 – If the member’s question is not answered, they can contact the Chief Executive Officer.
•  ➡️ Phase 4 – The Chief Executive Officer will respond to the inquiry within a day.
•  ➡️ Phase 5 – If the Chief Operating Officer cannot address the concern, the member may contact the Complaints and Disputes Resolution Committee (CDRC).

 

 

How to Switch my Medical Aid to Sizwe Hosmed

 

Switching your medical aid to Sizwe Hosmed is a simple process that can be completed in a few steps.

 

•  ➡️ Research and compare different medical aid options available from Sizwe Hosmed. Consider factors such as coverage, costs, and benefits that are important to you and your family.
•  ➡️ Contact Sizwe Hosmed to request an application form. This can be done by visiting their website, calling their customer service line, or visiting one of their branches.
•  ➡️ Complete the application form and provide any supporting documentation that may be required. This could include proof of income, ID documents, and medical records.
•  ➡️ Submit your application to Sizwe Hosmed. The scheme will review your application and provide you with confirmation of acceptance or rejection.
•  ➡️ If your application is accepted, you will receive a new member number and other necessary information.
•  ➡️ Notify your current medical aid scheme that you wish to cancel your membership and provide them with your new Sizwe Hosmed member number.
•  ➡️ Once your switch is complete, familiarize yourself with the benefits and cover provided by your new plan to ensure that you are aware of the benefits to which you are entitled.

 

👉🏿 Things to consider before cancelling your medical aid

 

 

Sizwe Hosmed Customer Support

 

To contact Sizwe Hosmed customer support, there are a few options available:

 

•  ➡️ Phone: You can call their customer support line and speak with a representative during business hours. The phone number should be available on their website or by searching online.
•  ➡️ Email: You can email their customer support team, and they will respond to your inquiry as soon as possible. The email address should be available on their website or by searching online.
•  ➡️ Online Contact Form: Some websites have a contact form you can fill out and submit to contact the customer support team.
•  ➡️ Social Media: Many companies now have customer support on their social media pages; you can reach out to them through their official social media page like Twitter, Facebook, Instagram, etc.
•  ➡️ Visit their physical office: you can visit your nearest office or check on their website for the nearest office location.

 

 

Sizwe Hosmed vs Platinum Health vs Fedhealth – A Comparison

 

🔎 Medical Aid	🥇 Sizwe Hosmed (2025)	🥈 Platinum Health (2024)	🥉 Fedhealth (2025)
📍 Years in Operation	35 Years	22 Years	87 Years
📌 Average # Members	172,000+	<55,000	150,000+
📈 GCR Rating	A+	A+	AA-
📉 Number of Employees	500 – 1,000	100+	500+
📊 Market Share	<5%	<5%	<5%
✔️ Market Coverage	South Africa	South Africa	South Africa
💙 Customer Rating	–	3/5	3.5
📍 Number of reviews	<1,000	3,000+	2,800+
📱 Mobile App	✅ Yes	No	✅ Yes
💵 Contribution Range (ZAR)	R2,636 – R9,788 ZAR	R 1,298 – 5,016 ZAR	R 1,055 ZAR – R16,9 37 ZAR
☑️ International Travel Benefit (ZAR)	100% of the Scheme Rate	–	–

 

 

💙 You might like to compare the following medical schemes with Sizwe Hosmed:

 

• 🆚 Discovery Health vs. Sizwe Hosmed Medical Scheme
• 🆚 KeyHealth vs. Sizwe Hosmed Medical Fund
• 🆚 BestMed Medical Scheme vs Sizwe Medical Fund
• 🆚 Momentum Medical Scheme vs Sizwe Hosmed Medical Fund
• 🆚 Bonitas vs. Sizwe Hosmed Medical Fund
• 🆚 Medshield vs Sizwe Hosmed Medical Fund
• 🆚 Fedhealth vs. Sizwe Hosmed Medical Fund
• 🆚 Medimed vs Sizwe Hosmed Medical Fund

 

 

 

Sizwe Hosmed Reviews by Members

 

Highest Praise.

I have never grown tired of praising them. To date, I have never had any unused funds from my medical aid at the end of the year. They have been consistent, even during a year when I underwent two surgeries, and my son underwent one.

 

We were both hospitalized a total of ten times. I am grateful that Sizwe Hosmed made the financial aspect of our medical crises the least stressful. – Amber Yates

 

 

Excellent Medical Scheme.

Sizwe Hosmed is an excellent medical scheme, of which I became a member on February 22. Our benefits start date was March 1st, 22. Later, we registered for their Bambino care program.

 

Finally, my partner received a call from Sizwe Hosmed informing her that our application had been approved and that she could consult with a gynecologist. – Steve Sharpe

 

 

Happy Member.

