Overall, the Sizwe Hosmed Access Saver Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and in-hospital procedures for its members. The Sizwe Hosmed Access Saver Medical Aid Plan starts from R3,371 ZAR.
👤 Main Member Contribution | R3,371 |
👥 Adult Dependent Contribution | R2,911 |
🍼 Child Dependent Contribution | R676 |
↪️ Gap Cover | None |
🏥 Hospital Cover | Unlimited for PMBs |
💙 Oncology Cover | R282 932.55 |
💶 Medical Savings Account | ☑️ Yes |
📉 Screening and Prevention | ☑️ Yes |
➡️ Prescribed Minimum Benefits | ☑️ Yes |
🟦 Maternity Benefits | ☑️ Yes |
💙 The Sizwe Hosmed Access Saver medical aid plan is one of 8, starting from R3,371 and includes a savings account containing 25% of monthly contributions pooled together and presented at the start of every year.
💙 This plan also covers chronic conditions, 8 additional non-PMB conditions, and more. Gap Cover is not available on the Sizwe Hosmed Access Saver 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 |
R3,371 | R2,911 | R676 |
👤 Main Member | 👥 Adult Dependent | 🍼 Child Dependent |
R10,080 per year | R8,736 per year | R1,992 per year |
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🔎 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. 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. 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 | 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. Basic dentistry benefit In-Hospital is limited to extensive conservative treatment for children under age of seven (7) years involving more than three (3) teeth. General anaesthetic benefits are only available for children under age of seven (7) years for extensive dental treatment, limited to once per beneficiary per year. 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 and Scheme rules. No benefit. |
🎗️ Drug and Alcohol Rehabilitation | Limited to R14,880.60 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. Subject to PMBs, pre-authorisation and protocols. Includes all services rendered at registered Step-Down facilities. Limited to 14 days per beneficiary yearly. |
🏠 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 with In-Hospital limit applicable. |
🦾 Instrumentation and Disc Prostheses Components Fixation Devices for back/spine | Maximum one (1) level per beneficiary per year for spine. 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 |
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☀️ Day Procedures | – |
Medical Savings Account (25%) | Medical Savings Account (MSA*) Limit Membe = R10 080 Adult = R8 736 Child = R1 992 |
🩻 Radiology and Pathology benefit | – |
⚕️Combined Basic Radiology and Pathology | 100% of Scheme Tariff* Combined limit of R4 312.35 per beneficiary per annum, subject to sub-limit below: • Basic Radiology: Limited to R2 610.30 per beneficiary per annum • Pathology: Limited to R3 345.30 per beneficiary per annum |
😷 Advanced /Specialised Radiology | Limited to R20 000 per family per annum. Limited to two (2) scans per beneficiary per annum at a limit of R3 500 per scan event in or Out-of-Hospital |
📌 Out-of-Hospital Consultations General Practitioners Specialists Outpatient Facilities | Covered up to 100% of the scheme tariff. General Practitioner Consultations: Paid from the medical savings account. Consultations once the MSA is depleted: Additional Doctor visits per family are limited to one per beneficiary. If the specialist consultation benefit is used after the MSA has been depleted, the additional GP visits are limited to three per family and one per beneficiary. Specialist Consultations: Paid from MSA. Specialist Consultations once the MSA is depleted: One additional specialist visit with either of the following: Paediatrician Gynecologists |
💴 Co-payments on day procedures | This will apply depending on the treatment. |
💊 Medicine | – |
💉 Acute Medicine | Covered up to 100% of the reference price. Paid from the MSA. If medication is obtained from a pharmacy, it is subject to available medical savings funds. |
🩺 PMB Disease List Medicines | Covered up to 100% of the reference price. Subject to pre-approval by DSP. Treatment protocols apply. Medicine formulary applies. Member must register chronic medicine. |
