Essential Copper
About this plan
🥇 Best suited for young, healthy individuals seeking affordable network hospital cover with comprehensive day-to-day benefits.
Principal Member
From
R3,625
per month
Adult Dependant
From
R3,625
per month
Child Dependant
From
R1,255
per month
What's covered
Hospital cover
Savings account
Day-to-day
Chronic cover
Dental
Optical
Maternity
Mental health
Waiting periods
- General
- 3 months
- Pre-existing conditions
- 12 months
Essential Copper
Sizwe Hosmed Essential Copper Plan (🇿🇦 2026)
Overall, the Sizwe Hosmed Essential Copper Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers international and 100% specialist coverage to its members. The Sizwe Hosmed Essential Copper Medical Aid Plan starts from R3,625 ZAR.| 👤 Main Member Contribution | R3,625 |
| 👥 Adult Dependent Contribution | R3,625 |
| 🍼 Child Dependent Contribution | R1,255 |
| ↪️ Gap Cover | None |
| 🏥 Hospital Cover | Unlimited for PMBs |
| ➡️ Oncology Cover | 100% Scheme Tariff*. Limited to PMBs. |
| 📉 Annual Limit | Unlimited Hospital Cover |
| 🌎 International Cover | Covered up to 100% of the scheme rates |
| 💶 Screening and Prevention | ☑️ Yes |
| 😊 Maternity Benefits | ☑️ Yes |
Sizwe Hosmed Essential Copper Plan - 7 Key Point Quick Overview
- ☑️ Sizwe Hosmed Essential Copper Plan Overview
- ☑️ Sizwe Hosmed Essential Copper Plan Contributions
- ☑️ Essential Copper Plan Benefits and Cover Comprehensive Breakdown
- ☑️ Essential Copper Plan Exclusions and Waiting Periods
- ☑️ Sizwe Hosmed Essential Copper Plan vs. Similar Plans from other Medical Schemes
- ☑️ Our Verdict on The Essential Copper Plan
- ☑️ Essential Copper Plan Frequently Asked Questions
Sizwe Hosmed Essential Copper Plan Overview
💙 The Sizwe Hosmed Essential Copper medical aid plan is one of 8, starting from R3,625 and includes unlimited basic cover for PMBs, international cover, 100% specialist cover, drug and alcohol rehabilitation, MRI and CT scans, Prostheses, and more.
💙 Gap Cover is not available on the Sizwe Hosmed Essential Copper Plan. However, Sizwe Hosmed offers 24/7 medical emergency assistance. According to the Trust Index, Sizwe Hosmed has a trust rating of 3.9.
Sizwe Hosmed offers 8 medical aid plans
- ✅ Sizwe Hosmed Access Core Plan
- ✅ Sizwe Hosmed Value Platinum Core
- ✅ Sizwe Hosmed Titanium Executive
- ✅ Sizwe Hosmed Gold Ascend
- ✅ Sizwe Hosmed Gold Ascend EDO
- ✅ Sizwe Hosmed Value Platinum Plan
- ✅ Sizwe Hosmed Essential Copper
- ✅ Sizwe Hosmed Access Saver
Sizwe Hosmed Essential Copper Plan Contributions
| 👤 Main Member | 👥 +1 Adult Dependent | 🍼 +1 Child Dependent |
| R3,625 | R3,625 | R1,255 |
Essential Copper Plan Benefits and Cover Comprehensive Breakdown
Essential Copper 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.
- ☑️ Essential Copper 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.
