Overall, the Sizwe Hosmed Value Platinum 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 Value Core Medical Aid Plan starts from R5,306 ZAR.
| 👤 Main Member Contribution | R5,306 |
| 👥 Adult Dependent Contribution | R5,082 |
| 🍼 Child Dependent Contribution | R1,353 |
| ↪️ Gap Cover | None |
| ☑️ Hospital Cover | Unlimited for PMBs |
| 📉 Oncology Cover | R601,965 |
| 💶 Medical Savings Account | None |
💙 The Sizwe Hosmed Value Core medical aid plan is one of 8, starting from R5,306 ZAR and includes maternity benefits, appliance benefits, optometry, dentistry, wellness program, and more.
💙 Gap Cover is not available on the Sizwe Hosmed Value 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 |
| R5,306 | R5,082 | R1,353 |
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💙 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. 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. |
| 1️⃣ Consultations and Procedures | Covered up to 100% of the negotiated tariff. |
| 2️⃣ Basic Radiology and Pathology | Covered up to 100% of the scheme tariff. |
| 3️⃣ Specialized Radiology | Limited to two scans per beneficiary yearly. Overall combined In- and Out-of-Hospital Specialised Radiology limit of R37 963.80 per family per annum. R1 653.75 co-payment per scan event except for PMBs. |
| 4️⃣ Oncology | 100% of DSP Tariff* Oncology limit: R601 965 per beneficiary per annum. Benefits utilisation more than R601 965 per beneficiary per annum will be subject to 20% co-payment |
| 5️⃣ Renal Dialysis | Covered up to 100% of the negotiated tariff. |
| ❤️ Organ Transplants | Covered up to 100% of the scheme tariff. |
| 🦷 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. 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 | Covered up to 100% of the scheme tariff. Subject to managed care protocols. Only symptomatic wisdom teeth and surgical exposure are allowed. All other operations are subject to PMB approval alone. Only symptomatic impacted wisdom teeth are removed on a day-to-day basis. |
| 🩺 Drug and Alcohol Rehabilitation | Covered up to 100% of the scheme tariff. Maximum three (3) days admission for withdrawal treatment and up to 21 days admission for rehabilitation at an appropriate facility. |
| 🧠 Psychiatric Treatment (PMB) Consultations Ward Fees Medicines Psychiatry/psychology therapy sessions | Covered up to 100% of the scheme tariff. Subject to available benefits of R48 620.25 per beneficiary per admission at R2 315.25 per day. |
| ✔️ Non-PMB Psychiatric Treatment | Sub-limits (non-PMB) Physiotherapy: R2 100 per beneficiary annum. |
| ⬇️ Step-down Facilities | Covered up to 100% of the negotiated tariff. Limit: R9 059.40 per family per annum. |
| 🏡 Home-Based Care | Covered up to 100% of the negotiated tariff. Limited to R6 069 per beneficiary per year. |
| 🩹 Negative Pressure Wound Therapy | Covered up to 100% of the negotiated tariff. |
| 😮💨 Hyperbaric Oxygen Therapy | 100% of Negotiated Tariff. Limited to PMBs. |
| 🅰️ Male Sterilisation/Vasectomy | Covered up to 100% of the negotiated tariff. Sterilization is limited to R19 263.30 per beneficiary per year. Subject to pre-approval and PMBs. |
| 🅱️ Female Sterilisation/Tubal Ligation | Covered up to 100% of the negotiated tariff. Sterilization is limited to R19 263.30 per beneficiary per year. Subject to pre-approval and PMBs. |
| 🧬 Back and Neck Surgery | 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 | Covered up to 100% of the scheme tariff. Only covers Primary Central Nervous System tumors. |
| 📌 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 | PMBs are covered in DSP facilities. Subject to clinical protocols. In-hospital procedures will incur a 20% co-payment, except for diagnostic laparoscopy, aspiration/excision ovarian cyst, lap-appendicectomy, and treatment of recurrent or bilateral inguinal hernias. A co-payment does not apply if procedures are done at a day hospital or as a day case. |
| 🦾 Internal and External Prostheses | Covered up to 100% of the negotiated tariff. Subject to PMBs and pre-approval. Overall Surgical and non- surgical Prosthesis limit R57 015 per family per annum. |
| 🦿 Instrumentation and disc prostheses, including components and fixation devices for the back or spine. | Two (2) levels per year done in one procedure. |
| 🦵 Internal Prostheses | Joints – hip and knee (partial and total), only one (1) Prosthesis and only one (1) joint per annum. |
