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Benefits Guide - 2018
pg 2 Sizwe History
A Brief history of Sizwe Medical Fund and Sechaba Medical Solutions
In the late 1960s, Black (African) doctors in the Rand, which consisted of Johannesburg, Pretoria, the Eastrand, and Vereeniging, formed themselves into “ The S. A. Medical Discussion Group” (SAMDG) which discussed matters of interest to Black doctors and their patients. The South African Medical Association was only open to white membership then.
The SAMDG met once a month on a Sunday afternoon. Meetings were hosted by members at their homes. Spouses attended meetings and held their own meeting whilst members discussed the business of the day. Meetings ended with a social. The executive of the SAMDG was appointed by region to facilitate executive meetings, in 1976, the executive was from the Eastrand, it was chaired by Dr. Mzamane of Katlegong.
It was in 1976 that Dr. Mokgesi who had a practice in Sebokeng, met a white colleague, Dr. Loots at a clinical meeting at the Joburg Gen. Dr. Loots suggested that it would be a good thing to register a medical aid scheme for blacks and a private hospital for blacks, he would introduce the matter to some government officials who would make the registering of a black company in the urban areas possible as this was not permissible then.
The matter of a medical aid scheme and a private hospital for blacks was discussed by the SAMDG and accepted. Dr. Motlana, who was very influential in black circles and highly respected by business leaders and politicians of all sectors of S African society took up leadership of the group, he led the selling of the idea to black doctors to take up shares, negotiated with white business to support the initiative, and served as chairman of the group. At this time, Dr. Motlana also led various committees of the STRUGGLE which took a great deal of his time and resulted in him spending many months under detention.
In 1978 The Kwacha Group was registered with 38 shareholders. Dr. Loots was the only white shareholder. He also served on the board of directors. Sizwe Medical Fund was registered, the 38 shareholders raised R3 000 000 as security to meet claims. Lesedi Clinic was to open its doors soon after Sizwe started. (Kwacha meaning ‘Day Break’ in Chewa was chosen as an appropriate name for the new company). Kwacha was later changed to Sechaba Group Holdings (Pty)Ltd
Sizwe Medical Fund - Benefits Guide 2018 pg 3
Sizwe H
istory2018 O
fferingsH
ospital Care
Gom
omo C
arePrim
ary Care
Affordable C
areFull B
enefit Care
Sizwe H
istory
A Brief history of Sizwe Medical Fund and Sechaba Medical Solutions
The motivation for forming the Kwacha Group
• To provide medical aid cover for blacks;• To enable black specialists to open private practice, black specialists of the day could only
work as GPs with specialist qualifications, as specialist fees were only affordable to medical aid members. Black specialists who worked in public hospitals were not recognised, they were humiliated as they could not give orders to white juniors and to white nurses of all ranks! Many black specialists elected to go into exile and practice in the USA and in Canada.
• To give black private patients and their doctors access to Xray, other investigations and expensive medications which were out of reach for virtually all who had no medical aid cover.
• To lead the black population in matters of healthcare.
Although Dr. Motlana tried to persuade the powers that be to allow black civil servants of the day to join Sizwe, the government refused, and instead registered Bonitas for black civil servents, Sanitas for Indians, and Prosano for coloured civil servents. All these schemes were to be administered by Medscheme this is certainly the reason for Bonitas being the second largest open scheme in S.A today.
The first members of Sizwe were drawn from the Barlow Rand Group, from Iscor, from PUTCO and from the steel companies and coal mining companies in Witbank and Middleburg as well as motor industry workers from Port Elizabeth and Uitenhage. The initiative by our founding fathers has survived to this day!!
Dr Tlakula
pg 4 2018 Healthcare Offerings
HOSPITAL CARE PRIMARY CAREGOMOMO CARE
The Hospital Care Option offers peace of mind knowing that in the event of hospitalisation, extensive cover is available at any private hospital.
In addition, the Hospital Care Option provides cover for 27 Chronic Disease List (CDL) conditions.
Primary Care Option offers good value for money with unlimited hospitalisation at any private hospital.
This traditional option has generous day-to-day benefitswhich cover acute medicines GPs,specialists, radiology, pathology and more to meet the needs of any family.
This is our entry-level option. Gomomo Care Option provides excellent value for money. GPs, specialists and acute medicines are accessible through a selected network provider Dentistry, radiology and pathology are also available from a network provider.
No overall limit for hospitalisation at any private hospital. Covers the 27 Chronic Disease List (CDL) conditions.
2018 HEALTHCARE
pg 4 2018 Healthcare Offerings - Subject to CMS approval
Sizwe Medical Fund - Benefits Guide 2018 pg 5
Sizwe H
istory2018 O
fferingsH
ospital Care
Gom
omo C
arePrim
ary Care
Affordable C
areFull B
enefit Care
2018 Offerings
FULL BENEFIT CARE
Our Full Benefit Care Option offers comprehensive cover and generous benefits to cover families and individuals who need access to unlimited hospitalisation at any private hospital.
This option also offers additional chronic conditions, specialised dentistry, GPs, specialists, acute medication, preventative care benefits and more rich benefits. This is the only option which offers Top-up cover when in hospital up to 200% of the Sizwe rate.
AFFORDABLE CARE
Our Affordable Care Option offers generous comprehensive cover with unlimited hospitalisation in any private hospital.
It also covers additional chronic conditions with specialised dentistry and preventative benefits.
This option is suitable for young and healthy families.
OFFERINGS
Sizwe Medical Fund - Benefits Guide 2018 pg5
pg 8 Hospital Care
HOSPITAL CAREOffers peace of mind
knowing that in the event of hospitalisation, extensive
cover is available at any private hospital.
Sizwe Medical Fund - Benefits Guide 2018 pg 9
Sizwe H
istory2018 O
fferingsH
ospital Care
Gom
omo C
arePrim
ary Care
Affordable C
areFull B
enefit Care
IN-HOSPITAL BENEFITS(All hospital admissions must be authorised.
