Sizwe Hosmed Medical Aid Scheme

Overall, Sizwe Hosmed offers 12 medical aid plans:

• ✅ Sizwe Hosmed Value Core
• ✅ Sizwe Hosmed Titanium Executive
• ✅ Sizwe Hosmed Silver Hospital
• ✅ Sizwe Hosmed Plus
• ✅ Sizwe Hosmed Platinum Enhanced
• ✅ Sizwe Hosmed Platinum Enhanced EDO
• ✅ Sizwe Hosmed Gold Ascend
• ✅ Sizwe Hosmed Gold Ascend EDO
• ✅ Sizwe Hosmed Value
• ✅ Sizwe Hosmed Essential Copper
• ✅ Sizwe Hosmed Access Saver 25
• ✅ Sizwe Hosmed Acces Core

price starting from R1870 per month. Additionally, Sizwe Hosmed offers 24/7 emergency support but does not offer comprehensive gap cover on any policy.

Sizwe Hosmed Review – Analysis of Medical Aids Main Features

1. ✅ Sizwe Hosmed at a Glance
2. ✅ Sizwe Hosmed Regulation
3. ✅ Sizwe Hosmed Plan Overview
4. ✅ Sizwe Hosmed – Advantages over Competitors
5. ✅ Sizwe Hosmed Medical Savings Account
6. ✅ How to apply for Medical Aid with Sizwe Hosmed
7. ✅ How to apply for Gap Cover with Sizwe Hosmed
8. ✅ How to Submit a Claim with Sizwe Hosmed
9. ✅ How to Submit a Compliment or Complaint with Sizwe Hosmed
10. ✅ How to Switch my Medical Aid to Sizwe Hosmed
11. ✅ Sizwe Hosmed Customer Support
12. ✅ Sizwe Hosmed vs Platinum Health vs Fedhealth – A Comparison
13. ✅ Sizwe Hosmed Member Reviews
14. ✅ Sizwe Hosmed – Our Verdict
15. ✅ Sizwe Hosmed Pros and Cons
16. ✅ Sizwe Hosmed Frequently Asked Questions

Medical Aid Sizwe Hosmed at a Glance

Sizwe Hosmed Regulation

The Council for Medical Schemes regulates Sizwe Hosmed Medical Scheme. The Council governs South Africa’s medical plan business for Medical Schemes (CMS), a regulating body set up under the Medical Schemes Act, No. 131 of 1998 (the Act). The CMS is responsible for a range of tasks related to the oversight of medical insurance plans, such as:

• Responsible for registering medical insurance plans and ensuring they comply with the law and other laws.
• Making sure healthcare plans have the money to pay claims.
• Examining and authorizing proposed price hikes for medical plans.
• Accepting and examining member complaints and initiating disciplinary action against medical plans that violate the Act or other applicable rules.
• Helping medical insurance plans follow the law and other laws.

Furthermore, if a medical scheme is found to violate the law, the CMS has the authority to issue administrative fines and penalties.

Sizwe Hosmed Plan Overview

· GP and Specialist Consult

· 10,704 ZAR (M+1 Dep.)

· 12,526 ZAR (M+2 Dep.)

· 14,325 ZAR (M+3 Dep.)

· 16,146 ZAR (M+4 Dep.)

· 17,956 ZAR (M+5 Dep.)

· 10,704 ZAR (M+1 Dep.)

· 12,526 ZAR (M+2 Dep.)

· 14,325 ZAR (M+3 Dep.)

· 16,146 ZAR (M+4 Dep.)

· 17,956 ZAR (M+5 Dep.)

· 23,980 ZAR (M+1 Dep.)

· 26,090 ZAR (M+2 Dep.)

· 23,980 ZAR (M+1 Dep.)

· 26,090 ZAR (M+2 Dep.)

· 11,214 ZAR (Adult)

· 10,647 ZAR (Adult)

· 30,848 ZAR (M+1 Dep.)

· 33,670 ZAR (M+2 Dep.)

· 18,585 ZAR (Adult)

Traditional Plans

A traditional plan offers daily benefits with a fixed monetary amount for each condition or treatment, which may vary depending on the size of your family. These benefits have a set amount; once used, they cannot be accessed again until the next year. These plans typically allow free choice of service providers and provide peace of mind that even if one benefit is fully used, other benefits may still be available for the family. In addition, unused benefits do not accumulate or carry over to the next year. However, they are renewed at the start of each year.

