Sizwe out-of-hospital benefits: 2017

By Staff Writer -

Click here to compare out-of-hospital benefits across all schemes, or use the menu bar above for more options. Sizwe home page.

Hospital Plan

No items found

Gomomo Plan

Sizwe Gomomo A 2017: Out Of Hospital Benefits
In brief: 100% scheme rate. Scheme pays out-of-hospital claims for: maternity. Limits apply. All else paid from savings or from out of pocket, unless PMB.
1. GP consultations:
  • Chosen GP: Unlimited if pre-authorised
  • Other GP: 4 consults if pre-authorised
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,666 R1,546 R410
Children: Pay for all children
Income limit: R0-R10,112 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some:maternity. Limits apply. All else paid from savings or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

2. Specialists consultations:
  • Covered if referred by GP
3. Pathology:
  • No benefit, unless PMB
4. General radiology:
  • No benefit, unless PMB
5. Specialised radiology:
  • R6,770 per family, in and out of hospital
6. Supplementary Services: (Physio, etc)
  • R2,400 per family

View this plan

Sizwe Gomomo B 2017: Out Of Hospital Benefits
In brief: 100% scheme rate. Scheme pays out-of-hospital claims for: GPs, specialists, medication, radiology, physio, pathology, standard dentistry, optometry, maternity. Limits apply. All else paid from out of pocket, unless PMB.
1. GP consultations:
  • Chosen GP: Unlimited if pre-authorised
  • Other GP: 4 consults if pre-authorised
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,060 R1,623 R420
Children: Pay for all children
Income limit: R10,113+ (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GPs, specialists, medication, radiology, physio, pathology, standard dentistry, optometry, maternity. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

2. Specialists consultations:
  • Covered if referred by GP
3. Pathology:
  • No benefit, unless PMB
4. General radiology:
  • No benefit, unless PMB
5. Specialised radiology:
  • R6,770 per family, in and out of hospital
6. Supplementary Services: (Physio, etc)
  • R2,400 per family

View this plan

Savings Plan

Sizwe Savings Care A 2017: Out Of Hospital Benefits
In brief: 100% scheme rate. Scheme pays out-of-hospital claims for: radiology, pathology, maternity. Limits apply. All else paid from out of pocket, unless PMB.
1. GP consultations:
  • Paid from day-to-day benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,015 R1,742 R490
Children: Pay for all children
Income limit: R0-R15,052 (other limits)
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GPs, specialists, medication, radiology, physio, pathology, standard dentistry, optometry, maternity. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R3,627 R3,136 R882

Compare with these plans:

2. Specialists consultations:
  • Paid from day-to-day benefit
3. Pathology:
  • Paid from day-to-day benefit
4. General radiology:
  • Paid from day-to-day benefit
5. Specialised radiology:
  • R23,960 per family, in and out of hospital
6. Supplementary Services: (Physio, etc)
  • Paid from day-to-day benefit

View this plan

Sizwe Savings Care B 2017: Out Of Hospital Benefits
In brief:
1. GP consultations:
  • Paid from day-to-day benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,800 R2,243 R555
Children: Pay for all children
Income limit: R15,053+ (other limits)
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R5,040 R4,037 R999

Compare with these plans:

2. Specialists consultations:
  • Paid from day-to-day benefit
3. Pathology:
  • Paid from day-to-day benefit
4. General radiology:
  • Paid from day-to-day benefit
5. Specialised radiology:
  • R23,960 per family, in and out of hospital
6. Supplementary Services: (Physio, etc)
  • Paid from day-to-day benefit

View this plan

Primary Plan

Sizwe Primary Care A 2017: Out Of Hospital Benefits
In brief:
1. GP consultations:
  • M =4 consults; M1 =9 consults; M2 =12 consults; M3 =14 consults etc
  • Paid from day-to-day benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R407 R407 R407
Children: Pay for all children
Income limit: R0-R530 (other limits)
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

Day-to-day limit: M =R5,390 M1 =R7,980 M2 =R9,330 M3 =R10,670 M4 =R12,020 M5 =R13,370 M6+ =R14,720
2. Specialists consultations:
  • Must be referred. Limited consults to: M =2 consults; M1 =6; M2 =7; M3 =8; M4 =9; M5 =10; M6+ =11
  • Paid from day-to-day benefit
3. Pathology:
  • M =R1,000 and M1+ =R1,900
  • Shared with radiology benefit
  • Paid from day-to-day benefit
4. General radiology:
  • M =R1,000 and M1+ =R1,900
  • Shared with pathology benefit
  • Paid from day-to-day benefit
5. Specialised radiology:
  • R17,710 per family, in and out of hospital
6. Supplementary Services: (Physio, etc)
  • Physio: from day-to-day benefit
  • Otherwise: R960 per person and and R1,550 per family, paid by scheme