A co-payment of R1 500 will be applied if pre-authorisation was not obtained)
AUXILIARY SERVICES
General 100% Sizwe rate
Dietician, speech therapy, occupational therapy
Subject to PMB, clinical protocols and pre-authorisation
PHYSIOTHERAPY
Reimbursement RatePre-authorisation and managed care protocols apply
100% Sizwe Rate
OUT OF HOSPITAL BENEFITS
Option Structure Major Medical; Day to day: Risk
OVERALL DAY-TO-DAY LIMIT
Benefit No benefit
GENERAL PRACTITIONERS
Reimbursement rate No benefit
SPECIALISTS (excluding psychiatrists), Acute Medicine,
Pathologists,Radiologists And Physiotherapists
Reimbursement rate No benefit
Benefits Only PMBs
ACUTE MEDICINES AND PHARMACY ADVISED THERAPY (PAT) - FALLS WITHIN DAY-TO-DAY BENEFIT WITH THE
FOLLOWING SUB-LIMITS
Reimbursement rate No benefit
RADIOLOGY AND RADIOGRAPHY
General Reimburse-ment rate No benefit
Specialist Reimburse-ment rate No benefit
PHYSIOTHERAPY
Reimbursement rate No benefit
PATHOLOGY
Reimbursement rate No benefit
BASIC DENTISTRY
Reimbursement rate No benefit
SPECIALISED DENTISTRY
Reimbursement rate No benefit
OPTICAL BENEFITS ACCESSED THROUGH PPN
Reimbursement rate No benefit
MENTAL HEALTH
Reimbursement rate No benefit
AUXILIARY SERVICES(Chiropractic Treatment, Homeopathy)
Reimbursement rate No benefit
MATERNITYSubject to registration on the Sizwe Baby Programme within
24 weeks of falling pregnant
Reimbursement rate 100% Sizwe rate
Ante-natal consultationsAnte-natal consultation: 9 GP, Midwife Visits2 Obstetrician visits
Pregnancy scans and blood tests
2 x 2D scansBlood tests:• Two (2) Haemoglobin Measurement tests, • One (1) Blood Grouping test, • One (1) VDRL test for Syphilis and • One (1) HIV blood test
Fertility No benefits
PSYCHOLOGICAL AND PSYCHIATRIC TREATMENT
Reimbursement rate No benefit
MEDICATION
Acute Reimburse-ment rate No benefits
OTC Reimburse-ment rate No benefits
CHRONIC CONDITIONS
PMB 100% negotiated tariff at Preferred Provider Network
Non-PMB No benefit
Limits Formulary, limit per family
Overall limits (Annual)
PrincipalMSA
Risk benefit per family
Adult MSA
Child MSA
IN-HOSPITAL BENEFITS(All hospital admissions must be authorised.
A co-payment of R1 500 will be applied if pre-authorisation was not obtained)
Overall annual limit Unlimited
Provider Network Any
BENEFITS
Top-up cover No benefit
Co Payments
General scopes R1 300
Endoscopic (Laparoscopic surgery) investigations
R3 000
AMBULANCE SERVICESContracted EUROP ASSISTSA (Telephone number:0860 11 77 99
100% Sizwe rate
PRIVATE HOSPITALS AND NURSING HOMES(Subject to treatment and case management protocols
and PMBs. Pre-authorisation required unless it is a medical emergency)
Accommodation Unlimited at any private hospital
Reimbursement rate 100% Sizwe rate
Clinical limitations and exclusions None
DENTISTRY(Subject to Dental Management Programme -
call 0860 109 556)
Conservative Dentistry
Reimbursement rate
100% Sizwe rate
Subject to pre-autho-rised and managed care protocols
Specialised Dentistry(Subject to pre-authorisation and Dental
Management Programme)
Reimbursement rate 100% Sizwe rate
Crowns and Bridges No benefit
Orthodontics (Braces) No benefit
Implants No benefit
Partial Metal Frame Dentures No benefit
Surgery Managed Care protocols apply
GENERAL PRACTITIONER AND MEDICAL SPECIALIST
Reimbursement rate100% Sizwe rate for consultations and visits in-hospital
CHRONIC BENEFITSSubject to pre-authorisation.Medicines:subject to registration on the Chronic
Medicine Programme. PMBs subject to pre-authorisation, preferred providers and
treatment protocols)HIV/AIDS
(Members are encouraged to register with the HIV/AIDS Programme. This benefit includes relevant consultations, counselling, medication and the cost of blood tests for
monitoring purposes)
Reimbursement rate 100% Sizwe rate
BenefitNo limits but subject to treatment protocols and PMB’s at a DSB H
ospital Care
PREVENTATIVE CAREWELLNESS SCREENING CONSULTATIONS
Reimbursement rate 100% Sizwe rate
Benefit
Subject to a family limit of R2 030 for flu vaccine and pneumococcal vaccine. Mammograms: once in a 2 year cycle for females over 40 years Papsmear: once in a 2 year cycle for females over 21 years Prostate-Spe-cific Antigen (PSA): once per year for males over 40 years
BLOOD SUGAR, CHOLESTEROL, BLOOD PRESSURE, BMI AND HIV
Reimbursement rate 100% Sizwe rate
Benefit R310
FEMALE CONTRACEPTIVES
Reimbursement rate No Benefit
IN-HOSPITAL BENEFITS(All hospital admissions must be authorised.
A co-payment of R1 500 will be applied if pre-authorisation was not obtained)
MATERNITY
Reimbursement RateHospitalisation (public or private hospitals) delivery, post-natal services and midwifery
100% Sizwe Rate
BLOOD TRANSFUSIONS AND BLOOD REPLACEMENT PRODUCTS
Reimbursement rate
100% Sizwe rate, subject to PMBs and annual limit of R79 490 per family
PROSTHESIS
Reimbursement rate: pre-au-thorisation and managed care protocols apply
100% Sizwe rate, subject to an annual limit of R37 930 per family; maximum of 3 cardiac stents and 2 vascular stents per family per annum
ONCOLOGY
Reimbursement rate 100% Sizwe rate
Benefit Overall limit of R320 000 per family
RADIOLOGY AND RADIOGRAPHY
Reimbursement rate 100% Sizwe rate
Specialised Radiology (MRI/CAT scan/ Anglogram) Pre-authorisation and managed care protocols
Limited to R25 270 per family
Interventional radiology
Payable from the hospital limit, subject to pre-authorisation and clinical protocols
PATHOLOGY
Reimbursement rate 100% Sizwe rate
MENTAL HEALTH
Reimbursement rate 100% Sizwe rate
Alcoholism, drug addiction, narcotism: subject to PMBs, pre-authorisation and minimum benefit package
3 days withdrawal treat-ment and up to 21 days rehabilitation at an appropriate facility
ORGAN TRANSPLANT AND RENAL DIALYSIS
(subject to pre-authorisation, minimum benefitpackage, treatment protocols and DSP)
Reimbursement rateSubject to PMB conditions and clinical protocols
Benefit Limited to R200 890 per family
REFRACTIVE SURGERY INCLUDING RADIAL KERATOTOMY
Benefit No Benefit
pg 10 Hospital Care
GOMOMO CAREProvides excellent value for money.
GPs, specialists and acute medicines are accessible through a selected
network provider.