A conventional design that offers affordable cover for young families with a single parent and young members. The features and benefits of this plan are as follows:

In-Hospital Benefit:

• No Overall Annual Limit

Out-of-Hospital Medical Benefits:

(Includes GP, Specialist (except for Psychiatrists), Physiotherapy, Radiology, Pathology, and Acute Medication:

• Main – R7,228 ZAR
• Main + 1 Dependent – R10,704 ZAR
• Main + 2 Dependents – R12,526 ZAR
• Main + 3 Dependents – R14,325 ZAR
• Main + 4 Dependents – R16,146 ZAR
• Main + 5 Dependents – R17,956 ZAR
• Main + 6 Dependents – R19,755 ZAR

• Statutorily Prescribed Minimum Benefits (PMBs) Unlimited.
• Cover for medical emergencies while traveling outside South Africa:
• 100% of Scheme rates are paid in ZAR.
• Subject to documentation completion before departure from RSA.
• Subject to Scheme’s approval.

Option at a discount that yet provides much-needed cover, with the following benefits:

In-Hospital Benefit:

• No Overall Annual Limit
• System Hospital DSP Applies to all advantages. A 10% co-payment is required for the voluntary use of non-DSP providers.

Out-of-Hospital Benefits:

(GP, Specialist (excluding Psychiatrists), Physiotherapy, Radiology, Pathology, and Acute Medication).

• Main – R7,228 ZAR
• Main + 1 Dependent – R10,704 ZAR
• Main + 2 Dependents – R12,526 ZAR
• Main + 3 Dependents – R14,325 ZAR
• Main + 4 Dependents – R16,146 ZAR
• Main + 5 Dependents – R17,956 ZAR
• Main + 6 Dependents – R19,755 ZAR

• Statutorily Prescribed Minimum Benefits (PMBs) Unlimited.
• Cover for medical emergencies while traveling outside South Africa:
• 100% of Scheme rates are paid in ZAR.
• Subject to documentation completion before departure from RSA.
• Subject to Scheme’s approval.

Sizwe Hosmed Medical – Value

Value is a conventional plan serving families who require extensive health care coverage. Furthermore, Value has the following benefits:

In-Hospital Benefit:

• No Overall Annual Limit

Out-of-Hospital Medical Benefits:

Other than GP & Specialist consultations, Pathology, Radiology, and Chronic Medicine, Out-of-Hospital Benefits are limited to the following per Family per year:

• Twenty visits to the doctor per family.
• Benefit for +18 Non-CDL Chronic disorders.
• Main – 11,356 ZAR
• Main + 1 Dependent – 23,980 ZAR
• Main + 2 Dependents – 26,090 ZAR
• Main + 3 Dependents – 29,722 ZAR

• Statutorily Prescribed Minimum Benefits (PMBs) Unlimited.
• Cover for medical emergencies while traveling outside South Africa:
• 100% of Scheme rates are paid in ZAR.
• Subject to documentation completion before departure from RSA.
• Subject to Scheme’s approval.

Sizwe Hosmed Medical – Value Core EDO

Reduced fees for accessing cover across available provider networks, with the following benefits:

In-Hospital Benefit:

• No Overall Annual Limit

Out-of-Hospital Medical Benefits:

Other than GP & Specialist consultations, Pathology, Radiology, and Chronic Medicine, Out-of-Hospital Benefits are limited to the following per Family per year:

• Twenty visits to the doctor per family.
• Benefit for +18 Non-CDL Chronic disorders.
• Main – 11,356 ZAR
• Main + 1 Dependent – 23,980 ZAR
• Main + 2 Dependents – 26,090 ZAR
• Main + 3 Dependents – 29,722 ZAR

• Statutorily Prescribed Minimum Benefits (PMBs) Unlimited.
• Cover for medical emergencies while traveling outside South Africa:
• 100% of Scheme rates are paid in ZAR.
• Subject to documentation completion before departure from RSA.
• Subject to Scheme’s approval.