| ✴️ Aphakic Lenses | Limited to R8 439.90 |
| 🔁 Cardiac Stents | Cardiac Stents – One (1) stent per Lesion, maximum three (3) stents per family per annum. • Vascular Stents – Two (2) stents per family per annum. |
| ⚗️ Internal sphincters and stimulators | Limited to PMBs. |
| ☑️ Neurostimulators/Internal nerve stimulators for Parkinson’s disease | Subject to the overall prostheses limit. |
| ✅ Unlisted prostheses, artificial limbs, and external prostheses | Subject to overall Prosthesis limit. Subject to PMBs |
| 🩸 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. |
| ❎ Deductibles – Applied for In-hospital procedures | – Joint Replacement – Umbilical Hernia Repair – Hysterectomy – Functional Nasal Surgery – Elective Caesarean Section |
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| 🟥 Day Hospital Procedures using a DSP hospital Network | Covered up to 100% of the scheme tariff. |
| 🟧 Co-payments on day procedures | This will apply depending on the treatment. |
| 🟨 Out-of-Hospital Consultations General Practitioners Specialists Outpatient Facilities | There is a limit of 20 GP visits per family per year or 10 GP visits per beneficiary. There is a 30% co-payment after the 7th GP visit per beneficiary. Members have the following number of visits to Specialists: Main Member – 3 visits Member + 1 Dependent – 5 Visits Member +2 and more dependents – 7 Visits |
| 🟩 Acute Medicine | Covered up to 100% of the reference price. |
| 🟦 PMB Disease List Medicines | Covered up to 100% of the reference price. Unlimited cover provided. Non-formulary medicines incur a 30% co-payment when obtained voluntarily. |
| 🟪 Other Chronic (non-CDL) medicines | Covered up to 100% of the reference price. Limited to R16,808.40 per family per year. Limited to R8,334,90 per beneficiary per year. Non-formulary medicines incur a 30% co-payment when obtained voluntarily. |
| 🟥 Pharmacy Advised Treatment (PAT) | Covered up to 100% of the reference price. |
| 🟧 Contraceptives | Covered up to 100% of the reference price. Limited to R3 497.55 per family per annum. Paid from MSA. |
| 🟨 Oral and injectable | 100% of Reference Price* |
| 🟩 Mirena Device | Mirena Sub-limit: R2 315.25 per beneficiary every five (5) years |
| 🤓 Spectacle Lenses | Covered up to 100% of the DSP tariff. The following is covered: Single vision Lens: R247.32 per lens or Bi-Focal Lens : R536.76 per lens or Multi Focal Lens: R984.96 per lens |
| 👁️ Contact Lenses | Covered up to 100% of the DST tariff. Limited to R2,128 per beneficiary every 2 years. |
| 👓 Frames/Lens Enhancements | Covered up to 100% of the DSP tariff. Limited to R1,175 per beneficiary. |
| 🅰️ Eye Tests | Covered up to 100% of the DSP tariff. Limited to one comprehensive consultation per beneficiary every 2 years. |
| 🅰️ Dentistry | – |
| 🦷 Basic/Conservative Dentistry | Covered up to 100% of the scheme tariff. |
| 💤 Conscious Sedation | Inhalation sedation: 100% of the Sizwe Hosmed rate; subject to Managed Care Protocols. |
| 📌 Consultations, Fillings, Extractions | Covered up to 100% of the scheme tariff. |
| 📍 Root Canal | Covered up to 100% of the scheme tariff. |
| 🧪 Fluoride Treatment | Covered up to 100% of the scheme tariff. |
| 🅱️ Advanced Dentistry | |
| 👑 Crowns Bridgework Dentures Orthodontics Removal of Impacted Wisdom Teeth Non-Surgical Periodontics | Covered up to 100% of the scheme tariff. Crowns and bridges: Pre- authorisation is required. One (1) crown per family per year. Once per tooth in a five-year period. |
| ✳️ Dental Implants | Limited to two implants per family per year over 5 years, limited to R17,199. |
| ↪️ Partial Metal Frame Dentures | Limited to beneficiaries 16> Limited to one set per beneficiary every 5 years. Subject to the advanced dentistry limit. |
| ➡️ Acrylic (Plastic) Dentures for beneficiaries 16> | Each beneficiary receives one pair of acrylic/plastic dentures every four years. Subject to the advanced dentistry limits. |
| 🥰 Maxillo-Facial and Oral Dental Surgery | Covered up to 100% of the Scheme Tariff. Only hospitalization benefits are payable in accidents, injuries, congenital anomalies, and oncology-related operations. |
| 1️⃣ Alternative Services For Example: Speech therapy Podiatry, Occupational therapy Social worker | 100% of Scheme Tariff*. Paid from MSA and/or Above Threshold Benefit limited to: M: R2 013.90 M+: R3 533.25 |