Sizwe Medical Fund - Benefits Guide 2018 pg 11
Sizwe H
istory2018 O
fferingsH
ospital Care
Gom
omo C
arePrim
ary Care
Affordable C
areFull B
enefit Care
OUT OF HOSPITAL BENEFITSMATERNITY
(subject to care rules, formulary and clinical protocols of DSP)
Reimbursement rate 100% Sizwe rate
Pregnancy scans 2 x 2D scans per pregnancy
OUT OF HOSPITAL BENEFITS
Option Structure Major Medical; Day to day: Risk
Provider Network
OVERALL DAY-TO-DAY LIMIT
Benefits
100% Sizwe rate, subject to managed care rules, formulary and clinical protocols of the DSP (Designated Service Provider)
GENERAL PRACTITIONERS
Reimbursement rate 100% Sizwe rate
Limits Only PMBs
Out of area visits4 visits per year per beneficiary, within the DSP network
SPECIALISTS
Reimbursement rate 100% Sizwe rate
LimitsRequired benefits for the full year all visits subject to referreal from a GP
RADIOLOGY AND PATHOLOGY
Basic Radiology and pathology
Reimburse-ment rate
100% Sizwe rate: subject to managed care rules, formulary and clinical protocols
Specialised Radiology in and out: Benefit is R 7140 per family
Reimburse-ment rate
Combined In-hospital and Out of hospital
PSYCHOLOGICAL AND PSYCHIATRIC TREATMENT
Reimbursement rate 100% Sizwe rate
Benefits Only PMBs
MEDICATION
Acute Reimburse-ment rate
100% Sizwe rate: subject to care rules, formulary and clinical protocols of DSP
OTC Limits 300 per family
CHRONIC CONDITIONS (subject to pre-authorisation, registration on the chronic
medicine programme, formulary and clinical protocols of the DSP)
Reimbursement rate 100% Sizwe rate
Benefits R7 870 per beneficiary
PMB 26
Non-PMB 0
PHYSIOTHERAPY(Include physiotherapists, speech therapists, clinical
psychologists, Podiatrist, equipment and external prosthesis)
Reimbursement rate 100% Sizwe rate
DENTISTRY (Subject to Dental Management Programme - 0860 109 556)
Reimbursement rate
100% Sizwe rate: subject to managed care rules, formulary and clinical protocols
Limits
M: R2 770
M+1: R3 190
M+2: R3 470
M+3: R3 750
M+4: R4 010
M+5: R4 290
M+6: R4 710
OPTICAL BENEFITS (Subject to care rules, formulary and clinical protocols of DSP)
Reimbursement rate 100% Sizwe rate
Cycle 2 years
Limit per family
M: R1 130 M+1: R1 300 M+2: R1 440 M+3: R2 070
CHRONIC BENEFITS(Subject to pre-authorisation.
Medicines: subject to registration on the Chronic Medicine Programme. PMBs subject to pre-authorisation, preferred providers and
treatment protocols.)Reimbursement rate 100% Sizwe rate
BenefitsR7 870 per beneficiary. Cover for 27 PMB chronic conditions
PMB At Cost
Non-PMB 100% Sizwe Rate
HIV/AIDS(Members are encouraged to register with the HIV/AIDS Programme. This benefit includes relevant consultations, counselling, medication and the cost of blood tests for
monitoring purposes)
Reimbursement rate 100% Sizwe rate
Benefits
Subject to PPDMP benefits include coun-seling, prescription medicine, pathology tests.’
IN-HOSPITAL BENEFITS(All hospital admissions must be authorised.
A co-payment of R1 500 will be applied if pre-authorisation was not obtained)
Overall annual limit Unlimited
Provider Network Any
BENEFITS
AMBULANCE SERVICESContracted EUROP ASSISTSA (Telephone number:0860 11 77 99
100% Sizwe rate
PRIVATE HOSPITALS AND NURSING HOMES
(Subject to treatment and case management protocols and PMBs. Pre-authorisation
required unless it is a medical emergency)
Accommodation Unlimited at any private hospital
Reimbursement rate 100% Sizwe rate
Clinical limitations
Advanced laparoscopic, reconstructive surgery, joint replacements, cardiac surgery including cardiac stents, spinal surgery, breast reconstructive surgery
Exclusions
Refractive surgery, breast reduction, breast augmentation, Keloids, Frail Care
DENTAL HOSPITALISATION(Subject to pre-authorisation, Dental Benefit
Management Programme and clinical protocols subject to R1 500 co-payment)
Reimbursement rate
Pre-authorisation is required, subject to managed care protocols and limited to PMBs level of care
General anaesthetic 100% Sizwe rate
Conscious sedation in roomsSubject to pre-authorisa-tion and limited to PMB level of care
IN-HOSPITAL BENEFITS(All hospital admissions must be authorised.
A co-payment of R1 500 will be applied if pre-authorisation was not obtained)
GENERAL PRACTITIONER AND SPECIALIST
Reimbursement rate100% Sizwe rate for consultations and visits in-hospital
AUXILIARY SERVICES
Reimbursement rate 100% Sizwe rate
Dietician, speech therapy, occu-pational therapy
Subject to clinical protocols and pre-au-thorisation
PHYSIOTHERAPY
Reimbursement rate 100% Sizwe rate
MATERNITY(Hospitalisation [public or private hospitals] delivery,
post-natal services and midwifery)
Reimbursement rate 100% Sizwe rate
BLOOD TRANSFUSIONS AND BLOOD REPLACEMENT PRODUCTS
Reimbursement rate 100% Sizwe rate: subject to PMBs
PROSTHESIS(Pre-authorisation and managed care
protocols apply)
Reimbursement rate 100% Sizwe rate
Benefits R28 090 per beneficiary
ONCOLOGY
Reimbursement rate 100% Sizwe rate
RADIOLOGY AND RADIOGRAPHY
Reimbursement rate 100% Sizwe rate
PATHOLOGY
Reimbursement rate 100% Sizwe rate
MENTAL HEALTH(Subject to pre-authorisation and managed care rules)
Reimbursement rate
100% Sizwe rate
Alcoholism, drug addiction, narcotism: subject to PMBs, pre-authorisation and minimum benefit package
Psychiatry hospitalisation
Limited to 21 days per beneficiary per annumPsychiatrist consulta-tions and 6 in-hospital Clinical Psychologists subject to PMBs
ORGAN TRANSPLANT AND RENAL DIALYSIS
Reimbursement rate 100% Sizwe rate
Benefits
Restricted to PMBs, subject to pre-authori-sation, minimum benefit package, treatment protocols and DSP
REFRACTIVE SURGERY INCLUDING RADIAL KERATOTOMY
Benefits No Benefit
OTHER SERVICES(Psychologists, Speech Therapists, Clinical Psychologists,
Podiologists, Equipment and External Prostheses)
Reimbursement rate 100% Sizwe rate
Benefits R2 530 per family: subject to PMBs
Gom
omo C
are
pg 12 Gomomo Care
PRIMARY CAREPrimary Care Option offers
good value for money with unlimited hospitalisation at any private hospital,
to meet the needs of any family.
