Sizwe Hosmed Silver Hospital Medical Aid Plan (2024)
Overall, the Sizwe Hosmed Silver Hospital Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and extended benefits to up to 3 Family Members. The Sizwe Hosmed Silver Hospital Medical Aid Plan starts from R2,140 ZAR.
| 👤 Main Member Contribution | R2,040 |
| 👥 Adult Dependent Contribution | R1,755 |
| 🍼 Child Dependent Contribution | R405 |
| 🌎 International Cover | Covered up to 100% of the scheme rates |
| 📉 Annual Limit | Unlimited Hospital Cover |
| 🧬 Spinal and Neck program | Limited to PMBs |
| ➡️ Oncology Cover | R546,000 |
| ↪️ Prescribed Minimum Benefits | ☑️ Yes |
| ✔️ Screening and Prevention | ☑️ Yes |
| 🟦 Medical Savings Account | None |
Sizwe Hosmed Silver Hospital Plan – 7 Key Point Quick Overview
- ☑️ Sizwe Hosmed Silver Hospital Plan Overview
- ☑️ Sizwe Hosmed Silver Hospital Plan Contributions
- ☑️ Silver Hospital Plan Benefits and Cover Comprehensive Breakdown
- ☑️ Silver Hospital Plan Exclusions and Waiting Periods
- ☑️ Sizwe Hosmed Silver Hospital Plan vs. Similar Plans from other Medical Schemes
- ☑️ Our Verdict on The Silver Hospital Plan
- ☑️ Silver Hospital Plan Frequently Asked Questions
Sizwe Hosmed Silver Hospital Plan Overview
The Sizwe Hosmed Silver Hospital medical aid plan is one of 12, starting from R2,140, and includes access to several Network Hospitals, Oncology covers, ambulance services, home-based care, extended benefits through the Sizwe Hosmed Bambino program, and more. Gap Cover is not available on the Sizwe Hosmed Silver Hospital 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 Silver Hospital Plan Contributions
| 👤 Main Member | 👥 +1 Adult Dependent | 🍼 +1 Child Dependent |
| R2,040 | R1,755 | R405 |
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Silver Hospital Plan Benefits and Cover Comprehensive Breakdown
Silver Hospital 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.
- Silver 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. |
| 💉 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. |
| 📈 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 R30,641 per family per year.
Where interventional radiology is needed, the benefit is paid from the overall hospital benefit. |
| 📊 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.
Limited to R230,889 per family per year.
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 in a day clinic.
Subject to pre-approval.
Treatment protocols will apply. |
| 🥰 Maxillo-facial and Oral Surgery | Covered up to 100% of the negotiated tariff.
The cover is limited to PMBs.
Subject to pre-approval and treatment protocols. |
| 🤕 Drug and Alcohol Rehabilitation | Limited to three days of withdrawal treatment and twenty-one days for rehabilitation.
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.
Four additional out-of-hospital consultations are available.
Limited to 21 days per beneficiary or 15 outpatient consultations per year.
Pre-authorization is needed.
Managed care protocols apply. |
| 🚑 Hospitalisation Alternatives | Covered up to 100% of the negotiated tariff.
Pre-authorization required.
Subject to relevant protocols |
| ⬇️ Step-down Facilities | Covered up to 100% of the negotiated tariff. |
| 🏡 Home-Based Care | Covered up to 100% of the negotiated tariff.
Limited to 14 days per year. |
| 🩹 Negative Pressure Wound Therapy | Covered up to 100% of the negotiated tariff. |
| 😮💨 Hyperbaric Oxygen Therapy | Covered up to 100% of the negotiated tariff.
Public sector protocols will apply. |
| 🅰️ Male Sterilisation/Vasectomy | Covered up to 100% of the negotiated tariff.
Pre-authorization required.
Subject to PMBs. |
| 🅱️ Female Sterilisation/Tubal Ligation | Covered up to 100% of the negotiated tariff.