🧪 Pharmacy Advised Treatment (PAT) | Covered up to 100% of the reference price. Paid from the MSA. |
🅰️ Contraceptives | Covered up to 100% of the reference price |
🅱️ Oral and injectable | 100% of Reference Price* Subject to the contraceptive formulary. |
🚩 Mirena Device | Subject to a sub-limit of R2 315.25 p per beneficiary every 5 years for abnormal uterine bleeding. Paid from the MSA. |
🤓 Spectacle Lenses | Covered up to 100% of the DSP tariff. Spectacle Lenses limit: Limited to R257.04 per lens – clear single vision or R544.32 per lens – clear bifocal or R544.32 per lens – base multifocal |
👁️🗨️ Contact Lenses | Covered up to 100% of the DSP tariff. Limited to R1,219 per beneficiary every 2 years. There is no cover if a beneficiary has already obtained spectacles. Subject to optical protocol. |
👓 Frames/Lens Enhancements | Covered up to 100% of the DSP tariff. Limited to R670 per beneficiary. |
👁️ Eye Tests | Covered up to 100% of the DSP tariff. Limited to one comprehensive consultation per beneficiary every 2 years. |
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🦷 Dentistry | – |
🔴 Basic/Conservative Dentistry | Covered up to 100% of the scheme tariff. Dental protocols apply, and pre-authorization is needed. Quantity limits will apply, and members must use a contracted network provider. |
🟠 Conscious Sedation | Conscious sedation: Intensive dental treatment (more than four fillings or extractions) subject to dental treatment protocols and pre-approval. |
🟡 Consultations, Fillings, Extractions | Paid from the Risk pool. |
🟢 Preventative Scale and Polish | Cover provided. |
🔵 Infection Control | Cover provided. |
🟣 Fluoride Treatment | Cover provided. |
🔴 Dental X-Rays | Cover provided but only for intra-oral x-rays. |
🦷 Advanced Dentistry | – |
🟠 Crowns Bridgework Dentures Orthodontics Removal of Impacted Wisdom Teeth Non-Surgical Periodontics | Non-PMBs are covered by MSA. Clinically valid specialized dental treatment is paid from the MSA. |
🟡 Acrylic (Plastic) Dentures for beneficiaries 16> | Each beneficiary receives one pair of acrylic/plastic dentures every four years. Denture repairs, realignment, and repair can be done every 12 months Only PMBs are covered. |
🟢 Maxillo-Facial and Oral Dental Surgery | Covered up to 100% of the scheme tariff. Only PMBs are covered. |
🟥 Alternative Services For example: Speech therapy Podiatry Occupational therapy Social worker Dietetics | Covered up to 100% of the scheme tariff. Collectively limited to R3 009.30 per family per annum Non-PMBs are paid from the MSA. Medicine dispensed is subject to the Acute Medicine Limit. Homeopathic medicine is not covered. |
🟧 Remedial and Other Therapies For example: Audiology Speech therapy Dieticians Hearing Aid Acousticians | Covered up to 100% of the scheme tariff. |
🟨 Physiotherapy Out-of-Hospital and Biokinetics | Covered up to 100% of the scheme tariff. Subject to PMB conditions and clinical protocols. Non-PMBs are covered by the MSA. Heart and respiratory conditions: A treatment plan and therapeutic goals must be provided. Maximum of six sessions per recipient, additional sessions contingent on progress reports and proof of response. |
✈️ Air/Road Ambulance and Emergency Services | Covered up to 100% of Negotiated Tariff 24-hour Contact Center Access, including Telephonic Nurse Advice Line. Emergency: Subject to pre-approval within 72 hours of the emergency. Only a preferred provider can perform inter-hospital transfers. Emergency response by road or air to the scene of the occurrence, as well as transfer from the scene to the nearest, most appropriate facility Escort repatriation of stranded children is possible. Non-emergency: Subject to pre-authorization. Medically justifiable inter-facility transfers. Medical repatriation. |
🧠 Psychology and Psychiatry Treatment | Covered up to 100% of the negotiated tariff. Only PMB conditions are covered. Non-PMBs are paid from the MSA. |
💟 Infertility | Covered up to 100% of the negotiated tariff. Non-PMBs are paid from the MSA. |
👩⚕️ Hospice and Private Nursing | Covered up to 100% of the negotiated tariff. Only PMB conditions are covered. Non-PMBs are paid from the MSA. |
💙 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.