Sizwe Medical Fund - Benefits Guide 2018 pg 13
Sizwe H
istory2018 O
fferingsH
ospital Care
Gom
omo C
arePrim
ary Care
Affordable C
areFull B
enefit Care
OUT OF HOSPITAL BENEFITS
Option Structure Major Medical; Day to day: Risk
Provider Any
OVERALL DAY-TO-DAY LIMIT
Benefits
M: R5 680M+1: R8 410M+2: R9 840M+3: R11 250M+4: R12 680M+5: R14 100M+6+: R15 520
GENERAL PRACTITIONERS
Reimbursement rate 100% Sizwe rate
Benefit
M: 4 M+1: 9 M+2: 12 M+3: 14 M+4: 15 M+5: 16 M+6+:17
SPECIALISTS (EXCLUDING PSYCHIATRISTS)
Reimbursement rate 100% Sizwe rate
Benefits
All visits subject to referral from a GP Non-referral will result in M: 2M+1: 6M+2: 7M+3: 8M+4: 9M+5: 10M+6+: 11
ACUTE MEDICINES AND PHARMACY ADVISED THERAPY (PAT) - FALLS WITHIN DAY-TO-DAY BENEFIT WITH THE
FOLLOWING SUB-LIMITS
Reimbursement rate 100% Sizwe rate
Structure Within day to day with, sub-limits:
Benefits
M: R1 770 M+1: R3 190 M+2: R3 550 M+3: R4 030 M+4: R4 140 M+5: R4 370 M+6+:R4 730
CHRONIC CONDITIONS
Reimbursement rate 100% Sizwe rate
Benefits
Subject to PMB chronic conditions, pre-au-thoristion, registration on the chronic disease prgramme formolary and clinical protocols
RADIOLOGY AND RADIOGRAPHY
Reimbursement rate 100% Sizwe rate
Benefits Subject to managed care protocols
Specialised
Reimburse-ment Rate 100% Sizwe Rate
Benefits R18 680 per family for in and out of hospital
PHYSIOTHERAPY
Reimbursement rate Subject to day to day benefits
PATHOLOGY
Reimbursement rate 100% Sizwe rate
Benefits Subject to day to day benefits
MENTAL HEALTH(Limited to Psychiatrist, Clinical, Counselling, Psychologist
excludes services covered under Auxillary Benefits)
Reimbursement rate 100% Sizwe rate
Benefits R5 180 per family
DENTISTRY(Subject to Dental Management Programme - 0860 109 556)
Reimbursement rate 100% Sizwe rate
Limit per beneficiary
2 general check ups a year per beneficiary once in six months Motivation may be requested for extensive restorative treatment plans (fillings)
OUT OF HOSPITAL BENEFITS
Plastic dentures
Root Canal, Clinical protocols apply 1 set per jaw every 4 years
SPECIALISED DENTISTRY(Subject to pre-authorisation
and Dental Management Programme)
Benefits 100% Sizwe rate
Crowns and Bridges No Benefit
Orthodontics (Braces) No Benefit
Implants No Benefit
Partial Metal Frame Dentures No Benefit
Surgery Managed Care protocols apply
OPTICAL BENEFITS ACCESSED THROUGH (PPN)
Reimbursement rate 100% Sizwe rate
Benefits No limit
Cycle 2 years
Limit per bb Limit per beneficiary
Frames R320
Single focus lenses R175 per lens
Bi-focal lenses R380 per lens
Multi-focal lenses R380 per lens
Contact lenses R1 200
AUXILIARY SERVICES (Speech Therapists, Podiatrists, Occupational Therapists,
Social Workers, Dieticians Audiologists, Chiropractors, Homeopathy, Educational Psychologists, Clinical
Technologist, Biokineticist and Registered Counsellors)
Reimbursement Rate 100% Sizwe rate
Benefits Risk benefit
Annual limit per family M: R1 010
Limits per family M+1+: R1 630
Chiropractor R1 000 per beneficiary
MATERNITY (Subject to registration on maternity
programme and 24 weeks of falling pregnant)
Reimbursement rate 100% Sizwe rate
Ante-natal consultations 9 GP/Midwife visits; 2 Specialist visits
Pregnancy scans 2 x 2D scans per pregnancy
CHRONIC BENEFITS(Subject to pre-authorisation.
Medicines: subject to registration on the Chronic Medicine Programme. PMBs subject to pre-authorisation, preferred providers and
treatment protocols.)Reimbursement rate 100% Sizwe rate
Benefits Cover for 27 PMB chronic conditions
HIV/AIDS(Members are encouraged to register with the
HIV/AIDS Programme. This benefit includes rele-vant consultations, counselling, medication and the cost of blood tests for monitoring purposes)
Reimbursement rate 100% Sizwe rate
Benefits
Subject to PPDMP benefits include counseling, prescription medicine, pathology tests.