Pre-authorization required.
Subject to PMBs. |
| 🧬 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 back and neck pain is subject to managed care guidelines.
Before authorizing surgery, Managed Care may require adherence to conservative treatment. |
| 🩺 Stereotactic Radiosurgery | Covered up to 100% of the scheme tariff.
Pre-authorization required.
Only PMBs are covered. |
| 🧪 Age-related Muscular Degeneration Treatment | Covered up to 100% of the scheme tariff.
Only PMBs will be covered.
Covered up to 100% of the negotiated tariff.
Pre-authorization required. |
| 🟥 Laparoscopic Hospitalisation and Associated Costs | Covered up to 100% of the scheme tariff.
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 |
🟩 Instrumentation and Disc Prostheses
Components
Fixation Devices for back/spine
Internal Prostheses
External Prostheses
Aphakic Lenses
Cardiac Stents
Internal Sphincters and Stimulators
Unlisted Prostheses such as artificial limbs, artificial eyes, etc. | Covered up to 100% of the negotiated tariff.
Subject to PMBs and pre-approval. |
| 🩸 Blood Transfusions | Covered up to 100% of the 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. |
| ☑️ Deductible for in-hospital procedures | Covered up to 100% of the scheme tariff.
Limited to PMB. |
Silver Hospital Day-to-Day Benefits
| 🔴 Day Hospital Procedures using a DSP hospital Network | Covered up to 100% of the negotiated tariff.
Only the following PMB conditions are covered:
Umbilical and Inguinal hernia repair
Colonoscopy
Cystoscopy
Gastroscopy and Oesophagoscope
Hysteroscopy
Grommets
Termination of pregnancy
Breast biopsy
Cataracts
Circumcision
ERCP
Hemorrhoidectomy
Vasectomy
Tubal Ligation
Excision of extensive skin lesions or repair of wounds and skin grafts
Dental procedures
Repair nail bed & Removal of toenails
Minor orthopedic procedures such as tennis elbow, Dupuytren’s contracture, trigger finger, ganglion, carpal tunnel syndrome
Minor Gynecological procedures – cone biopsy, colposcopy,
Mirena devise for abnormal uterine bleeding |
| 🟠 Co-payments on day procedures | This will apply depending on the treatment. |
🟡 Out-of-Hospital Consultations
General Practitioners
Specialists
Outpatient Facilities | Covered up to 100% of the Scheme tariff.
Limited to PMB. |
| 🟢 Acute Medicine | Covered up to 100% of the Scheme tariff.
Limited to the CDL. |
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Silver Hospital 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.
- 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.
Silver Hospital 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 | Covered up to 100% of the negotiated tariff. |
| 💛 Home Delivery | Covered up to 100% of the negotiated tariff. |
| 💚 Maternity Ultrasounds | Nine antenatal consultations with a GP or midwife.
Two antenatal specialist consultations, subject to referral by a GP.
Two 2D Scans per pregnancy. |
| 💙 Maternity Visits/Consultations | Covered up to 100% of the negotiated tariff.
Subject to DSP GP and Specialist Consultation limit. |
💜 Antenatal Pathology Screening
Haemoglobin
Syphilis
Chlamydia
Bacteriuria
Hepatitis B
Rhesus incompatibility | One Full Blood Count
Two Hemoglobin
One Blood Grouping
One VDRL
Two HIV
Twelve Urine Analysis |
| ❤️ Vitamins | Limited to R120. |
| 🧡 Child Immunisation Benefit | According to the Immunisation schedule of the Department of Health, only up to 6 years old. |
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Silver Hospital 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. |
| 🟠 Immunization for children up to 6 years old | According to the guidelines of the DOH.
Subject to wellness screening family limit. |
| 🟡 HIV/AIDS Management Program | Covered up to 100% of the negotiated 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. |
Silver Hospital Chronic Diseases Benefit
Sizwe Hosmed Silver Hospital 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
and many more.