Sizwe Hosmed Medical – Plus

A conventional plan designed for families and individuals with substantial medical requirements. Furthermore, the Plus plan has the following benefits:

In-Hospital Benefit:

• No Annual Maximum Payment and 200% of the Scheme Rate.

Out-of-Hospital Medical Benefits:

• Out-of-Hospital Benefits Other Than GP & Specialist Consultations, Pathology, Radiology, and Chronic Medicine are Limited to:
• Main – 14,641 ZAR
• Main + 1 Dependent – 30,848 ZAR
• Main + 2 Dependents – 33,670 ZAR
• Main + 3 Dependents – 37,078 ZAR

New Generation Plan

A Savings plan offers a set monetary amount, based on a percentage of your total contribution, allocated to a Members’ Savings Account (MSA) annually. For example, Sizwe Hosmed members can set aside 15% or 25% of their monthly contribution towards their MSA. The MSA is intended for the family’s out-of-hospital (day-to-day) healthcare needs. At the same time, the Scheme also offers additional specific, out-of-hospital benefits to help preserve the MSA. The MSA belongs to the member, and unused funds accumulate yearly. Furthermore, it can be transferred to another savings type plan. If a member resigns from a savings-type plan, any unused funds will be refunded to the member after four months.

In the case of the Sizwe Hosmed Access Saver Plan, the Scheme will cover the following out-of-hospital benefits, meaning they will not be drawn from the member’s MSA account. This is an excellent offering for the member and their family.

Sizwe Hosmed Medical – Access Saver-25

In-Hospital Benefit:

• No Overall Annual Limit

Outpatient Medical Benefits:

MSA pays for benefits outside the hospital, such as GP and specialist consultations, pathology, radiology, and chronic medicine. Annual Member Savings Account: For members who have 25% of their payments allocated to personal medical savings accounts:

• Main Member – 9,277 ZAR
• Adult Dependent – 8,007 ZAR
• Child Dependent – 1,855 ZAR

• Outpatient care is subject to sub-limit and MSA*
• No Overall Annual Limit
• Statutorily Prescribed Minimum Benefits (PMBs) Unlimited.
• Cover for medical emergencies while traveling outside South Africa:
• 100% of Scheme rates are paid in ZAR.
• Subject to documentation completion before departure from RSA.
• Subject to Scheme’s approval.

Sizwe Hosmed Medical – Access Core

In-Hospital Benefit:

• No Overall Annual Limit

Outpatient Medical Benefits:

MSA pays for benefits Out-of-Hospital, such as GP and specialist consultations, pathology, radiology, and chronic medicine. Annual Member Savings Account: For members who have 25% of their payments allocated to personal medical savings accounts:

• Main Member – 7,260 ZAR
• Adult Dependent – 6,252 ZAR
• Child Dependent – 1,464 ZAR

• Outpatient care is subject to sub-limit and MSA*
• No Overall Annual Limit
• Statutorily Prescribed Minimum Benefits (PMBs) Unlimited.
• Cover for medical emergencies while traveling outside South Africa:
• 100% of Scheme rates are paid in ZAR.
• Subject to documentation completion before departure from RSA.
• Subject to Scheme’s approval.

Hybrid Plans

Hybrid plans combine the benefits of traditional and new-generation savings plans. In addition, these plans provide peace of mind by offering additional benefits once the Member Savings Account (MSA) is fully utilized, with a small self-funded gap. Unused MSA funds will carry forward each year. Should a member resign from a savings plan, any unused funds will be refunded to the member after four months. Hybrid plans are well-suited for large families who desire comprehensive in- and out-of-hospital coverage while also providing flexibility and peace of mind with the availability of an above-threshold benefit (ATB) in times of need.

In the case of Sizwe Hosmed hybrid plans, the Scheme will cover the following out-of-hospital benefits, which will not be drawn from the member’s MSA account, effectively extending the value of benefits available to the member’s family.