IN-HOSPITAL BENEFITS(All hospital admissions must be authorised. A
co-payment of R1 500 will be applied if pre-authorisation was not obtained)
Overall annual limit Unlimited
Provider Network Any
Primary C
are
IN-HOSPITAL BENEFITS(All hospital admissions must be authorised. A
co-payment of R1 500 will be applied if pre-authorisation was not obtained)
BENEFITS
AMBULANCE SERVICESContracted EUROP ASSISTSA (Telephone number:0860 11 77 99
100% Sizwe rate
PRIVATE HOSPITALS AND NURSING HOMES(subject to pre-authorisation and case management
protocols and PMB’s unless its a medical emergency)
Accommodation
A co-payment will apply to all unauthorised admissions unless it is an emergency. Unlimited at any private hospital
Reimbursement rate 100% Sizwe rate
Clinical limitations and exclusions
Advanced laparoscopic, reconsructive surgery, joint replacements, cardiac surgery including cardiac stents, spinal surgery, breast reconstructive surgery
Exclusions
Refractive surgery, breast reduction, breast augmentation, Keloids, Frail Care
DENTAL HOSPITALISATION(Subject to pre-authorisation, Dental Benefit Management
Programme and clinical protocols subject to R1 500 co-payment on some options)
Reimbursement rate 100% Sizwe rate
General anaestheticPre-authorisation is required, subject to managed care protocols
Laughing gas in dental rooms 100% Sizwe rate
Conscious sedation in roomsSubject to pre-authorisa-tion and managed care protocols
GENERAL PRACTITIONER AND MEDICAL SPECIALIST
Reimbursement rate100% Sizwe rate for consultations and visits in-hospital
AUXILIARY SERVICES
General 100% Sizwe rate
AUXILIARY SERVICES
Reimbursement rate 100% Sizwe rate
Benefits
Subject to pre–authori-sation and PMBs, limited to dieticians, speech therapy, occupational therapy and clinical technology
PHYSIOTHERAPY
Reimbursement ratePre-authorisation and managed care protocols apply
100% Sizwe rate
MATERNITY
Reimbursement rateHospitalisation (public or private hospitals) delivery, post-natal services and midwifery
100% Sizwe rate
BLOOD TRANSFUSIONS AND BLOODREPLACEMENT PRODUCTS
Reimbursement rate
100% of the cost of blood transfusions and blood replacement prod-ucts, limited to PMBs
PROSTHESIS
Reimbursement rate
100% Sizwe rate,Subject to pre-authorisa-tion, treatment protocols, DSPs and PMBsMaximum of 3 cardiac stents and 2 vascular stents per family per annumAnnual limit: R 25 600
ONCOLOGY
Reimbursement rate 100% Sizwe rate
pg 14 Primary Care
IN-HOSPITAL BENEFITS(All hospital admissions must be authorised. A
co-payment of R1 500 will be applied if pre-authorisation was not obtained)
Benefits Overall limit of R143 780 per family
RADIOLOGY AND RADIOGRAPHY
Reimbursement rate 100% Sizwe rate:subject to clinical protocols
Specialised Radiology (MRI/CAT scan/ Anglogram) Pre-authorisa-tion and managed care protocols
Limited to R18 680 per family per annum
Interventional radiology
Payable from the hospital limit, subject to pre-authorisation and clinical protocols
PATHOLOGY
Reimbursement rate 100% Sizwe rate
MENTAL HEALTH
Psychiatry hospitalisation
Limited to 21 days per beneficiary per annumPsychiatrist consulta-tions and 6 in-hospital Clinical Psychologists subject to PMBs
Alcoholism, drug addiction, narcotism: subject to PMBs, pre-authorisation and minimum benefit package
3 days withdrawal treat-ment and up to 21 days rehabilitation
ORGAN TRANSPLANT AND RENAL DIALYSIS
Reimbursement rate 100% Sizwe rate
Benefits Subject to PMBs at DSPs
REFRACTIVE SURGERY INCLUDING RADIAL KERATOTOMY
Reimbursement rate No Benefit
PREVENTATIVE BENEFITS
WELLNESS SCREENING CONSULTATIONS
Reimbursement rate 100% Sizwe rate
Consultation Benefits R1 000
Screening benefits
Subject to a family limitof R2 020 for flu vaccine and pneumococcal vaccine.
Mammograms: once in a 2 year cycle for females over 40 years
Papsmear: once in a 2year cycle for females over 21 years
Prostate-Specific Antigen (PSA): once per year for males over 40 years
BLOOD SUGAR, CHOLESTEROL, BLOOD PRESSURE, BMI AND HIV
Reimbursement rate 100% Sizwe rate
Benefit R260
ORAL CONTRACEPTIVES
Reimbursement rate 100% Sizwe rate
Benefits R2 620 per family per annum
OTHER BENEFITS: IN-HOSPITAL OR OUT-OF-HOSPITAL
AppliancesM: R1 010
M+1+:R1 630
Wheelchair R1 800 per family
Hearing aids R7 500 per family
Private nursing R4 540 per family
Sizwe Medical Fund - Benefits Guide 2018 pg 15
Sizwe H
istory2018 O
fferingsH
ospital Care
Gom
omo C
arePrim
ary Care
Affordable C
areFull B
enefit Care
AFFORDABLE CAREOffers generous comprehensive cover with unlimited hospitalisation in any
private hospital. This option is suitable for young and healthy families.
pg 16 Affordable Care
IN-HOSPITAL BENEFITS
AUXILIARY SERVICES(Dietician, Speech Therapy, Occupational Therapy)
General 100% Sizwe rate
Dietician, speech therapy, occu-pational therapy
Subject to pre–authori-sation and PMBs
PHYSIOTHERAPY(Pre-authorisation and managed care protocols apply)
Reimbursement rate 100% Sizwe rate
MATERNITY(Hospitalisation [public or private hospitals]delivery, post-natal
services and midwifery)
Reimbursement rate 100% Sizwe rate
BLOOD TRANSFUSIONS AND BLOOD REPLACEMENT PRODUCTS
Reimbursement rate 100% Sizwe rates; limited to PMBs
PROSTHESIS(Subject to pre-authorisation, treatment protocols and PMBs)
Reimbuirsement rate 100% Sizwe rate
Benefits
100% of costMaximum of 3 cardiac stents and 2 vascular stents per family per annumAnnual limit: R42 670
ONCOLOGY
Reimbursement rate 100% Sizwe rate
Benefit R314 170 per family
RADIOLOGY AND RADIOGRAPHY
Reimbursement rate 100% Sizwe rate
Specialised Radiology (MRI/CAT scan/ Anglogram) Pre-authorisa-tion and managed care protocols
Limited to R28 400 per family per annum, pre-authorisation and managed care protocols
Interventional radiology
Payable from the hospital limit, subject to pre-authorisation and clinical protocols
OUT OF HOSPITAL BENEFITS
Option Structure Major Medical; Day to day: Risk
Provider Any
OVERALL DAY-TO-DAY LIMIT
Benefit
M: R9 840M+1: R14 100M+2: R16 230M+3: R17 660M+4: R19 790M+5: R21 930M+6+: R23 930
GENERAL PRACTITIONERS (CARE OPTION ONLY)
Reimbursement rate 100% Sizwe rate
Benefits Limited number of visits
Chosen GP
M: 7M+1: 14M+2: 16M+3: 18M+4: 20M+5: 21M+6+: 22
SPECIALISTS
Reimbursement rate 100% Sizwe rate
Benefits
Subject to referral by a GP, with the exception of: Follow-up visits, Emergencies, Gynaecologist and Paediatrician visits for babies up to the age of 12 months.