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Silver Hospital Plan Exclusions and Waiting Periods
Silver Hospital 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 many more!
Silver Hospital 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 also has a late joiner fee
Sizwe Hosmed Silver Hospital Plan vs. Similar Plans from other Medical Schemes
| 🔎 Medical Aid Plan | 🥇 Sizwe Hosmed Silver Hospital | 🥈 LA Health KeyPlus | Medihelp MedVital |
| 🌎 International Cover | Covered up to 100% of the scheme rates | R5 million | Scheme Tariff |
| 👤 Main Member Contribution | R2,040 | R1,310 – R2,080 | R2,256 |
| 👥 Adult Dependent Contribution | R1,755 | R1,144 – R1,851 | R1,722 |
| 🍼 Child Dependent Contribution | R405 | R479 – R777 | R744 |
| 📉 Annual Limit | Unlimited Hospital Cover | Unlimited | None |
Our Verdict on The Silver Hospital Plan
Sizwe Hosmed Silver Hospital is a medical aid plan offered by Sizwe Medical Fund, a South African medical aid scheme. This plan provides cover for hospitalization, specialized procedures, and chronic medication. However, it has some limitations, such as limited out-of-hospital coverage and several treatments that are not covered. The Sizwe Hosmed Silver Hospital plan offers unlimited hospitalization coverage at network hospitals, including general wards, intensive care units, and specialized units. The plan also covers in-hospital specialist consultations, diagnostic tests, and surgical procedures. Chronic medication for approved conditions is also covered.
One of the main drawbacks of the Sizwe Hosmed Silver Hospital plan is its limited out-of-hospital coverage. This plan does not cover consultations with general practitioners or specialists outside the hospital. Unfortunately, this means that members may need to pay for these services out of their own pockets, which can be costly. Another limitation of the Sizwe Hosmed Silver Hospital plan is that it does not cover specific treatments, such as cosmetic surgery, infertility treatment, and orthodontics. This may be a disadvantage for members who require these treatments.
Silver Hospital Plan Frequently Asked Questions
What is the Silver Hospital plan offered by Sizwe Hosmed?
The Silver Hospital plan is one of the healthcare plans offered by Sizwe Hosmed that provides comprehensive hospital coverage and limited day-to-day benefits.
What does the Silver Hospital plan cover?
The Hosmed Silver Hospital plan covers in-hospital expenses such as surgery, specialist consultations, and hospital accommodation. It also provides limited cover for medical expenses such as GP consultations and prescribed medication.
What are the benefits of choosing the Hosmed Silver Hospital plan?
The Silver Hospital plan offers comprehensive hospital coverage at an affordable monthly premium. It also provides limited cover for day-to-day medical expenses.
How much does the Silver Hospital plan from Sizwe Hosmed cost?
The Silver Hospital plan costs R2,040 for the main member, R1,755 per adult, and R405 per child dependent.
Does the Silver Hospital plan from Sizwe Hosmed cover chronic conditions?
The Silver Hospital plan from Sizwe Hosmed provides limited coverage for chronic conditions such as hypertension and diabetes.
Can I add dependents to my Silver Hospital plan from Sizwe Hosmed?
Yes, you can add dependents such as a spouse, children, or parents to your Silver Hospital plan from Sizwe Hosmed.
How do I claim with Sizwe Hosmed Silver Plan?
To claim with Sizwe Hosmed Silver Plan, you must submit a claim form and any relevant supporting documents, such as medical certificates or invoices.
Does Sizwe Hosmed Silver have a network of healthcare providers?
Yes, Sizwe Hosmed Silver has a network of healthcare providers, such as hospitals, clinics, and specialists, that members can use to receive medical treatment.
Can I change my Sizwe Hosmed Silver healthcare plan ?
Yes, you can change your healthcare plan with Sizwe Hosmed during the annual open enrollment period or in certain qualifying events, such as getting married or having a child.
