Sizwe Full Benefit A medical aid plan: 2017 vs 2018

View all plans in this scheme.
Please note that these benefits are still being updated as more information is made available to us. Always consult with your broker before making final decisions regarding your healthcare cover.

COSTS and OVERVIEW:
Full Benefit A
2018 costs In brief:
What’s new in 2018?
Main: Adult: Child:
Cost 2018: R R R
Cost 2017: (R4,210) (R3,825) (R860)
Gap (optional): KaeloXelus: R350 per family
(R600 per family if anyone is 60yrs+)
Overal Limit: 2018 benefits coming soon. 2017 benefits:
  • Unlimited
PMBs: Day-to-day expenses for PMBs (eg. cancer) are always paid for by the scheme, according to protocols. Find out more
Children:
Income band: This plan is only available to households with income in pm band.
View other income bands

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Avoid bills! Get up to: 800% scheme rate;  R12,800 per ER visit; unlimited cancer cover;  

co-payments paid and cash payout for hospital stay. R350pm per family


IN HOSPITAL PROCEDURES:
Full Benefit A
2017 v 2018 benefits Gap benefits Notes
Payout Rate for Specialists: 2018 benefits coming soon. 2017 benefits:
  • Up to 500% of scheme rate
  • In case of admission related to accident:
    • R300 per day, for days 1-13
    • R600 per day for days 14-20
    • R1,200 per day for days 21-30

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Hospital Choice: 2018 benefits coming soon. 2017 benefits:
  • Unlimited
Specialised Radiology: 2018 benefits coming soon. 2017 benefits:
  • R35,422 per family, in and out of hospital
Supplementary Services: (Physio, etc) 2018 benefits coming soon. 2017 benefits:
  • 100% scheme rate
  • Dietician, speech therapy, occupational therapy: subject to PMBs
Transplants: 2018 benefits coming soon. 2017 benefits:
  • PMBs only
Co-payments:
  • Gap covers co-payments for most scopes and a defined list of other procedures, incl MRIs etc See full list
Alternatives to hospitals: 2018 benefits coming soon. 2017 benefits:
  • R8,610 per family
Casualty: 2018 benefits are coming soon!
Other: 2018 benefits are coming soon!
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OUT OF HOSPITAL BENEFITS:
Full Benefit A
2017 v 2018 benefits Gap benefits Notes
GP consultations: 2018 benefits coming soon. 2017 benefits:
  • M =12 consults; M1 =20 consults; M2 =25 consults; M3 =29 consults etc
  • Paid from day-to-day benefit


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Childcare:
  • No benefit
Specialists consultations: 2018 benefits coming soon. 2017 benefits:
  • Must be referred. Limited consults to: M =7 consults; M1 =12; M2 =15; M3 =16; M4 =17; M5 =19; M6+ =20
  • Paid from day-to-day benefit
Pathology: 2018 benefits coming soon. 2017 benefits:
  • M =R1,300 and M1+ =R2,750
  • Shared with radiology benefit
  • Paid from day-to-day benefit
General radiology: 2018 benefits coming soon. 2017 benefits:
  • M =R1,300 and M1+ =R2,750
  • Shared with pathology benefit
  • Paid from day-to-day benefit
Specialised radiology: 2018 benefits coming soon. 2017 benefits:
  • R35,420 per family, in and out of hospital
Supplementary Services: (Physio, etc) 2018 benefits coming soon. 2017 benefits:
  • Physio: from day-to-day benefit
  • Otherwise, R2,630 per person and R4,420 per family, paid by scheme
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MATERNITY BENEFITS:
Full Benefit A
2017 v 2018 benefits Gap benefits Notes
Hospital stay: 2018 benefits coming soon. 2017 benefits:
  • 100% scheme rate

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Consultations: 2018 benefits coming soon. 2017 benefits:
  • 9 consults with GP or midwife
  • 6 consults with OB, on referral
  • Paid by scheme
Scans: 2018 benefits coming soon. 2017 benefits:
  • 2 x 2D scans, paid by scheme
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CANCER (ONCOLOGY):
Full Benefit A
2017 v 2018 benefits Gap benefits Notes
Overall coverage (in and out of hospital): 2018 benefits coming soon. 2017 benefits:
  • R319,500 per family
All oncology benefits are assessed on a case-by-case basis, and are subject to protocols, preferred providers and scheme rules. Benefit covers out-of-hospital treatment too, like chemotherapy.
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DENTISTRY:
Full Benefit A
2017 v 2018 benefits Gap benefits Notes
Dentistry: 2018 benefits coming soon. 2017 benefits:
  • Standard dentistry: R3,600 per family
  • Specialised dentistry: 1 full or partial plastic dentures per person every 4 years and 2 partial metal frames per person every 5 years
  • 3 crowns per family
  • Implants: R3,500 per implant, 2 implants per person every 5 years

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Orthodontics: 2018 benefits coming soon. 2017 benefits:
  • 9-18yrs
Maxillo Facial Surgery: 2018 benefits are coming soon!