M: 4M+1: 8M+2: 9M+3: 10M+4: 11M+5: 12M+6+:13
ACUTE MEDICINES
Reimbursement rate 100% Sizwe rate
Benefits
Within day to day
M: R3 420 M+1: R5 210 M+2: R6 160 M+3: R6 630 M+4: R7 580 M+5: R7 820 M+6+:R8 060
RADIOLOGY AND RADIOGRAPHY
Reimbursement rate 100% Sizwe rate
Benefits Subject to clinical protocols
Specialised Radiology: (MRI/CAT scan/Angio-gram) pre-au-thorisation and managed care protocols
Benefits
Subject to an overall combined in and out of hospital limit of R28 400 per family
MENTAL HEALTH
Reimbursement rate
100% Sizwe rateLimited to Psychiatrists, Clinical and Counselling Psychologists subject to R8 580 per family
Benefit Risk benefit
PHYSIOTHERAPY
Reimbursement Rate100% Sizwe RatePaid from the day to day limit
PATHOLOGY
Reimbursement rate 100% Sizwe rate
OUT OF HOSPITAL BENEFITSDENTISTRY
(Subject to Dental Management Programme - 0860 109 556)
Reimbursement rate 100% Sizwe rate
Benefits
2 general check ups a year per beneficiary Motivation may be re-quested for extensive re-storative treatment plans (fillings)
Plastic dentures
Clinical protocols apply
Root Canal: Managed Care Protocols apply
1 Set dentures, full or partial every 4 years
SPECIALISED DENTISTRY
Reimbursement rate 100% Sizwe rate
BenefitsBenefits: Subject to pre-authorised and managed care protocols
Crowns and bridges 1 Crown per family per year
Dentures
Partial frames per beneficiary in a 5 year period lmited to 1 beneficiary per annum
Orthodontic treatment
Pre-authorisation and clinical protocolsRestricted to beneficiary < 18 years, 35% co-pay
OPTICAL BENEFITS ACCESSED THROUGH PPN
Reimbursement rate 100% Sizwe rate
Cycle 2 years
Benefits Limit per beneficiary
Frames R800
Single focus lenses R175 per lens
Bi-focal lenses R380 per lens
Multi-focal lenses R695 per lens
Contact lenses R1 500
AUXILIARY SERVICES (Speech therapy; Podiatry; Occupational Therapy; Social Worker; Dietetics; Audiology, Homeopathy; Educational Psychologist; Biokineticist and Registered Counselor)
Reimbursement Rate 100% Sizwe rate
Benefits M: R 1 510 M+1+: R 2 640
MATERNITY (Subject to registration on the Sizwe Baby Programme within
24 weeks of falling pregnant)
Reimbursement rate 100% Sizwe rate
Ante-natal consultations 9 GP/Midwife visits; 4 Specialist visits
Pregnancy scans 2 x 2D scans per pregnancy
IN-HOSPITAL BENEFITS(All hospital admissions must be authorised
R1500 co-payment will be applied if authorisa-tion was not obtained except in emergencies)
Annual LimitSubject to pre-authorisa-tion and managed care protocols
Provider Limits Preferred provider network
AMBULANCE SERVICES
100% cost as authorised by EUROP ASSIST SA (Telephone number: 0860 11 77 99)
PRIVATE HOSPITALS AND NURSING HOMES(Subject to treatment and case management protocolsand
PMBs. Pre-authorisation required unless it is a medical emergency. A co-payment will apply to all unauthorised
admissions unless it is an emergency.)
Accommodation Unlimited at any private hospital
Reimbursement rate 100% Sizwe rate
Clinical limitations and exclu-sions None
DENTAL HOSPITALISATION(Subject to pre-authorisation, Dental Benefit Management
Programme and clinical protocols subject to R1 500 co-payment)
Reimbursement rate 100% Sizwe rate
General anaestheticPre-authorisation is required, subject to managed care protocols
Laughing gas in dental rooms 100% Sizwe rate
Conscious sedation in roomsSubject to pre-authorisation and managed care protocols
GENERAL PRACTITIONER AND SPECIALIST
Reimbursement rate100% Sizwe rate for consultations and visits in-hospital
CHRONIC MEDICINES
Reimbursement rate 100% Sizwe rate
PMB 26
Beneficiary R5 540 per beneficiary
Non PMB
M: R5 540 M+1: R11 090 M+2: R16 640 M+3: R22 190 M+4: R27 730M+5: R33 300M+6+:R38 850
HIV/AIDS(Members are encouraged to register with the HIV/AIDS Programme. This benefit includes relevant consultations, counselling, medication and the cost of blood tests for
monitoring purposes)
Reimbursement rate 100% Sizwe rate
Benefit Subject to treatment protocols and PMBs
Sizwe Medical Fund - Benefits Guide 2018 pg 17
Sizwe H
istory2018 O
fferingsH
ospital Care
Gom
omo C
arePrim
ary Care
Affordable C
areFull B
enefit Care
IN-HOSPITAL BENEFITS
PATHOLOGY
Reimbursement rate 100% Sizwe rate
MENTAL HEALTH
Psychiatry hospitalisation
Limited to 21 days per beneficiary per annumPsychiatrist consulta-tions and 6 in-hospital Clinical Psychologists subject to PMBs
Alcoholism, drug addiction, narcotism: subject to PMBs, pre-authorisation and minimum benefit package
3 days withdrawal treat-ment and up to 21 days rehabilitation
ORGAN TRANSPLANT AND RENAL DIALYSIS
Reimbursement rate 100% Sizwe rate
Benefits
Restricted to PMBs, subject to pre-authori-sation, minimum benefit package, treatment protocols and DSP
REFRACTIVE SURGERY INCLUDING RADIAL KERATOTOMY
Reimbursement rate Limited to R6 310 per family
OVERALL ANNUAL LIMIT
R6310 per family per annum
PREVENTATIVE BENEFITSORAL CONTRACEPTIVES
Reimbursement rate 100% Sizwe rate
Benefits R2 620 per family
OTHER BENEFITS: IN-HOSPITAL OR OUT-OF-HOSPITAL
Appliances M: R1 510M+1+1: R2 640
Wheelchair(Once every four years)
Limited to R3 150 per family
Hearing aids 12 000 Once in every 3 years
Private nursing R6 780
PREVENTATIVE CARE
Limits
Females:
Mammogram every 2 years for women above age 40 years:
Pap smear every 2 years for women above 21 years
Males (above 40 years): Prostate-Specific Antigen test
Screening & vaccines 2 020 per family
Wellness screening 260 per beneficiary
Wellness consults 1 470 per family
Contraceptives 2 620 per family
Chiropractors 1 300 per beneficiary
Affordable C
are
pg 18 Affordable Care
FULL BENEFIT CAREoffers comprehensive cover and
generous benefits to cover families and individuals who need access to
unlimited hospitalisation at any private hospital.
