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 assista...
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
💙 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.
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.
In-hospital General Practitioner and Specialist services
☑️ PMB and case management protocols apply.
☑️ All procedures must be approved in advance.
Failing to pre-authorize or notify the scheme of admission within 48 hours will result in claim payments being withheld.
🅰️ 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.
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.
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.
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.
💙 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.
The Access Core Plan is a medical aid scheme offered by Sizwe Hosmed that provides comprehensive healthcare coverage to members.
What does the Access Core Plan cover?
The Access Core Plan covers in-hospital and out-of-hospital care, chronic medication for certain health conditions, and medical emergencies.
What is the cost of the Access Core Plan in 2026 ?
The Access Core Plan costs R3,161 for the main member, R2,726 for adult dependents, and R636 for children.
Does the Access Core Plan cover pre-existing conditions?
Yes, the Access Core Plan covers pre-existing conditions, but there may be waiting periods before coverage begins.
What hospitals are covered under the Access Core Plan?
The Access Core Plan covers a network of private hospitals across South Africa, including many leading medical facilities.
Can I add dependents to the Access Core Plan?
Yes, members can add dependents such as spouses, children, and parents to the Access Core Plan.
How do I join the Access Core Plan?
To join the Access Core Plan, you must complete an application form and provide relevant personal and health information.
Are there any co-payments associated with the Access Core Plan?
Yes, the Access Core Plan has a co-payment for specific medical procedures, which may vary depending on the specific procedure.
Can I choose my own doctor with the Access Core Plan?
Yes, members of the Access Core Plan can choose their own doctors. However, it is recommended to use network providers for maximum coverage.
How do I claim with the Access Core Plan?
To claim with the Access Core Plan, you must submit a claim form and relevant documentation to Sizwe Hosmed. Claims can also be made online or via the Sizwe Hosmed mobile app.