Sizwe Hosmed Medical – Platinum Enhanced

A hybrid plan designed for households requiring extensive health care coverage. The Platinum Enhanced plan has the following benefits and features:

In-Hospital Benefit:

• No Overall Annual Limit

Out-of-Hospital Medical Benefits:

• Subject to MSA, Self-Payment Gap, and Above Threshold Benefit.
• Above Threshold Benefit (includes cover for Acute Medicine, General Practitioners, X-Rays, Blood Tests, and other Out-of-Hospital Benefits:

✅ Main Member: R6 097

✅ Adult Dependant: R3 586

✅ Child Dependant: R1 558

• Benefit for more than 25 chronic non-CDL conditions.
• Statutorily Prescribed Minimum Benefits (PMBs).
• Cover for medical emergencies while traveling outside South Africa:
• 100% of Scheme rates are paid in ZAR.
• Subject to documentation completion before departure from RSA.
• Subject to Scheme’s approval.

Sizwe Hosmed Medical – Platinum Enhanced EDO

In-Hospital Benefit:

• No Overall Annual Limit.
• Option for Members of the EDO Network.
• System Hospital DSP Applies to all advantages. A 10% co-payment is required for the voluntary use of non-DSP providers.
• Benefit for an additional 25 non-CDL chronic diseases.

Out-of-Hospital Medical Benefits:

• Subject to MSA, Self-Payment Gap, and Above Threshold Benefit.
• Above Threshold Benefit (includes cover for Acute Medicine, General Practitioners, X-Rays, Blood Tests, and other Out-of-Hospital Benefits:

✅ Main Member: R6 097
✅ Adult Dependant: R3 586
✅ Child Dependant: R1 558

• Statutorily Prescribed Minimum Benefits (PMBs).
• Cover for medical emergencies while traveling outside South Africa:
• 100% of Scheme rates are paid in ZAR.
• Subject to documentation completion before departure from RSA.
• Subject to Scheme’s approval.

Sizwe Hosmed Medical – Titanium Executive

In-Hospital Benefit:

• No Annual Maximum Payment and 300%of Scheme Rate.

Out-of-Hospital Medical Benefits:

• Benefits Out-of-Hospital is subject to MSA, Self-Payment Gap, and Above Threshold Benefit.
• Main – 21,004 ZAR
• Main + 1 Dependent – 18,585 ZAR
• Main + 2 Dependents – 4,291 ZAR

Above Threshold Benefits sub-limit:

• Physiotherapy – 16,425 ZAR per family per year.
• Pathology and Radiology – 16,425 ZAR per family per year.

Acute medicine:

• 7,665 ZAR Main Member
• 7,665 ZAR Adult Dependent
• 2,190 ZAR Child Dependent

• Cover for medical emergencies while traveling outside South Africa:
• 100% of Scheme rates are paid in ZAR.
• Subject to documentation completion before departure from RSA.
• Subject to Scheme’s approval.

Custom Plan and Hospital Plan

The Essential Copper plan can be customized according to the member’s income. At the same time, Silver Hospital offers a comprehensive hospital plan to members.

Sizwe Hosmed Medical – Essential Copper

Appropriate for families seeking unlimited basic coverage, featuring the following:

In-Hospital Benefit:

• No Overall Annual Limit
• Limited exclusively to PMB conditions
• Utilization of a non-DSP* hospital will incur a 10% co-payment.

Outpatient Medical Benefits:

• GP and Specialist consultations, Pathology, Radiology, and Chronic Medicine, are restricted to PMBs.
• Unlimited PMB benefits, subject to DSP.

Statutorily Prescribed Minimum Benefits (PMBs) Unlimited. Cover for medical emergencies while traveling outside South Africa:

• 100% of Scheme rates are paid in ZAR.
• Subject to documentation completion before departure from RSA.
• Subject to Scheme’s approval.

Sizwe Hosmed Medical – Silver Hospital

A healthcare plan that instills confidence, featuring the following:

In-Hospital Benefit:

• No Overall Annual Limit

• The Network Hospital DSP covers all benefits. A 10% co-payment is required for the voluntary use of non-DSP providers
• Statutorily Prescribed Minimum Benefits (PMBs) Unlimited.

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• 100% of Scheme rates are paid in ZAR.
• Subject to documentation completion before departure from RSA.
• Subject to Scheme’s approval.

