Value Platinum Plan
About this plan
🥇 Best suited for families and professionals seeking premium hospital cover with comprehensive day-to-day benefits and a Medical Savings Account.
Principal Member
From
R6,696
per month
Adult Dependant
From
R6,287
per month
Child Dependant
From
R1,834
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
Value Platinum Plan
Sizwe Hosmed Value Platinum Plan (🇿🇦 2026)
Overall, the Sizwe Hosmed Value Platinum Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and unlimited hospital cover to its members. The Sizwe Hosmed Value Platinum Medical Aid Plan starts from R6 696 ZAR.| 👤 Main Member Contribution | R6 696 |
| 👥 Adult Dependent Contribution | R6 287 |
| 🍼 Child Dependent Contribution | R1 834 |
| 🌎 International Cover | Covered up to 100% of the scheme rates |
| 📉 Annual Limit | Unlimited Hospital Cover |
| 🚑 Hospital Cover | Unlimited for PMBs |
| 💶 Prescribed Minimum Benefits | ☑️ Yes |
| ↪️ Screening and Prevention | ☑️ Yes |
| 💳 Medical Savings Account | None |
| 💙 Maternity Benefits | ☑️ Yes |
Sizwe Hosmed Value Platinum Plan - 7 Key Point Quick Overview
- ☑️ Sizwe Hosmed Value Platinum Plan Overview
- ☑️ Sizwe Hosmed Value Platinum Plan Contributions
- ☑️ Value Platinum Plan Benefits and Cover Comprehensive Breakdown
- ☑️ Value Platinum Plan Exclusions and Waiting Periods
- ☑️ Sizwe Hosmed Value Platinum Plan vs. Similar Plans from other Medical Schemes
- ☑️ Our Verdict on The Value Platinum Plan
- ☑️ Value Platinum Plan Frequently Asked Questions
Sizwe Hosmed Value Platinum Plan Overview
💙 The Sizwe Hosmed Value Platinum Medical Aid Plan is one of 8, starting from R6 696 and includes cover for 26 chronic and 18 additional non-PMB conditions, contraceptives, optical optometry from scheme risk, unlimited hospital cover, GP and Specialist consultations, and more.
💙 Gap Cover is not available on the Sizwe Hosmed Value Platinum 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 Value Platinum Plan Contributions
| 👤 Main Member | 👥 Adult Dependent | 🍼 Child Dependent |
| R6 696 | R6 287 | R1 692 |
Value Platinum Plan Benefits and Cover Comprehensive Breakdown
Value Platinum 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.
- ☑️ Value Platinum 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 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 R39 861.99 per family per annum. R1 736.44 co-payment per scan event except for PMBs. |
| 4️⃣ Oncology | 100% of DSP Tariff* Oncology limit: R632 063.25 per beneficiary per annum. Benefits utilisation more than R632 063.25 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 R51 051.26 per beneficiary per admission at R2 431.01 per day. |
| ✔️ Non-PMB Psychiatric Treatment | No benefit |
| ⬇️ Step-down Facilities | Covered up to 100% of the negotiated tariff. Subject to PMBs, pre-authorisation and managed care protocols at registered step-down and nursing facilities. Subject to the Hospital Benefit Management programme and the Disease Management programme. |
| 🏡 Home-Based Care | Covered up to 100% of the negotiated tariff. Limited to R9 512.37 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 R20 226.47 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 R20 226.47 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 R59 865.75 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 861.90 |
| 🔁 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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Value Platinum Day-to-Day Benefits
| 🟥 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 R17 648.82 per family per year. Limited to R8 751.65 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 672.43 per family per annum. Paid from MSA. |
| 🟨 Oral and injectable | 100% of Reference Price* |
| 🟩 Mirena Device | Mirena Sub-limit: limit per beneficiary every five (5) years will occur. |
Value Platinum Optical Benefits
| 🤓 Spectacle Lenses | Covered up to 100% of the DSP tariff. The following is covered: Single vision Lens: R259.69 per lens or Bi-Focal Lens : R536.76 per lens or Multi Focal Lens: R1034.21 per lens |
| 👁️ Contact Lenses | Covered up to 100% of the DST tariff. Limited to R2,234.40 per beneficiary every 2 years. |
| 👓 Frames/Lens Enhancements | Covered up to 100% of the DSP tariff. Limited to R1,233.75 per beneficiary. |
| 🅰️ Eye Tests | Covered up to 100% of the DSP tariff. Limited to one comprehensive consultation per beneficiary every 2 years. |
Value Platinum Dentistry Benefits
| 🅰️ 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 : R 18 058.95. |
| ↪️ 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. |
Value Platinum Auxiliary Benefits
| 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 0114.60 M+: R3 709.91 |
| 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 823.54 per beneficiary per annum. |
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Value Platinum Medical Appliances Benefits
Appliances:- ☑️ Covered up to 100% of the negotiated tariff.