Every time my son was hospitalized while enrolled with Sizwe Hosmed, they provided coverage that exceeded my expectations. I am grateful, as private medical care can be quite expensive. – Bethany Welch

 

 

 

Sizwe Hosmed – Our Verdict

 

💙 Sizwe Hosmed is a South African medical aid scheme that offers its members a range of healthcare services and plans. Some of the services offered by Sizwe Hosmed include in and Out-of-Hospital cover, maternity care, and a members savings account (MSA) option.

 

💙 One of the benefits of Sizwe Hosmed is that it offers comprehensive coverage, including coverage for out-of-hospital expenses, which can help preserve a member’s MSA.  Additionally, Sizwe Hosmed offers a range of plans, which allows members to choose a plan that best fits their needs and budget.

 

💙 However, like any medical aid scheme, Sizwe Hosmed has some cons.  One potential downside is that members must pay out of pocket for certain expenses, such as gap cover. Additionally, Sizwe Hosmed may not have as many providers in certain areas, which can limit a member’s choice of healthcare providers.

 

 

👉🏿 Some more interesting articles:

• 5 Best Medical Aids under R200
• 5 Best Medical Aids under R300
• 5 Best Medical Aids under R1000

 

 

Sizwe Hosmed Pros and Cons

 

✅ Pros	❎ Cons
Sizwe Hosmed offers flexible options to suit all budgets	Sizwe Hosmed has expensive Out-of-Hospital expenses
There is a dedicated hospital plan offered	There is no native gap cover

 

 

👉🏿  You might like to know more about the Top 100 Medical Aid Questions

 

 

Sizwe Hosmed Frequently Asked Questions

 

Is Hosmed part of Sizwe?

Sizwe Medical Fund and Hosmed Medical Aid Scheme united in 2021 to form South Africa’s eighth-largest medical scheme, now known as Sizwe Hosmed Medical Scheme.

 

What is the waiting period for Sizwe Hosmed Medical Aid?

There could be a three-month waiting time before a new member of Sizwe Hosmed can receive benefits after joining the scheme. Apart from where Prescribed Minimum Benefits apply, a new member with a pre-existing ailment may be subject to a condition-specific waiting period of up to a year.

 

When did Sizwe and Hosmed Merge?

Effective November 1, 2021, the CMS formally approved the merger of the Sizwe Medical Fund with the Hosmed Medical Scheme.

 

Who administers Sizwe?

3Sixty Health administers the Sizwe Hosmed Medical Scheme. 3Sixty Health is a black-owned and black-managed company that offers administration and managed-care services. Their core competencies include: membership management, billing, claim adjudication, and customer services.

 

How can I access Sizwe Hosmed Authorizations?

You can request authorization from your member’s area on the official website or the mobile app.

Furthermore, Pre-authorization and case management procedures apply to all inpatient hospital stays (including PMBs). Emergency admissions must be reported to the Scheme within 48 hours. Claims will not be paid if admission is not pre-authorized or reported to the plan.

 

How many Sizwe Hosmed Options are available for 2025?

Sizwe Hosmed offers 8 plans for 2025.

 

Where can I find my Sizwe Hosmed member login?

You can find the login on the official Sizwe Hosmed website homepage.

 

What is the Sizwe Hosmed Medical Aid contact number?

Sizwe Hosmed can be contacted on the toll-free number 0860 100 871.

 

How do I Downgrade my Plan with Sizwe Hosmed?

To downgrade your plan with Sizwe Hosmed, you can Contact Sizwe Hosmed customer service.

 

How do I add a Beneficiary to Sizwe Hosmed?

If you want to add a child or adult dependent, you can log into your Sizwe Hosmed profile and Contact Sizwe Hosmed.  You can reach out to Sizwe Hosmed through their customer service number or email or visit their website for more information on adding a beneficiary.

 

What hospital plans does Sizwe Hosmed offer?

Sizwe Hosmed offers the Access Core Hospital plan that offers unlimited coverage for in-hospital treatment and procedures but does not cover out-of-hospital and day-to-day medical treatment.

 

Does Sizwe Hosmed cover chronic medication?

Yes, Sizwe Hosmed covers chronic medication for members diagnosed with a chronic medical condition.

 

What is the provider network for Sizwe Hosmed?

Sizwe Hosmed has a provider network of healthcare providers, including hospitals, clinics, and doctors, where members can access medical treatment.

 

What are the waiting periods for Sizwe Hosmed?

Sizwe Hosmed has waiting periods for certain benefits, such as maternity and pre-existing medical conditions. These waiting periods range from 3 to 12 months.

 

What exclusions does Sizwe Hosmed have?