Sizwe Hosmed – Advantages over Competitors

• Employers – Sizwe Hosmed provides the chance for you, as an employer, to assist your employees in obtaining medical coverage.
• Network choices – Sizwe Hosmed has a vast network of medical professionals who will provide you with the highest quality care at the most affordable rates.
• Hospitalization and all-inclusive coverage – You can rest assured that you will be covered for routine and emergency medical care and procedures.
• Sizwe Hosmed is prepared to explain their programs and assist you in determining which plan meets your income and healthcare requirements.
• Sizwe Hosmed is committed to serving its members with patience, understanding, and skill, expanding the scheme, and ensuring that its members benefit from the plan’s rising financial stability and various advantages.
• Sizwe Hosmed offers a dedicated back and neck program to assist people with chronic back and neck pain in managing their condition and enhancing their quality of life.
• There is a special maternity benefit offered. The Sizwe Hosmed Bambino Program is intended to aid pregnant mothers and their partners in navigating this joyful period. The program is chock-full of helpful information, support, and perks to aid parents during their pregnancy.
• The Sizwe Hosmed Disease Risk Management Program aims to improve your general health, well-being, and quality of life using an interdisciplinary approach. By enrolling in the program, you are taught about your disease so that you may manage it more effectively.

Sizwe Hosmed Medical Savings Account

Members of the Sizwe Hosmed Savings Plan can choose a certain annual percentage of their payments to be placed in a separate account called the Members Savings Account (MSA). Each member can contribute 15% or 25% of their monthly contributions to their MSA. This MSA is set aside to cover non-hospital medical expenses incurred by the family, and the Scheme provides additional non-hospital benefits to help keep the MSA intact. If a member decides to leave the MSA before the end of the year, they will retain ownership of the MSA and any accumulated funds from the previous year, which can be rolled over into another savings plan or repaid to them after four months.

Sizwe Hosmed Access Saver Plan is a good option for families because the Scheme provides coverage for a wide range of non-hospital benefits without depleting the member’s MSA.

How to apply for Medical Aid with Sizwe Hosmed

Medical Aid Quote Sizwe Hosmed Medical Scheme process explained

The process for applying for medical aid with Sizwe Hosmed in South Africa can vary depending on the specific plan and options you choose. However, generally, the following steps can be expected:

• Gather the necessary documentation: This may include proof of identity (such as a copy of your ID or passport), proof of income (such as your payslip or a letter from your employer), and any other relevant information (such as a letter from a doctor if you have a pre-existing medical condition).
• Choose a plan: Sizwe Hosmed offers a variety of medical aid plans, so it’s important to research and compares the different options to find the one that best suits your needs.
• Complete the application form: The application form can be found on the Sizwe Hosmed website or obtained from one of the company’s branches. The form must be completed and submitted along with the necessary documentation.
• Wait for approval: Once the application is received, it will be reviewed by Sizwe Hosmed. If the application is approved, you will receive confirmation of acceptance and instructions on how to make your first payment.
• Make your first payment: Once your application is approved, you will need to make your first payment to activate your medical aid.
• Wait for your membership card: After receiving your first payment, Sizwe Hosmed will send you a membership card, which you will need to present when visiting a medical provider.
• Contact Sizwe Hosmed if you have any questions or concerns: Sizwe Hosmed has a call center available to answer any questions about your medical aid or concerns about your application or coverage.
• New Members 35 years or older may be subject to late-joiner penalties on Sizwe Hosmed Medical Aid Plans.

Get a Sizwe Hosmed Medical Aid quote from our Dedicated Medical Aid Specialists Broker

How to apply for Gap Cover with Sizwe Hosmed

Sizwe Hosmed does not currently offer its own gap cover. However, the typical guideline to apply for gap cover in South Africa in 2024 can involve the following steps, subject to the provider:

• Research different gap covers providers and compares their policies and benefits to determine which best suits your needs.
• Contact your chosen provider by visiting their website or calling their customer service number.
• Provide the provider with your personal and financial information, including your ID number, income, and current medical aid scheme details.
• Review and sign the gap cover contract, ensuring you understand the terms and conditions before submitting it.
• Make the initial payment or arrange for automatic monthly payments.
• Keep all documentation safe and ensure you know the terms and conditions of the gap cover.
• Contact the provider if you have any questions or concerns.

How to Submit a Claim with Sizwe Hosmed

Your account should indicate if a consultation or treatment with a healthcare professional was filed directly to the Scheme following the consultation or treatment. Please consult with your healthcare provider if uncertain. Please follow the below steps if the account has not been submitted.

