Sizwe Hosmed Essential Copper Medical Aid Plan
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 up to 3 Family Members. The Sizwe Hosmed Essential Copper Medical Aid Plan starts from R1,870 ZAR.
| 👤 Main Member Contribution | R1,890 – R2,839 |
| 👥 Adult Dependent Contribution | R1,890 – R2,839 |
| 🍼 Child Dependent Contribution | R650 – R846 |
| ↪️ Gap Cover | None |
| 🏥 Hospital Cover | Unlimited for PMBs |
| ➡️ Oncology Cover | R546,000 |
| 📉 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 12, starting from R1,870 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 12 medical aid plans
Sizwe Hosmed Essential Copper Plan Contributions
| 💶 Monthly Income Bracket | 👤 Main Member | 👥 +1 Adult Dependent | 🍼 +1 Child Dependent |
| R0 – R8,500 | R1,870 | R1,870 | R650 |
| R8,501 – R13,000 | R2,240 | R2,240 | R829 |
| R13,001> | R2,839 | R2,839 | R846 |
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.
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 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.
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 R13,498 per family yearly.
Covered up to 100% of the scheme tariff.
Limited to PMBs. |
🧠 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. |
| 🩹 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 | 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. |
| 🅰️ 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. |
| 🅱️ Non-PMB Laparoscopic Procedures | In-hospital procedures will attract an R5,250 co-payment except for diagnostic laparoscopies done on the following:
Aspiration/excision of ovarian cyst
Lap-appendicectomy
Repair of recurring or bilateral inguinal hernias |
| 🦾 Internal and External Prostheses | Covered up to 100% of the negotiated tariff.
Subject to PMBs and pre-approval.
Overall prostheses limit of R21,457 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. |
| 1️⃣ Aphakic Lenses | Limited to PMBs. |
| 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 R10,190, 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. |
You might consider the 5 Best Hospital Plans for Domestic Workers
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 | 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 R1,386 per beneficiary and R3,864 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.
Limited to R709 per family per year.
Maximum R110 per script is covered. |
| 🟥 Contraceptives | Covered up to 100% of the reference price |
| 🟧 Oral and injectable | Limited to R79 per beneficiary monthly.
Limited to R840 per family per year. |
| 🟨 Mirena Device | Subject to the contraceptive formulary. |
Essential Copper Optical Benefits
| 😎 Spectacle Lenses | Covered up to 100% of the DSP tariff.
Limited to R221 per lens (clear – single vision), R467 per lens (clear bifocal), or R467 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 R677 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 R315 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.
Maximum of six sessions per recipient, additional sessions contingent on progress reports and proof of response.
Essential Copper Medical Appliances Benefits
- Appliances include Hearing Aids, Wheelchairs, Calipers, etc.
- Covered up to 100% of the negotiated tariff.
- Limited to R2,137 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 R599 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 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.
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
and more.
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
and more.
You might like the 5 Best Medical Aid Schemes for Employees
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 | 🥈 Bonitas BonStart | 🥉 Medihelp MedMove! |
| 👤 Main Member Contribution | R1,870 – R2,839 | R1,338 | R1,254 |
| 👥 Adult Dependent Contribution | R1,870 – R2,839 | R1,338 | R1,254 |
| 🍼 Child Dependent Contribution | R650 – R846 | R1,338 | R1,254 |
| ↪️ 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.
Essential Copper Plan Frequently Asked Questions
What is Sizwe Hosmed Essential Copper?
Sizwe Hosmed Essential Copper is a medical aid plan offered by Sizwe Medical Fund, which provides affordable healthcare coverage to individuals and families in South Africa. Furthermore, it covers a range of essential medical services, including chronic medication, primary healthcare services, and day-to-day medical expenses.
What are the benefits of the Sizwe Hosmed Essential Copper plan?
The plan offers unlimited private hospital coverage, access to a network of healthcare providers, wellness programs, preventative care, and emergency medical assistance services. Furthermore, Essential Copper also provides comprehensive cover for essential medical services, making it an affordable option for many individuals and families.
How do I apply for Sizwe Hosmed Essential Copper Plan?
Prospective members can apply for Sizwe Hosmed Essential Copper Plan by completing an application form, which can be obtained from the Sizwe website or by contacting their customer service team. Furthermore, the application will typically require information about the member and any dependents and details about the level of cover required.
How do I claim with Sizwe Hosmed Essential Copper Plan?
Members can claim with this plan by submitting a claim form and any supporting documentation, such as medical bills or receipts. Claims can be submitted online or via email, fax, or post.
Who is eligible for the Sizwe Hosmed Essential Copper plan?
The plan is available to all South African residents, subject to specific eligibility criteria, such as age and income requirements.
How much does the Sizwe Hosmed Essential Copper plan cost?
The plan’s cost varies depending on several factors, such as the level of cover required, the number of dependents, and the member’s income. For example, Essential Copper starts from R1,870 for the main member on an income from R0 to R13,000.
What are the limitations and exclusions of the Sizwe Hosmed Essential Copper plan?
The plan may have certain limitations and exclusions, such as waiting periods, exclusions for pre-existing conditions, and limitations on certain medical treatments. Prospective members should carefully review the terms and conditions of the plan before signing up to ensure that it meets their healthcare needs.