❤️ 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. Can only be done by a registered Midwife |
💚 Maternity Ultrasounds | Limited to 3 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. Extra 7 GP maternity appointments and 2 specialist consultations each pregnancy at GP or Specialist. More ante-natal consultations will be covered from the day-to-day benefit once these limits have been achieved. |
💙 Antenatal Pathology Screening Haemoglobin Syphilis Chlamydia Bacteriuria Hepatitis B Rhesus incompatibility | Covered up to 100% of the scheme tariff. |
🤍 Child Immunisation Benefit | According to the Immunisation schedule of the Department of Health, only up to 6 years old. |
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💖 Wellness Consultations | Limited to R1,219 per family per year. |
😷 COVID-19 Vaccination | Covered according to guidelines. |
✅ Pap Smear for female beneficiaries 18> | One per qualifying beneficiary yearly. |
☑️ Mammogram for female beneficiaries 40> | One per qualifying beneficiary yearly. |
📌 PSA for Male Beneficiaries 40> | One per qualifying beneficiary yearly. |
📍 Cholesterol Test for beneficiaries 20> | One per qualifying beneficiary yearly. |
💉 Flu Vaccine for all beneficiaries | One per beneficiary yearly. |
🩸 Colon Cancer Blood Test for beneficiaries 50> | One per qualifying beneficiary yearly. |
🩸 Blood Pressure test for all beneficiaries. | One per beneficiary yearly. |
🎗️ HIV test for all beneficiaries | One per beneficiary yearly. |
✳️ HPV Vaccines for beneficiaries between 9 and 12. | One per qualifying beneficiary. |
🤒 Pneumococcal Vaccines for beneficiaries 65> | One per qualifying beneficiary yearly. |
🦴 Bone density testing for female beneficiaries between 50 and 69 and male beneficiaries 65 years old. | One per qualifying beneficiary yearly. |
🟦 HIV/AIDS Management Program | Covered up to 100% of the scheme tariff. Treatment is subject to the treatment care plan. Clinical protocols per CDL apply. |
🟪 Chronic Disease Management Program (CDL) | Covered up to 100% of the scheme tariff. Treatment is subject to the treatment care plan. Clinical protocols per CDL apply. |
😷 COVID-19 Screening, Diagnosis, and Treatment | Covered up to 100% of the scheme tariff. |
Sizwe Hosmed Access Saver covers the following chronic conditions on the CDL list:
💙 Siwe Hosmed Access Saver also covers the following eight additional Non-PMB conditions, paid from available funds in the MSA:
💙 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.
🔎 Medical Aid Plan | 🥇 Sizwe Hosmed Access Saver 25 | 🥈 Fedhealth MyFED | 🥉 Medshield MediSwift |
👤 Main Member Contribution | R3,371 | R1,278 – R3,700 | R2,037 |
👥 Adult Dependent Contribution | R2,911 | R1,278 – R3,700 | R1,986 |
🍼 Child Dependent Contribution | R676 | R687 – R1,170 | R522 |
📊 Annual Limit | Unlimited Hospital Cover | No Overall Annual Limit | Unlimited Hospital Cover |
🏥 Hospital Cover | Unlimited for PMBs | Unlimited | Unlimited |
📈 Oncology Cover | R282 932.55 per beneficiary per annum . | Unlimited for PMBs | Unlimited, subject to PMBs |
💶 Medical Savings Account | ☑️ Yes | ☑️ Yes | None |
💙 Sizwe Hosmed Access Saver is a medical aid plan that offers comprehensive healthcare coverage with a savings component. The Sizwe Hosmed Access Saver includes unlimited in-hospital benefits, chronic medication coverage, maternity benefits, and a savings account.
💙 Members can use the savings account to cover their day-to-day medical expenses such as doctor consultations, medications, and pathology tests. In addition to these features, the Access Saver plan offers dental benefits, optical benefits, and travel insurance coverage.
💙 The advantages of the Sizwe Hosmed Access Saver plan include access to private hospitals and doctors, specialist consultations, preventative healthcare services, a network of healthcare providers, and additional benefits such as dental and optical coverage.
💙 This plan also covers emergency medical and ambulance services and provides travel insurance coverage. As a result, members can manage their healthcare expenses and have peace of mind knowing they are covered for various healthcare needs.
💙 The drawbacks of the Sizwe Hosmed Access Saver plan include a higher premium than the Access Core plan and a limited savings amount, which may not cover all day-to-day medical expenses. This plan also has a waiting period for certain benefits, which may be inconvenient for members who need immediate medical attention.
Access Saver offers more savings. Therefore, its contributions are higher than Access Core. The main member pays R3,371 while there is an R2,911 contribution for adult dependents and R676 for kids.
Access Saver is a medical aid plan offered by Sizwe Hosmed in South Africa that offers generous savings for out-of-hospital medical expenses such as GP and specialist consults, medication, and non-PMB treatment.
Yes, chronic medication is covered under Access Saver.
The savings account can be utilized by members to pay for their routine medical costs, such as doctor visits, medications, and pathology tests.
The Sizwe Hosmed Access Saver plan offers various benefits, such as access to private hospitals and doctors, specialist consultations, preventative healthcare services, a network of healthcare providers, and extra coverage for dental and optical services.
Some disadvantages of the Sizwe Hosmed Access Saver plan are that it comes with a higher premium compared to the Access Core plan, and a limited savings amount which may not suffice for all day-to-day medical expenses. Additionally, this plan has a waiting period for specific benefits, which could be inconvenient for members in urgent need of medical attention.
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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