Sizwe Hosmed has exclusions for specific medical treatments and procedures, such as cosmetic surgery and non-medical treatments.

 

What is Sizwe Medical Fund?

Sizwe Medical Fund is a registered medical scheme in South Africa that offers a range of medical aid plans to individuals and families. Furthermore, Sizwe Hosmed is one of the country’s most popular medical schemes.

 

What are the benefits of Sizwe Medical Aid?

Sizwe Medical Aid offers a range of benefits to its members, including comprehensive cover for essential medical services, access to a network of healthcare providers, wellness programs, preventative care, and emergency medical assistance services.

 

What are the chronic benefits offered by Sizwe Medical Fund?

Sizwe Medical Fund offers coverage for a range of chronic conditions, including HIV/AIDS, diabetes, hypertension, and asthma. In addition, members can access chronic medication and treatments as part of their medical aid plan.

 

What is the hospital network for Sizwe Medical Fund?

Sizwe Medical Fund has a network of hospitals and healthcare providers that members can access for medical treatment. The network includes private and public hospitals, specialist clinics, and medical practitioners.

 

What are Siswe Hosmed auxiliary benefits?

Auxiliary benefits refer to medical services and appliances such as optometry, dentistry, hearing aids, and other medical devices.

 

What is a moratorium at Sizwe Hosmed?

At Sizwe Hosmed, a moratorium is a waiting period during which patients with pre-existing conditions are not covered but could be eligible for coverage after completing the waiting period.

 

What is a special enrollment period at Sizwe Hosmed?

An individual can enroll in Sizwe Hosmed outside of the open enrollment period if they meet the requirements for a special enrollment period, such as having a child or getting married.

 

What are Sizwe Hosmed’s underwriting criteria?

The underwriting criteria of Sizwe Hosmed are the rules by which the medical scheme evaluates an individual’s risk and establishes their premiums and waiting periods.

 

What maternity benefits does Sizwe Hosmed offer?

Sizwe Hosmed offers maternity benefits that cover prenatal and postnatal care, hospitalization for childbirth, and specific tests and procedures.

 

What are the waiting periods for maternity benefits with Sizwe Hosmed?

Waiting periods for maternity benefits with Sizwe Hosmed vary depending on the member’s plan. In general, waiting periods range from 9 to 12 months.

👉🏿 Women can make use of our free Ovulation Calculator

 

Does Sizwe Hosmed offer a hospital cash benefit?

Yes, some of Sizwe Hosmed’s medical aid plans offer a hospital cash benefit, which pays out a daily amount if you are hospitalized.

 

Can I join Sizwe Hosmed online?

Yes, you can apply to join Sizwe Hosmed online via their website.

 

How do I claim from Sizwe Hosmed?

To claim from Sizwe Hosmed, you can submit your claim online, by email, or by fax.

 

Does Sizwe Hosmed offer dental benefits?

Yes, Sizwe Hosmed offers dental benefits on some medical aid plans.

 

Does Sizwe Hosmed cover HIV/AIDS treatment?

Yes, Sizwe Hosmed covers HIV/AIDS treatment, including antiretroviral therapy and other related medications.

 

Does Sizwe Hosmed offer wellness benefits?

Yes, Sizwe Hosmed offers wellness benefits, which may include things like health screenings and lifestyle coaching.

 

Can I choose my own healthcare provider with Sizwe Hosmed?

Yes, Sizwe Hosmed allows members to choose their healthcare providers, but using network providers may lower out-of-pocket expenses.

 

What is Sizwe Hosmed’s gap cover?

Sizwe Hosmed’s gap cover is an optional extra that covers the difference between what medical practitioners charge and what your medical aid pays out.

 

Can I change my payment option with Sizwe Hosmed?

Yes, you can change your payment option with Sizwe Hosmed by contacting their customer service department and making the necessary arrangements.

 

What are pre-existing conditions with Sizwe Hosmed?

Pre-existing conditions are medical conditions that existed before a member joined the medical aid scheme.

 

Does Sizwe Hosmed cover pre-existing conditions?

Yes, Sizwe Hosmed covers pre-existing conditions, but there may be waiting periods before you can claim for specific conditions.

 

What are the payment options for Sizwe Hosmed?

Sizwe Hosmed offers a range of payment options, including debit orders, EFT, and cash payments at certain branches.

 

How do I submit a claim with Sizwe Hosmed?

You can submit a claim with Sizwe Hosmed by completing a claim form and submitting it with the relevant documentation, such as invoices or receipts.

 

What is the turnaround time for claims with Sizwe Hosmed?

The turnaround time for claims with Sizwe Hosmed varies depending on the type of claim and the case’s complexity. In general, claims are processed within 14 days of receipt of all relevant information.