- ☑️ Limited to Limited to M: R2 114.60 and M+: R3 711.02
- ☑️ Subject to pre-authorisation, clinical criteria and benefit limits
- ☑️ Subject to the overall prostheses limits for children under 7.
- The following applies:
- ☑️ Wheelchairs are limited to one claim per beneficiary every three years (subject to pre-authorization). Family Limit: R4 207.35 per cycle
- ☑️ Hearing aids are limited to one claim per beneficiary every 2 years (subject to pre-authorization). Annual family limit: R16 042.95
- ☑️ Blood Pressure Monitors are subject to a sub-limit of R659.40 for beneficiaries registered for Hypertension.
Value Platinum 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 | 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. |
Value Platinum: 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 | Covered up to 100% of the negotiated tariff. A registered Midwife, GP, or medical specialist can only do it. Materials included in benefit. |
| 🤰 Maternity Ultrasounds | Limited to three 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 6 GP maternity appointments and 3 specialist consultations each pregnancy at GP or Specialist. |
| ➡️ Antenatal Pathology Screening | 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. |
Value Platinum Preventative Care Benefits
| 👩⚕️ Wellness Consultations | Limited to R1,219 per family per year. |
| 💉 COVID-19 Vaccination | Covered according to guidelines. |
| 1️⃣ Pap Smear for female beneficiaries 18> | One per qualifying beneficiary yearly. |
| 2️⃣ Mammogram for female beneficiaries 40> | One per qualifying beneficiary yearly. |
| 3️⃣ PSA for Male Beneficiaries 40> | One per qualifying beneficiary yearly. |
| 4️⃣ Cholesterol Test for beneficiaries 20> | One per qualifying beneficiary yearly. |
| 5️⃣ Flu Vaccine for all beneficiaries | One per beneficiary yearly. |
| 6️⃣ 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. |
Value Platinum Chronic Diseases Benefit
Sizwe Hosmed Value Platinum 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
- ✅ Attention Deficit Hyperactivity
- ✅ Disorder (ADHD)
- ✅ Allergic Rhinitis
- ✅ Benign Prostatic Hypertrophy (BPH)
- ✅ Cushing’s Disease
- ✅ Cystic Fibrosis
- ✅ Depression
- ✅ Endometriosis
- ✅ Gout
- ✅ Hyperthyroidism
Value Platinum Plan Exclusions and Waiting Periods
Value Platinum 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
Value Platinum 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. 👉🏿 Discover the basics of Late Joiner Penalties
Sizwe Hosmed Value Platinum Plan vs. Similar Plans from other Medical Schemes
| 🔎 Medical Aid Plan | 🥇 Sizwe Hosmed Value (2026) | 🥈 Fedhealth FlexiFED 3 (2026) | 🥉 Medihelp MedPrime (2026) |
| 👤 Main Member Contribution | R6 696,00 | R3,705 – R4,946 | R5 790 |
| 👥 Adult Dependent Contribution | R6 287,00 | R3,398 – R4,531 | R4 896 |
| 🍼 Child Dependent Contribution | R1 834,00 | R1,314 – R1,753 | R1 692 |
| 📉 Annual Limit | Unlimited Hospital Cover | Unlimited Hospital Cover | Unlimited Hospital Cover |
| 💙 Hospital Cover | Unlimited for PMBs | Unlimited | Unlimited |
| ➡️ Oncology Cover | R632 063.25 | From R311,900 | R336 000 per family per year |
Our Verdict on The Value Platinum Plan
💙 Sizwe Hosmed is a South African medical aid scheme that offers several healthcare plans, including the Sizwe Hosmed Value Platinum Plan. This plan is designed for individuals who want basic healthcare coverage at an affordable price.
💙 The Sizwe Hosmed Value Platinum Plan offers members access to private hospitals, general practitioners, specialists, and chronic medication.
💙 It also covers day-to-day medical expenses such as consultations, X-rays, and blood tests. In addition, members can access a 24-hour helpline and use the Hosmed Wellness Program for health assessments and advice.
💙 One of the drawbacks of the Sizwe Hosmed Value Platinum Plan is its limited benefits. While it covers essential healthcare services, it does not offer as many benefits as other, more comprehensive plans. The plan also has some restrictions on the use of benefits, such as a limit on the number of consultations with specialists.
💙 Therefore, The Sizwe Hosmed Value Platinum Plan is an excellent choice for individuals who want basic healthcare coverage at an affordable price. It offers access to private hospitals, specialists, and chronic medication and includes day-to-day medical expenses.
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