| 2️⃣ Remedial and Other Therapies | Covered up to 100% of the scheme tariff. Paid from MSA and/or Above Threshold Benefit |
| 3️⃣ Physiotherapy Out-of-Hospital and Biokinetics | Covered up to 100% of the scheme tariff. Paid from MSA and/or Above Threshold Benefit |
| Allied Services | Subject to pre-authorisation, PMBs and Managed Care Protocol Includes: Homeopathy, Naturopathy, Chiropractor. 100% Scheme Tariff*. Paid from MSA and or Above Threshold limit Limited to R1 736.70 per beneficiary per annum. |
Appliances:
| ✈️ 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 scheme tariff. Limited to R8,101 per family per year or R3,224 per beneficiary. |
| ☑️ Infertility | Covered up to 100% of the scheme tariff. |
| 👩⚕️ Hospice and Private Nursing | Covered up to 100% of the Negotiated Tariff. Subject to the combined limit of 14 days per year except for PMBs. |
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💙 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. |
| 🔴 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. |
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Sizwe Hosmed Value Core covers the following chronic conditions on the CDL list:
Sizwe Hosmed Value Core covers the following 18 additional non-PMB conditions:
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💙 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 Plans | 🥇 Sizwe Hosmed Value Core | 🥈 Discovery Health Classic Saver | 🥉 Profmed ProSecure Savvy |
| 🌎 International Cover | Covered up to 100% of the scheme rates | R5 million | R8 million |
| 👤 Main Member Contribution | R5,306 | R4,182 | R4,816 |
| 👥 Adult Dependent Contribution | R5,082 | R3,299 | R4,458 |
| 🍼 Child Dependent Contribution | R1,353 | R1,676 | R1,881 |
| ➡️ Hospital Cover | Unlimited for PMBs | Unlimited | Covers up to 100% of the negotiated tariff |
| ↪️ Oncology Cover | R601,965 | R250,000 | R466,155 |
💙 The Value Core Option is designed to provide affordable healthcare coverage for individuals and families. It offers basic cover for in-hospital treatment and limited day-to-day medical expenses.
💙 Furthermore, members of this option can choose to receive treatment in a network of hospitals and healthcare providers. Another Sizwe Hosmed Value Core plan feature is the limited day-to-day medical benefits, including GP consultations, basic dentistry, and optometry.
💙 Members with chronic conditions can also access chronic medication through the scheme’s designated service provider. Additionally, the plan includes emergency medical services, such as ambulance services, which can be essential in medical emergencies.
💙 One of the major advantages of the Sizwe Hosmed Value Core plan is that it is an affordable option for individuals and families who may be unable to afford more comprehensive medical coverage. In addition, the plan offers basic medical coverage at a lower cost, which can benefit those on a tight budget.
💙 However, it is important to note that the Sizwe Hosmed Value Core plan has some limitations and exclusions. For instance, the day-to-day medical benefits are limited, and members may need to pay out-of-pocket for some medical expenses.
💙 Also, the plan may not cover all medical conditions or treatments, which can limit members’ access to medical care.
The Sizwe Hosmed Value Core plan is available to individuals and families looking for a basic healthcare plan that provides essential medical coverage. Anyone can apply for this plan, regardless of age or medical history.
Yes, the Sizwe Hosmed Value Core plan has some limitations and exclusions. For example, the day-to-day medical benefits are limited, and members may need to pay out-of-pocket for some medical expenses. The plan may also not cover all medical conditions or treatments, which can limit members’ access to medical care. Therefore, members should carefully review the plan’s terms and conditions before enrolling.
Yes, chronic medication is available on this Hosmed plan.
Yes, you can switch to a different Sizwe Hosmed plan. Members can contact customer service to discuss their options and make the necessary changes.
Members can pay for their Sizwe Hosmed Value Core plan through various payment options, including debit orders, EFT, or cash payment at selected retailers.
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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