• Send only the account’s original receipt.
• Do not send duplicate statements or bills.
• If you have already paid the bill, including your receipt, identify the account as a “refund member,” as some physicians give a discount if you pay the bill immediately.
• All accounts must contain complete membership information.

How to Submit a Compliment or Complaint with Sizwe Hosmed

Sizwe Medical Fund provides its members with the highest standard of service and communication. Despite this commitment, there may be instances where errors occur, or dissatisfaction arises. In such cases, members are encouraged to submit queries or complaints, which the scheme will promptly and efficiently address. Sizwe Medical Fund has implemented an enhanced query and escalation process to improve communication with its valued members.

• Phase 1 – If a member is unhappy with the service they received from the Help Desk, each member is assigned a unique reference number that must be included in future correspondence. Furthermore, it can take up to 72 hours to get a response to a member’s inquiry.
• Phase 2 – either the Member’s question has been answered, or the Member has followed up with the Call Center using the reference number provided.
• Phase 3 – If the member’s question is not answered, they can contact the Chief Executive Officer.
• Phase 4 – The Chief Executive Officer will respond to the inquiry within a day.
• Phase 5 – If the Chief Operating Officer cannot address the concern, the member may contact the Complaints and Disputes Resolution Committee (CDRC).

How to Switch my Medical Aid to Sizwe Hosmed

Switching your medical aid to Sizwe Hosmed is a simple process that can be completed in a few steps.

• Research and compare different medical aid options available from Sizwe Hosmed. Consider factors such as coverage, costs, and benefits that are important to you and your family.
• Contact Sizwe Hosmed to request an application form. This can be done by visiting their website, calling their customer service line, or visiting one of their branches.
• Complete the application form and provide any supporting documentation that may be required. This could include proof of income, ID documents, and medical records.
• Submit your application to Sizwe Hosmed. The scheme will review your application and provide you with confirmation of acceptance or rejection.
• If your application is accepted, you will receive a new member number and other necessary information.
• Notify your current medical aid scheme that you wish to cancel your membership and provide them with your new Sizwe Hosmed member number.
• Once your switch is complete, familiarize yourself with the benefits and cover provided by your new plan to ensure that you are aware of the benefits to which you are entitled.

Sizwe Hosmed Customer Support

To contact Sizwe Hosmed customer support, there are a few options available:

• Phone: You can call their customer support line and speak with a representative during business hours. The phone number should be available on their website or by searching online.
• Email: You can email their customer support team, and they will respond to your inquiry as soon as possible. The email address should be available on their website or by searching online.
• Online Contact Form: Some websites have a contact form you can fill out and submit to contact the customer support team.
• Social Media: Many companies now have customer support on their social media pages; you can reach out to them through their official social media page like Twitter, Facebook, Instagram, etc.
• Visit their physical office: you can visit your nearest office or check on their website for the nearest office location.

Sizwe Hosmed vs Platinum Health vs Fedhealth – A Comparison

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Sizwe Hosmed Reviews by Members

Highest Praise.

I have never grown tired of praising them. To date, I have never had any unused funds from my medical aid at the end of the year. They have been consistent, even during a year when I underwent two surgeries, and my son underwent one. We were both hospitalized a total of ten times. I am grateful that Sizwe Hosmed made the financial aspect of our medical crises the least stressful. – Amber Yates

Excellent Medical Scheme.

Sizwe Hosmed is an excellent medical scheme, of which I became a member on February 22. Our benefits start date was March 1st, 22. Later, we registered for their Bambino care program. Finally, my partner received a call from Sizwe Hosmed informing her that our application had been approved and that she could consult with a gynecologist. – Steve Sharpe

Happy Member.