| 🏥 Hospital Admissions High Care Unit General Ward Theatre Recovery Room | Covered up to 100% of the DSP Tariff. The benefit is limited to PMBs Emergency admissions must be notified to the Scheme within 48 hours of admission. Admissions for elective procedures must be pre-authorised at least 72 hours before admission date. 30% penalty will be imposed for non-emergency late pre-authorisations. Deductibles* are applicable to a defined list of procedures. Voluntary use of non-DSP* hospital will result in 30% co-payment. 30% penalty will be imposed for non emergency late pre-authorisations. |
| 💊 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. General anaesthetic benefits are 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 | No Benefit |
| 🥰 Drug and Alcohol Rehabilitation | 100% Scheme Tariff Limited to R15 625.73 per family per annum |
| 🧠 Psychiatric Treatment Consultations Ward Fees Medicines Psychiatry/psychology therapy sessions | Covered up to 100% of the scheme tariff. Subject to preferred provider networks (PPN). 21 days In-Hospital or 15 out-of-hospital sessions per beneficiary which includes Psychiatrist consultations and six (6) In-Hospital consultations by Clinical Psychologist. Maximum three (3) days for Psychologist/psychiatrist combined therapy sessions during the same admission; thereafter pre-authorisation required with treatment plan. 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. Applicable to members age 55 upwards. |
| 🧪 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, • 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: R24 839.33per family per annum |
| 🦿 Spine Instrumentation and Disc Prostheses including all components and fixation devices for back/spine | Limited to 1 event per beneficiary yearly. Limited to PMBs. |
| 🦵 Joints Prosthesis for joint replacement (Hip, Knee, Shoulder and Ankle) Subject to Managed Care Protocols. | Limited to the equivalent in the state. This benefit does not include cement. |
| 1️⃣ Aphakic Lenses | Limited to PMBs |
| 2️⃣ Cardiac Stents | Limited to PMBs. One (1) per Lesion- maximum of three (3) Lesions. 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 796.75, 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. |
Essential Copper Day-to-Day Benefits
| ☑️ Day Procedures | - |
| 🟥 Day Hospital Procedures using a DSP hospital Network | Subject to the scheme tariff. Only the following PMB conditions are covered: Biopsy Breast Biopsy Cataract Colonoscopy Cone Biopsy/ Colposcopy Cystoscopy ERCP Excision of Extensive Skin lesions /Repair/Skin Graft Gastroscopy or Colonoscopy or Oesophagoscope Hemorrhoidectomy Hysteroscopy, D&C, Minor Gynecological Procedures Myringotomy / Grommets Repair of Wounds Termination of Pregnancy Tonsillectomy and Adenoidectomy Umbilical and Inguinal Hernia |
| 🟧 Out-of-Hospital Consultations General Practitioners Specialists Outpatient Facilities | Covered up to 100% of the DSP tariff. General Practitioner Consultations: Only DSPs can be used. Subject to PMBs. Unlimited visits and acute medication can be obtained from any GP in the DSP network, paid up to 100% of the DSP tariff. There is a 30% co-payment for consultations outside the DSP network. Specialist Consultations: Covered up to 100% of the scheme tariff. There is a limit of 3 visits per family yearly. Requires referral from a DSP GP. Subject to pre-approval. Only PMBs are covered. |
| 🟨 Co-payments on day procedures | This will apply depending on the treatment. |
| ☑️ Medicine | - |
| 🟩 Acute Medicine obtain from Pharmacy | Covered up to 100% of the reference price. Unlimited acute medication if dispensed by a DSP GP. If medication is obtained from a pharmacy, there is a limit of R1,855. 35per beneficiary and R5,173.35 per family per year. Subject to the medicine formulary. Homeopathic medicine is not covered. |
| 🟦 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. Members can only use a network pharmacy. |
| 🟪 Pharmacy Advised Treatment (PAT) | Covered up to 100% of the reference price. 100% of Reference Price. Limited to R820.26 per family per annum. Maximum R127.89 per script. |
| 🟥 Contraceptives | Limited to R91.51 per beneficiary per month. Subject to R972.41 limit per family per annum. |
Essential Copper Optical Benefits
| 😎 Spectacle Lenses | Covered up to 100% of the DSP tariff. R271.03 per lens – clear single vision or R571.54 per lens – clear bifocal or R571.54 per lens – base multifocal There will not be a benefit for contact lenses if spectacle lenses are obtained. Subject to the Optical Protocols. |
| 👁️ Contact Lenses | Covered up to 100% of the DSP tariff. Limited to R829.50 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 R385.35 per beneficiary. |
| 🅰️ Eye Tests | Covered up to 100% of the DSP tariff. Limited to one comprehensive consultation per beneficiary every 2 years. |
Essential Copper Dentistry Benefits
| 🔴 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 | Cover provided. |
| 🟣 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 | Covered up to 100% of the scheme tariff. |
| 🟢 Crowns Bridgework Dentures Orthodontics Removal of Impacted Wisdom Teeth Non-Surgical Periodontics | Limited to PMBs. |
| 🟣 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. Members may only use a contracted network provider |
| 🔵 Maxillo-Facial and Oral Dental Surgery | Covered up to 100% of the scheme tariff. Only PMBs are covered. |
👉🏿 READ more about the 5 Best Dental Gap Cover
Essential Copper Auxiliary Benefits
- ✅ Remedial and Other Therapies include Audiology, Speech therapy, Dieticians, Hearing Aid Acousticians, Occupational Therapy, and more.