Avoid bills! Get up to: 800% scheme rate;  R12,800 per ER visit; unlimited cancer cover;  

co-payments paid and cash payout for hospital stay. R350pm per family

MEDICATION:
Full Benefit A
2017 v 2018 benefits Gap benefits Notes
Chronic: 2018 benefits coming soon. 2017 benefits:
  • non-PMB: 33 additional conditions covered
  • R10,400 per person

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Acute (presrcibed) medication: 2018 benefits coming soon. 2017 benefits:
  • Paid from day-to-day benefit, with following sub limits:
M =R4,380 M1 =R7,750 M2 =R8,990 M3 =R10,230 M4 =R10,890 M5 =R11,460 M6+ =R12,020
Over-the-counter:
Birth Control: 2018 benefits coming soon. 2017 benefits:
  • Paid from R2,490 per family
On Discharge:
Biological:
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OPTOMETRY:
Full Benefit A
2017 v 2018 benefits Gap benefits Notes
Optometry: 2018 benefits coming soon. 2017 benefits:
  • Eye test: one per person every 2 years
  • Frames: R300 per person every 2 years
  • Lenses: R165 per lend for single, R360 for bifocal, R660 for multifocal, every 2 years
  • Contact lenses: R525 per person
  • Refractive surgery: R11,490 per per family

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MENTAL HEALTH:
Full Benefit A
2017 v 2018 benefits Gap benefits Notes
In-hospital: 2018 benefits coming soon. 2017 benefits:
  • 21 days per person

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Out-of-hospital: 2018 benefits coming soon. 2017 benefits:
  • R15,680 per family
Trauma:
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OTHER BENEFITS:
Full Benefit A
2017 v 2018 benefits Gap benefits Notes
General Appliances: 2018 benefits coming soon. 2017 benefits:
  • M =R2,510 and M1+ = R4,180
  • No benefit

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1.1. Hearing Aids: 2018 benefits coming soon. 2017 benefits:
  • R12,700 per family
  • No benefit
1.2. Wheelchairs: 2018 benefits coming soon. 2017 benefits:
  • R4,170 per family
  • No benefit
Dialysis: 2018 benefits coming soon. 2017 benefits:
  • PMBs only
HIV: 2018 benefits coming soon. 2017 benefits:
  • Subject to treatment protocols
  • No benefit
Emergency Transport:
  • No benefit
International Insurance: 2018 benefits are coming soon!
  • No benefit
Other: 2018 benefits are coming soon!
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WELLNESS/PREVENTATIVE BENEFITS:
Full Benefit A
2017 v 2018 benefits Gap benefits Notes
Flu vaccination: 2018 benefits coming soon. 2017 benefits:
  • Covered, with R2,500 per family sublimit for all preventative benefits
  • No benefit

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Pneumonia vaccines: 2018 benefits coming soon. 2017 benefits:
  • Covered, with R2,500 per family sublimit for all preventative benefits
  • No benefit
Back Rehabilitation Programme: 2018 benefits are coming soon!
  • No benefit
Biometric Screening: 2018 benefits are coming soon!
  • No benefit
Child Immunisation: 2018 benefits are coming soon!
  • No benefit
Pap Smear: 2018 benefits coming soon. 2017 benefits:
  • Covered, with R2,500 per family sublimit for all preventative benefits
  • No benefit
Mammogram: 2018 benefits coming soon. 2017 benefits:
  • Covered, with R2,500 per family sublimit for all preventative benefits
  • No benefit
PAS Test: 2018 benefits coming soon. 2017 benefits:
  • Covered, with R2,500 per family sublimit for all preventative benefits
  • No benefit
HIV Test: 2018 benefits are coming soon!
  • No benefit
Other:
  • No benefit

Avoid bills! Get up to: 800% scheme rate;  R12,800 per ER visit; unlimited cancer cover;  

co-payments paid and cash payout for hospital stay. R350pm per family

2017 v 2018 benefits Gap benefits Notes
Overal Limit:
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Sub-limits:

    Important!
  • Unless specified, assume that all benefits are paid are paid at 100% scheme rate
  • No limits or co-payments can apply to treatment of PMBs, which is always unlimited, although subject to strict protocols and scheme rules.
  • “Unlimited” benefits are still subject to authorisation, protocols and sublimits
  • Assume that all benefits need to be pre-authorised