Every time my son was hospitalized while enrolled with Sizwe Hosmed, they provided coverage that exceeded my expectations. I am grateful, as private medical care can be quite expensive. – Bethany Welch

Sizwe Hosmed – Our Verdict

Sizwe Hosmed is a South African medical aid scheme that offers its members a range of healthcare services and plans. Some of the services offered by Sizwe Hosmed include in and Out-of-Hospital cover, maternity care, and a members savings account (MSA) option. One of the benefits of Sizwe Hosmed is that it offers comprehensive coverage, including coverage for out-of-hospital expenses, which can help preserve a member’s MSA. Additionally, Sizwe Hosmed offers a range of plans, which allows members to choose a plan that best fits their needs and budget. However, like any medical aid scheme, Sizwe Hosmed has some cons. One potential downside is that members must pay out of pocket for certain expenses, such as gap cover. Additionally, Sizwe Hosmed may not have as many providers in certain areas, which can limit a member’s choice of healthcare providers.

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Sizwe Hosmed Pros and Cons

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Sizwe Hosmed Frequently Asked Questions

Is Hosmed part of Sizwe?

Sizwe Medical Fund and Hosmed Medical Aid Scheme united in 2021 to form South Africa’s eighth-largest medical scheme, now known as Sizwe Hosmed Medical Scheme.

What is the waiting period for Sizwe Hosmed Medical Aid?

There could be a three-month waiting time before a new member of Sizwe Hosmed can receive benefits after joining the scheme. Apart from where Prescribed Minimum Benefits apply, a new member with a pre-existing ailment may be subject to a condition-specific waiting period of up to a year.

When did Sizwe and Hosmed Merge?

Effective November 1, 2021, the CMS formally approved the merger of the Sizwe Medical Fund with the Hosmed Medical Scheme.

Who administers Sizwe?

Sechaba Medical Solutions administers Sizwe Hosmed.

How can I access Sizwe Hosmed Authorizations?

You can request authorization from your member’s area on the official website or the mobile app.

Furthermore, Pre-authorization and case management procedures apply to all inpatient hospital stays (including PMBs). Emergency admissions must be reported to the Scheme within 48 hours. Claims will not be paid if admission is not pre-authorized or reported to the plan.

How many Sizwe Hosmed Options are available for 2024?

Sizwe Hosmed offers 12 options, including Titanium Executive, Platinum Enhanced, Platinum Enhanced EDO, Plus, Value, Value Core, Gold Ascend, Gold Ascend EDO, Access Core, Access Saver-25, and Essential Copper.

Where can I find my Sizwe Hosmed member login?

You can find the login on the official Sizwe Hosmed website homepage.

What is the Sizwe Hosmed Medical Aid contact number?

Sizwe Hosmed can be contacted on the toll-free number 0860 100 871.

How do I Downgrade my Plan with Sizwe Hosmed?

To downgrade your plan with Sizwe Hosmed, you can Contact Sizwe Hosmed customer service.

How do I add a Beneficiary to Sizwe Hosmed?

If you want to add a child or adult dependent, you can log into your Sizwe Hosmed profile and Contact Sizwe Hosmed. You can reach out to Sizwe Hosmed through their customer service number or email or visit their website for more information on adding a beneficiary.

What hospital plans does Sizwe Hosmed offer?

Sizwe Hosmed offers the Silver Hospital plan that offers unlimited coverage for in-hospital treatment and procedures but does not cover out-of-hospital and day-to-day medical treatment.

Does Sizwe Hosmed cover chronic medication?

Yes, Sizwe Hosmed covers chronic medication for members diagnosed with a chronic medical condition.

What is the provider network for Sizwe Hosmed?

Sizwe Hosmed has a provider network of healthcare providers, including hospitals, clinics, and doctors, where members can access medical treatment.

What are the waiting periods for Sizwe Hosmed?

Sizwe Hosmed has waiting periods for certain benefits, such as maternity and pre-existing medical conditions. These waiting periods range from 3 to 12 months.

What exclusions does Sizwe Hosmed have?

Sizwe Hosmed has exclusions for specific medical treatments and procedures, such as cosmetic surgery and non-medical treatments.

What is Sizwe Medical Fund?

Sizwe Medical Fund is a registered medical scheme in South Africa that offers a range of medical aid plans to individuals and families. Furthermore, Sizwe Hosmed is one of the country’s most popular medical schemes.

What are the benefits of Sizwe Medical Aid?

Sizwe Medical Aid offers a range of benefits to its members, including comprehensive cover for essential medical services, access to a network of healthcare providers, wellness programs, preventative care, and emergency medical assistance services.

What are the chronic benefits offered by Sizwe Medical Fund?