Sizwe Medical Fund - Benefits Guide 2018 pg 19
Sizwe H
istory2018 O
fferingsH
ospital Care
Gom
omo C
arePrim
ary Care
Affordable C
areFull B
enefit Care
IN-HOSPITAL BENEFITS
AUXILIARY SERVICES
General 100% Sizwe rate
Dietician, speech therapy, occu-pational therapy
Subject to pre–authori-sation and PMBs
PHYSIOTHERAPY
Reimbursement ratePre-authorisation and managed care protocols apply
100% Sizwe rate
MATERNITY
Reimbursement rateHospitalisation (public or private hospitals) delivery, post-natal services and midwifery
100% Sizwe rate
BLOOD TRANSFUSIONS AND BLOOD REPLACEMENT PRODUCTS
Benefits
100% of the cost of blood transfusions and blood replacement products, limited to PMBs
PROSTHESIS
Benefit limit: pre-authorisation and managed care protocols apply
100% of costSubject to pre-authorisa-tion, treatment protocols and PMBsMaximum of 3 cardiac stents and 2 vascular stents per family per annumAnnual limit: R56 330
ONCOLOGY
Reimbursement rate 100% Sizwe rate
Benefit Overall limit of R377 010 per family
OUT OF HOSPITAL BENEFITS
OPTION STRUCTURE Major Medical; Day to day: Risk
Provider Any
OVERALL DAY-TO-DAY LIMIT
Limits
M: R16 230M+1: R21 930M+2: R24 650M+3: R27 490M+4: R30 350M+5: R33 190M+6+:R36 020
GENERAL PRACTITIONERS (ADDITIONAL GP VISITS PER FAMILY ON THE PRIMARY
CARE OPTION ONLY)
Reimbursement rate 100% Sizwe rate
Benefits
Subject to availability in day to day limits
M: 12M+1: 20M+ 2: 25M+3: 29M+4: 30M+5: 31M+6+:32
SPECIALISTS (EXCLUDING PSYCHIATRISTS)
Reimbursement rate 100% Sizwe rate
Benefits
M: 7 M+1: 12 M+2: 15 M+3: 16 M+4: 17 M+5: 19 M+6+:20
ACUTE MEDICINES AND PHARMACY ADVISED THERAPY (PAT) - FALLS WITHIN DAY-TO-DAY
BENEFIT WITH THE FOLLOWING SUB-LIMITS
Reimbursement rate 100% Sizwe rate
Benefits subject to day to day limits
Limits
M: R4 620 M+1: R8 170 M+2: R9 480 M+3: R10 790M+4: R11 480M+5: R12 090M+6+:R12 680
RADIOLOGY AND RADIOGRAPHY
Reimbursement rate 100% Sizwe rate on general radiology
Speacialists rates (MRI/CAT scan/Angiogram)
RateR37 360 per family in-hospital and out of hospital limit
Structure Combined In-hospital and Out of hospital
Limits R37 370 per family
CHRONIC CONDITIONS
Reimbursement rate
100% Sizwe rate subject to pre-authorisation preferred provider and treatment protocols
PMB 26 Chronic conditions
Non-PMB
M: R10 970M+1: R21 960M+2: R32 820M+3: R43 800M+4: R54 780M+5: R65 760M+6+:R76 750
PSYCHOLOGICAL AND PSYCHIATRIC TREATMENT
Reimbursement rate 100% Sizwe rate
Benefits Subject to R16 540 per family
PHYSIOTHERAPY
Reimbursement rate 100% Sizwe rate
PATHOLOGY
Reimbursement rate 100% Sizwe rate
Structure Risk benefit, within day to day limit
OUT OF HOSPITAL BENEFITSBASIC DENTISTRY
(Conservative Dentistry: Subject to Dental Management Programme - 0860 109 556)
Reimbursement rate 100% Sizwe rate
Benefits
2 general check ups a year per bb Motivation may be re-quested for extensive re-storative treatment plans (fillings)
Plastic dentures
Clinical protocols apply
Root canal: subject to managed care protocols 1 per jaw every 4 years
SPECIALISED DENTISTRY
Reimbursement rate 100% Sizwe rate
Benefits
“3 crowns pfpa, 2 metal frames pfpa, 2 implants per bb/ 5 years limited to R3 690 per implant”
Orthodontic treatment
Pre-authorisation and clinical protocolsRestricted to bbs < 18 years
OPTICAL BENEFITS ACCESSED THROUGH A CONTRACTED SERVICE PROVIDER
Reimbursement rate 100% Sizwe rate
Cycle 2 years
Frames R1 000
Single focus lenses R175 per lens
Bi-focal lenses R380 per lens
Multi-focal lenses R695 per lens
Contact lenses R1 700
MENTAL HEALTH (Psychiatrists, Clinical and Counselling
Psychologists - only if related to mental health, excludes Educational Psychologists, Social Workers and
Registered Counsellors)
Reimbursement rate 100% Sizwe rate
Benefits Subject to R16 540 per family
AUXILIARY SERVICES (Speech Therapy; Podiatry; Occupational Therapy; Social Worker; Dietetics; Audiology; Homeopathy; Educational Psychologist; Biokineticist and Registered Counselor)
Reimbursement rate 100% Sizwe rate
Benefits M: R2 770M+1+: R4 660
MATERNITY (Subject to registration on the Sizwe Baby Programme within
24 weeks of falling pregnant)
Reimbursement Rate 100% Sizwe Rate
Pregnancy scans 2 x 2D scans per pregnancy
CHRONIC BENEFITS(Subject to pre-authorisation.
Medicines: subject to registration on the Chronic Medicine Programme. PMBs subject to pre-authorisation, preferred providers and
treatment protocols.)