View this plan

Sizwe Primary Care B 2017: Out Of Hospital Benefits
In brief:
1. GP consultations:
  • M =4 consults; M1 =9 consults; M2 =12 consults; M3 =14 consults etc
  • Paid from day-to-day benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,907 R1,488 R480
Children: Pay for all children
Income limit: R531-R8,766 (other limits)
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

Day-to-day limit: M =R5,390 M1 =R7,980 M2 =R9,330 M3 =R10,670 M4 =R12,020 M5 =R13,370 M6+ =R14,720
2. Specialists consultations:
  • Must be referred. Limited consults to: M =2 consults; M1 =6; M2 =7; M3 =8; M4 =9; M5 =10; M6+ =11
  • Paid from day-to-day benefit
3. Pathology:
  • M =R1,000 and M1+ =R1,900
  • Shared with radiology benefit
  • Paid from day-to-day benefit
4. General radiology:
  • M =R1,000 and M1+ =R1,900
  • Shared with pathology benefit
  • Paid from day-to-day benefit
5. Specialised radiology:
  • R17,710 per family, in and out of hospital
6. Supplementary Services: (Physio, etc)
  • Physio: from day-to-day benefit
  • Otherwise: R960 per person and and R1,550 per family, paid by scheme

View this plan

Sizwe Primary Care C 2017: Out Of Hospital Benefits
In brief:
1. GP consultations:
  • M =4 consults; M1 =9 consults; M2 =12 consults; M3 =14 consults etc
  • Paid from day-to-day benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,326 R1,519 R480
Children: Pay for all children
Income limit: R8,767+ (other limits)
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

Day-to-day limit: M =R5,390 M1 =R7,980 M2 =R9,330 M3 =R10,670 M4 =R12,020 M5 =R13,370 M6+ =R14,720
2. Specialists consultations:
  • Must be referred. Limited consults to: M =2 consults; M1 =6; M2 =7; M3 =8; M4 =9; M5 =10; M6+ =11
  • Paid from day-to-day benefit
3. Pathology:
  • M =R1,000 and M1+ =R1,900
  • Shared with radiology benefit
  • Paid from day-to-day benefit
4. General radiology:
  • M =R1,000 and M1+ =R1,900
  • Shared with pathology benefit
  • Paid from day-to-day benefit
5. Specialised radiology:
  • R17,710 per family, in and out of hospital
6. Supplementary Services: (Physio, etc)
  • Physio: from day-to-day benefit
  • Otherwise: R960 per person and and R1,550 per family, paid by scheme

View this plan

Affordable Plan

Sizwe Affordable Care A 2017: Out Of Hospital Benefits
In brief:
1. GP consultations:
  • M =7 consults; M1 =14 consults; M2 =16 consults; M3 =18 consults etc
  • Paid from day-to-day benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,733 R2,511 R630
Children: Pay for all children
Income limit: R0-R15,052 (other limits)
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

Day-to-day limit: M =R9,330 M1 =R13,370 M2 =R15,390 M3 =R16,740 M4 =R18,760 M5 =R20,790 M6+ =R22,690
2. Specialists consultations:
  • Must be referred. Limited consults to: M =4 consults; M1 =8; M2 =9; M3 =10; M4 =11; M5 =12; M6+ =13
  • Paid from day-to-day benefit
3. Pathology:
  • M =R1,100 and M1+ =R2,200
  • Shared with radiology benefit
  • Paid from day-to-day benefit
4. General radiology:
  • M =R1,100 and M1+ =R2,200
  • Shared with pathology benefit
  • Paid from day-to-day benefit
5. Specialised radiology:
  • R26,920 per family, in and out of hospital
6. Supplementary Services: (Physio, etc)
  • Physio: from day-to-day benefit
  • Otherwise, R1,440 per person and R2,510 per family, paid by scheme

View this plan

Sizwe Affordable Care B 2017: Out Of Hospital Benefits
In brief:
1. GP consultations:
  • M =7 consults; M1 =14 consults; M2 =16 consults; M3 =18 consults etc
  • Paid from day-to-day benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,843 R2,610 R660
Children: Pay for all children
Income limit: R15,053-R18,444 (other limits)
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