Sizwe Medical Fund offers coverage for a range of chronic conditions, including HIV/AIDS, diabetes, hypertension, and asthma. In addition, members can access chronic medication and treatments as part of their medical aid plan.

What is the hospital network for Sizwe Medical Fund?

Sizwe Medical Fund has a network of hospitals and healthcare providers that members can access for medical treatment. The network includes private and public hospitals, specialist clinics, and medical practitioners.

What are Siswe Hosmed auxiliary benefits?

Auxiliary benefits refer to medical services and appliances such as optometry, dentistry, hearing aids, and other medical devices.

What is a moratorium at Sizwe Hosmed?

At Sizwe Hosmed, a moratorium is a waiting period during which patients with pre-existing conditions are not covered but could be eligible for coverage after completing the waiting period.

What is a special enrollment period at Sizwe Hosmed?

An individual can enroll in Sizwe Hosmed outside of the open enrollment period if they meet the requirements for a special enrollment period, such as having a child or getting married.

What are Sizwe Hosmed’s underwriting criteria?

The underwriting criteria of Sizwe Hosmed are the rules by which the medical scheme evaluates an individual’s risk and establishes their premiums and waiting periods.

What maternity benefits does Sizwe Hosmed offer?

Sizwe Hosmed offers maternity benefits that cover prenatal and postnatal care, hospitalization for childbirth, and specific tests and procedures.

What are the waiting periods for maternity benefits with Sizwe Hosmed?

Waiting periods for maternity benefits with Sizwe Hosmed vary depending on the member’s plan. In general, waiting periods range from 9 to 12 months.

Does Sizwe Hosmed offer a hospital cash benefit?

Yes, some of Sizwe Hosmed’s medical aid plans offer a hospital cash benefit, which pays out a daily amount if you are hospitalized.

Can I join Sizwe Hosmed online?

Yes, you can apply to join Sizwe Hosmed online via their website.

How do I claim from Sizwe Hosmed?

To claim from Sizwe Hosmed, you can submit your claim online, by email, or by fax.

Does Sizwe Hosmed offer dental benefits?

Yes, Sizwe Hosmed offers dental benefits on some medical aid plans, including the Platinum Enhanced plan.

Does Sizwe Hosmed Medical Aid cover hearing aids for pensioners in South Africa ?

Yes, Sizwe Hosmed Medical Aid covers Hearing aids on GOLD ASCEND & EDO PLAN to the value of R8 325 per year per family subject to one unit per beneficiary every 4 years from date of acquisition

Does Sizwe Hosmed cover HIV/AIDS treatment?

Yes, Sizwe Hosmed covers HIV/AIDS treatment, including antiretroviral therapy and other related medications.

Does Sizwe Hosmed offer wellness benefits?

Yes, Sizwe Hosmed offers wellness benefits, which may include things like health screenings and lifestyle coaching.

Can I choose my own healthcare provider with Sizwe Hosmed?

Yes, Sizwe Hosmed allows members to choose their healthcare providers, but using network providers may lower out-of-pocket expenses.

What is Sizwe Hosmed’s gap cover?

Sizwe Hosmed’s gap cover is an optional extra that covers the difference between what medical practitioners charge and what your medical aid pays out.

Can I change my payment option with Sizwe Hosmed?

Yes, you can change your payment option with Sizwe Hosmed by contacting their customer service department and making the necessary arrangements.

What are pre-existing conditions with Sizwe Hosmed?

Pre-existing conditions are medical conditions that existed before a member joined the medical aid scheme.

Does Sizwe Hosmed cover pre-existing conditions?

Yes, Sizwe Hosmed covers pre-existing conditions, but there may be waiting periods before you can claim for specific conditions.

What are the payment options for Sizwe Hosmed?

Sizwe Hosmed offers a range of payment options, including debit orders, EFT, and cash payments at certain branches.

How do I submit a claim with Sizwe Hosmed?

You can submit a claim with Sizwe Hosmed by completing a claim form and submitting it with the relevant documentation, such as invoices or receipts.

What is the turnaround time for claims with Sizwe Hosmed?

The turnaround time for claims with Sizwe Hosmed varies depending on the type of claim and the case’s complexity. In general, claims are processed within 14 days of receipt of all relevant information.