Reimbursement rate
100% Sizwe rate subject to pre-authori-sation, preferred providers and Treatment Protocols
PMB At Cost
Non-PMB
M: R10 970M+1: R21 960M+2: R32 820M+3: R43 800M+4: R54 780M+5: R65 760M+6+:R76 750
Full Benefit C
areCHRONIC BENEFITS
(Subject to pre-authorisation.Medicines: subject to registration on the
Chronic Medicine Programme. PMBs subject to pre-authorisation, preferred providers and
treatment protocols.)HIV/AIDS MANAGEMENT PROGRAMME
(Members are encouraged to register with the HIV/AIDS Programme. This benefit includes relevant consultations, counselling, medication and the cost of blood tests for
monitoring purposes)
Reimbursement rate 100% Sizwe rate
BenefitNo limit, subject to treatment protocols and PMBs
IN-HOSPITAL BENEFITSAnnual Limits Unlimited
Provider Any
BENEFITSAMBULANCE SERVICESContracted EUROP ASSISTSA (Telephone number:0860 11 77 99
100% Sizwe rate
PRIVATE HOSPITALS AND NURSING HOMES(Subject to treatment and case management
protocols and PMBs. Pre-authorisation required unless it is a medical emergency)
Accommodation Unlimited at any private hospital
Reimbursement rate 100% Sizwe rate
Clinical limitations and exclu-sions None
DENTAL HOSPITALISATION(Subject to pre-authorisation, Dental Benefit
Management Programme and clinical protocols subject to R1 500 co-payment on some options)
Reimbursement rate 100% Sizwe rate
General anaestheticPre-authorisation is required, subject to managed care protocols
Laughing gas in dental rooms 100% Sizwe rate
Conscious sedation in roomsSubject to pre-authorisa-tion and managed care protocols
GENERAL PRACTITIONER AND MEDICAL SPECIALIST
Reimbursement rate 100% Sizwe rate
pg 20 Full Benefit Care
PREVENTATIVE BENEFITS
OTHER BENEFITS: IN-HOSPITAL OR OUT-OF-HOSPITAL
AppliancesM: R2 640 M+1+:R4 400
Private nursing Limit per family 9 080 per family
Chiropractors R2 000 per beneficiary
IN-HOSPITAL BENEFITSRADIOLOGY AND RADIOGRAPHY
General reimbursement rate 100% Sizwe rate
Specialised Radiology (MRI/CAT scan/ Anglogram) Pre-authorisa-tion and managed care protocols
Limited to R37 360 per family per annumCombined in-hospital and out-of-hospital limit
Interventional radiology
Payable from the hospital limit, subject to pre-authorisation and clinical protocols
PATHOLOGY
Reimbursement rate 100% Sizwe rate
MENTAL HEALTH
Psychiatry hospitalisation
Limited to 21 days per beneficiary per annumPsychiatrist consulta-tions and 6 in-hospital Clinical Psychologists subject to PMBs
Alcoholism, drug addiction, narcotism: subject to PMBs, pre-authorisation and minimum benefit package
3 days withdrawal treat-ment and up to 21 days rehabilitation
ORGAN TRANSPLANT AND RENAL DIALYSIS
Reimbursement rate 100% Sizwe rate
Benefits Subject to PMBs
REFRACTIVE SURGERY INCLUDING RADIAL KERATOTOMY
Reimbursement rate 100% Sizwe rate
Benefits R12,120 per family per annum
PREVENTATIVE BENEFITS
WELLNESS CONSULTATIONS
Reimbursement rate 100% Sizwe rate
Consultation benefits R1 470
Screening benefits
Subject to R2 875 per family for flu vaccine and pneumococcal vaccine.
Mammograms: once in a 2 year cycle for females over 40 years
Papsmear: once in a 2year cycle for females over 21 years
Prostate-Specific Antigen (PSA): once per year for males over 40 years
BLOOD SUGAR, CHOLESTEROL, BLOOD PRESSURE, BMI AND HIV
Reimbursement rate 100% Sizwe rate
Benefit R260 per beneficiary
ORAL CONTRACEPTIVESReimbursement rate 100% Sizwe rate
Benefit R2,620 per family per annum
Sizwe Medical Fund - Benefits Guide 2018 pg 21
Sizwe H
istory2018 O
fferingsH
ospital Care
Gom
omo C
arePrim
ary Care
Affordable C
areFull B
enefit Care
Full Benefit C
are
2018 Contributions
HOSPITAL CARE
CHILD
% of total contribution paid to savings account
ADULT
PRINCIPAL
GOMOMO CARE
Contribution Income Band Contribution Income Band
R877R1 156R1 649R2 048
R0 - R7 147R7 148 - R8 337R8 338 - R10 719R10 720 +
R0 - R7 147R7 148 - R8 337R8 338 - R10 719R10 720 +
R0 - R7 147R7 148 - R8 337R8 338 - R10 719R10 720 +
R1 500 All
R867R1 156R1 592R1 672
R1 100 All
R365R419R458R489
R500 All
0%0%
2018 Contributions
PRIMARY CARE FULL BENEFIT CAREAFFORDABLE CARE
Contribution Income Band Contribution Income Band Contribution Income Band
R419R1 964R2 396
R4 336R5 032
R2 815R2 928R3 767
R0 - R562R563 - R9 292R9 293 +
< R32 499R32 500+
R0 - R15 955R15 956 - R32 499R32 500+
Traditional Traditional Traditional
R0 - R562R563 - R9 292R9 293 +
< R32 499R32 500+
R0 - R15 955R15 956 - R32 499R32 500+
R0 - R562R563 - R9 292R9 293 +
< R32 499R32 500+
R0 - R15 955R15 956 - R32 499R32 500+
R419R1 533R1 565
R3 940R4 574
R2 586R2 688R3 349
R419R494R494
R886R989
R649R680R752
0% 0%0%
pg 24 Full Benefit Care
CHRONIC MEDICATION PROGRAMME:Tel: 0860 103 455 | 011 353 0030 Fax: 011 353 0352/0076Email: [email protected] PRE-AUTHORISATION, HOSPITAL BENEFIT MANAGEMENT PROGRAMME:Tel: 0860 101 176
DENTAL BENEFIT MANAGEMENT:Tel: 0860 109 556 | Fax: 0866 770 336 Email: [email protected] PROGRAMME – HELPLINE FOR ASTHMA, CARDIOVASCULAR DISEASE, DIABETES AND MENTAL HEALTH:Tel: 0860 103 455 | Fax: 011 221 5238Email: [email protected]
IMPORTANT CONTACT DETAILS
Sizwe Medical Fund - Benefits Guide 2018 pg 25
Sizwe H
istory2018 O
fferingsH
ospital Care
Gom
omo C
arePrim
ary Care
Affordable C
areFull B
enefit Care
HIV/AIDS MANAGEMENT PROGRAMME:Tel: 0860 103 454 | Fax: 011 221 5235/56EUROP ASSISTANCE SA, MEDICAL EMERGENCIES, 24-HOUR AMBULANCE SERVICES AND MEDICAL ADVICE:Tel: 0860 117 799
SIZWE BABY PROGRAMME:Fax: 011 221 5218Email: [email protected]
TIP-OFFS ANONYMOUS FRAUD LINE:Tel: 0800 204 702 | Fax: 0800 007 788 Email: [email protected] MEDICATION PROGRAMME:Tel: 0860 103 455 | 011 353 0030 Fax: 011 353 0352/0076Email: [email protected]
IMPORTANT CONTACT DETAILS
[email protected] 100 871