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 R2,636 ZAR.
| 👤 Main Member Contribution | R2,636 |
|---|---|
| 👥 Adult Dependent Contribution | R2,273 |
| 🍼 Child Dependent Contribution | R530 |
| 🔁 Gap Cover | None |
| 📉 Annual Limit | Unlimited Hospital Cover |
| 💙 Hospital Cover | Unlimited for PMBs |
| ➡️ Prescribed Minimum Benefits | ☑️ Yes |
| 🟦 Screening and Prevention | ☑️ Yes |
💙 The Sizwe Hosmed Access Core medical aid plan is one of 8, starting from R2,636 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
| 👤 Main Member | 👥 Adult Dependent | 🍼 Child Dependent |
|---|---|---|
| R2,636 | R2,273 | R530 |
Hospital admissions
In-hospital General Practitioner and Specialist services
💙 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 R254 554.65 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 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. 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: R12 700 per stent – Drug eluting stents: R15 400 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 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 2025 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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💙 No benefits on this plan.
💙 No Benefits on this plan.
| ✈️ 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 | Limit: R6 069 per family per annum. |
💙 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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| 🍼 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: R283.50 perpregnancy paid from Risk |
💙 Sizwe Hosmed Access Core Plan covers the following chronic conditions on the CDL list:
💙 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.
💙 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.
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| 🔎 Medical Aid Plan | 🥇 Sizwe Hosmed Access Core | 🥈 Medshield MediCore | 🥉 Bestmed Rhythm 1 |
|---|---|---|---|
| 🌎 International Cover | Covered up to 100% of the scheme rates | Only Organ Transplants | R1 million in USA – Other countries R5 million |
| 👤 Main Member Contribution | R2,636 | R3,474 | R1,615 – R3 363 |
| 👥 Adult Dependent Contribution | R2,273 | R2,940 | R1,615 – R3 363 |
| 🍼 Child Dependent Contribution | R530 | R801 | R665 – R1,742 |
| 📉 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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💙 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.
The Access Core Plan covers in-hospital and out-of-hospital care, chronic medication for certain health conditions, and medical emergencies.
The Access Core Plan costs R2,636 for the main member, R2,273 for adult dependents, and R530 for children.
Yes, the Access Core Plan covers pre-existing conditions, but there may be waiting periods before coverage begins.
The Access Core Plan covers a network of private hospitals across South Africa, including many leading medical facilities.
Yes, members can add dependents such as spouses, children, and parents to the Access Core Plan.
To join the Access Core Plan, you must complete an application form and provide relevant personal and health information.
Yes, the Access Core Plan has a co-payment for specific medical procedures, which may vary depending on the specific procedure.
Yes, members of the Access Core Plan can choose their own doctors. However, it is recommended to use network providers for maximum coverage.
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.
Adriaan holds an MBA and specializes in medical aid research. With his commitment to perfection, he ensures the accuracy of all data presented on medicalaid.com every three months. When he is not conducting research, Adriaan can be found indulging in his passion for trout fishing amidst nature.
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