- ✅ Covered up to 100% of the scheme tariff.
- ✅ Only PMBs are covered.
- ☑️ Physiotherapy Out-of-Hospital and Biokinetics:
- ☑️ Covered up to 100% of the scheme tariff.
- ☑️ Only PMBs are covered.
- ☑️ Clinical protocols will apply.
- ✅ Heart and respiratory conditions:
- ✅ A treatment plan and therapeutic goals must be provided.
Essential Copper Medical Appliances Benefits
- ☑️ Benefits include Hearing Aids, Wheelchairs, Calipers, etc.
- ☑️ Covered up to 100% of the negotiated tariff.
- ☑️ Limited to R2,473.80 per family per year.
- ☑️ In and out-of-hospital cover is limited to PMB conditions.
- ☑️ Blood Pressure Monitors are subject to a sub-limit of R693.42 for beneficiaries registered for hypertension.
Essential Copper Other Benefits
| ✈️ 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 | Only PMBs are covered. |
| ➡️ Infertility | Only PMBs are covered. |
| 👩⚕️ Hospice and Private Nursing | Covered up to 100% of the negotiated tariff. Only PMBs are covered. |
Essential Copper 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.
| ❤️ 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 | Authorization is required. Can only be done by a registered Midwife |
| 💚 Maternity Ultrasounds | Limited to 2 2D ultrasounds in and out-of-hospital. Covered up to 100% of the negotiated tariff. |
| 💜 Maternity Visits/Consultations | Covered up to 100% of the negotiated tariff. Subject to DSP GP and Specialist Consultation limit. |
| 💙 Antenatal Pathology Screening | Covered up to 100% of the negotiated tariff. |
| 🖤 Child Immunisation Benefit | According to the Immunisation schedule of the Department of Health, only up to 6 years old. |
👉🏿 Discover more about Health Insurance for Kids
Essential Copper Preventative Care Benefits
| 🔎 Wellness Consultations | Limited to R2 061.68 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. Subject to PMB. |
Essential Copper Chronic Diseases Benefit
Sizwe Hosmed Essential Copper 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
- ☑️ Cardiomyopathy
- ☑️ Hypertension
- ☑️ Chronic Renal Disease
- ☑️ Hypothyroidism
- ☑️ Chronic Obstructive Pulmonary Disease
Essential Copper Plan Exclusions and Waiting Periods
Essential Copper 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
- ✅ Ozone therapy
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Essential Copper 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 Essential Copper Plan vs. Similar Plans from other Medical Schemes
| 🔎 Medical Aid Plan | 🥇 Sizwe Hosmed Essential Copper (2026) | 🥈 Bonitas BonStart (2026) | 🥉 Medihelp MedMove! (2026) |
| 👤 Main Member Contribution | R3,625 | R1,603 | R1,734 |
| 👥 Adult Dependent Contribution | R3,625 | R1,603 | R1,734 |
| 🍼 Child Dependent Contribution | R1,255 | R1,603 | R1,734 |
| ↪️ Hospital Cover | Unlimited for PMBs | Unlimited | Unlimited |
| 💙 Annual Limit | Unlimited Hospital Cover | Unlimited Hospital Cover | Unlimited Hospital Cover |
Our Verdict on The Essential Copper Plan
💙 In conclusion, the Sizwe Hosmed Essential Copper medical aid plan is viable for individuals and families seeking affordable healthcare coverage in South Africa.
💙 With its comprehensive coverage for essential medical services, access to a network of healthcare providers, and additional benefits such as wellness programs and emergency medical assistance services, this plan offers a good balance of value and affordability.
💙 However, it may not be suitable for those with more extensive medical needs, as it may not provide sufficient cover for chronic illnesses or expensive medical treatments.
💙 Therefore, it is important for prospective members to carefully consider their healthcare needs and budget before choosing a medical aid plan and to review the limitations and exclusions of each plan carefully to ensure they are getting the coverage they need.
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