Day-to-day limit: M =R9,330 M1 =R13,370 M2 =R15,390 M3 =R16,740 M4 =R18,760 M5 =R20,790 M6+ =R22,690
2. Specialists consultations:
  • Must be referred. Limited consults to: M =4 consults; M1 =8; M2 =9; M3 =10; M4 =11; M5 =12; M6+ =13
  • Paid from day-to-day benefit
3. Pathology:
  • M =R1,100 and M1+ =R2,200
  • Shared with radiology benefit
  • Paid from day-to-day benefit
4. General radiology:
  • M =R1,100 and M1+ =R2,200
  • Shared with pathology benefit
  • Paid from day-to-day benefit
5. Specialised radiology:
  • R26,920 per family, in and out of hospital
6. Supplementary Services: (Physio, etc)
  • Physio: from day-to-day benefit
  • Otherwise, R1,440 per person and R2,510 per family, paid by scheme

View this plan

Sizwe Affordable Care C 2017: Out Of Hospital Benefits
In brief:
1. GP consultations:
  • M =7 consults; M1 =14 consults; M2 =16 consults; M3 =18 consults etc
  • Paid from day-to-day benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R3,657 R3,251 R730
Children: Pay for all children
Income limit: R18,445+ (other limits)
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

Day-to-day limit: M =R9,330 M1 =R13,370 M2 =R15,390 M3 =R16,740 M4 =R18,760 M5 =R20,790 M6+ =R22,690
2. Specialists consultations:
  • Must be referred. Limited consults to: M =4 consults; M1 =8; M2 =9; M3 =10; M4 =11; M5 =12; M6+ =13
  • Paid from day-to-day benefit
3. Pathology:
  • M =R1,100 and M1+ =R2,200
  • Shared with radiology benefit
  • Paid from day-to-day benefit
4. General radiology:
  • M =R1,100 and M1+ =R2,200
  • Shared with pathology benefit
  • Paid from day-to-day benefit
5. Specialised radiology:
  • R26,920 per family, in and out of hospital
6. Supplementary Services: (Physio, etc)
  • Physio: from day-to-day benefit
  • Otherwise, R1,440 per person and R2,510 per family, paid by scheme

View this plan

Full Benefit Plan

Sizwe Full Benefit A 2017: Out Of Hospital Benefits
In brief:
1. GP consultations:
  • M =12 consults; M1 =20 consults; M2 =25 consults; M3 =29 consults etc
  • Paid from day-to-day benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R4,210 R3,825 R860
Children: Pay for all children
Income limit: R0-R18,879 (other limits)
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

Day-to-day limit: M =R15,390 M1 =R20,790 M2 =R23,370 M3 =R26,060 M4 =R28,770 M5 =R31,460 M6+ =R34,150
2. Specialists consultations:
  • 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
3. Pathology:
  • M =R1,300 and M1+ =R2,750
  • Shared with radiology benefit
  • Paid from day-to-day benefit
4. General radiology:
  • M =R1,300 and M1+ =R2,750
  • Shared with pathology benefit
  • Paid from day-to-day benefit
5. Specialised radiology:
  • R35,420 per family, in and out of hospital
6. Supplementary Services: (Physio, etc)
  • Physio: from day-to-day benefit
  • Otherwise, R2,630 per person and R4,420 per family, paid by scheme

View this plan

Sizwe Full Benefit B 2017: Out Of Hospital Benefits
In brief:
1. GP consultations:
  • M =12 consults; M1 =20 consults; M2 =25 consults; M3 =29 consults etc
  • Paid from day-to-day benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R4,885 R4,441 R960
Children: Pay for all children
Income limit: R18,880+ (other limits)
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

Day-to-day limit: M =R15,390 M1 =R20,790 M2 =R23,370 M3 =R26,060 M4 =R28,770 M5 =R31,460 M6+ =R34,150
2. Specialists consultations:
  • 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
3. Pathology:
  • M =R1,300 and M1+ =R2,750
  • Shared with radiology benefit
  • Paid from day-to-day benefit
4. General radiology:
  • M =R1,300 and M1+ =R2,750
  • Shared with pathology benefit
  • Paid from day-to-day benefit
5. Specialised radiology:
  • R35,420 per family, in and out of hospital
6. Supplementary Services: (Physio, etc)
  • Physio: from day-to-day benefit
  • Otherwise, R2,630 per person and R4,420 per family, paid by scheme

View this plan


Medical Aid Bible helps South Africans choose the best medical aid plan for their needs. Quickly view the benefits on any open plan, and compare any two plans with a simple click.
.