Day-to-Day benefits – Network providers apply
- Unlimited GP consultations within the GP Network
- GP consultations out of network, a 30% co-payment will apply
- Unlimited acute medication dispensed by GP Network
- Acute medication obtained at pharmacy R1 767 per beneficiary subject to family limit R4 927
- Pharmacy Advised Treatment (PAT) (over the counter) R744 per family
- Up to three (3) specialist consultations per family on referral and authorisation, limited to PMB • All benefits are subject to authorisation with the Network administrator
- Pre-authorisations and general enquiries Tel: 0860 100 871, Email: queries@sizwehosmed.co.za
Dental care – Benefit managed by 3SixtyHealth
- Benefit cover for conservative dentistry per beneficiary
- Oral hygiene
- Extractions
- Intraoral X-rays
- Plastic Dentures: One (1) set per beneficiary in a four (4) year period
- Pre-authorisations and general enquiries Tel: 0860 100 871
Optical – Benefit managed by 3SixtyHealth
- One (1) claim per beneficiary every 24-month treatment date cycle
- One (1) eye test per beneficiary
- Frames: R340 per beneficiary
- Lenses: R239 single vision up to R504 for bifocal & multifocal lenses
- Authorisation and benefit enquiries Tel: 0860 100 871
Maternity benefits – Register on the Bambino programme
- Ten (10) antenatal visits per pregnancy, six (6) either with a GP, Midwife and four (4) with a Specialist Obstetrician within the network provider
- Blood tests covered
- Two (2) 2D scans combined in and out of hospital
- Childhood Immunisation per the Department of Health – up to 12 years of age. One (1) heart, hearing and vision screening for babies under two (2) years of age
Essential Copper Plan is a PMB based plan offering benefits within designated network providers for both In and Out of hospital.
Cover for 26 PMB chronic conditions, subject to registration and approval. Covered medication, bloods and GP within PMB protocols and authorisations.
- Addison’s disease
- Asthma
- Bipolar Mood Disorder
- Bronchiectasis
- Cardiac failure
- Cardiomyopathy
- Chronic obstructive pulmonary disease
- Chronic renal disease
- Coronary artery disease
- Crohn’s disease
- Diabetes insipidus
- Diabetes mellitus types 1 & 2
- Dysrhythmias
- Epilepsy
- Glaucoma
- Haemophilia
- HIV/Aids
- Hyperlipidaemia
- Hypertension
- Hypothyroidism
- Multiple sclerosis
- Parkinson’s disease
- Rheumatoid arthritis
- Schizophrenia
- Systemic Lupus Erythematosus
- Ulcerative colitis
Health screening is an essential part of preventative healthcare and is vital to maintaining overall well-being and improving outcomes by providing care at the earliest possible stage. Preventative Care and Screening Benefits include
- Covid-19 vaccination per beneficiary
- One (1) pap smear for females over 18 years per beneficiary per annum
- One (1) mammogram for females over 40 years of age per beneficiary per annum
- One (1) skin cancer screening per beneficiary above 55 years of age, annually
- One (1) PSA for males over 40 years per beneficiary per annum
- One (1) cholesterol test for beneficiaries over 20 years of age
- One (1) flu vaccination per beneficiary
- One (1) blood sugar test for beneficiaries over 15 years of age
- One (1) Colon Cancer blood test for beneficiaries over 50 years of age
- One (1) blood pressure test per beneficiary
- One (1) HIV test per beneficiary
- One (1) HPV vaccination for beneficiaries between nine (9) and 12 years of age
- One (1) Pneumococcal vaccine for beneficiaries over 65 years of age Female Contraceptive Benefit
- R83 per beneficiary per month, subject to R882 per family per annum
Principal
Adult
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