Sizwe Medical Fund Has Affordable Plans for Low Income Groups

Sizwe is a relatively large, community-focused open medical aid scheme that offers a “one-stop solution” for companies that want to provide their employees with affordable medical plans. The company prides itself on being able to offer medical aid to everyone from “the lowest-paid blue-collar worker to top-earning executives”.

Founded in 1978, the Sizwe mission has always been provide simple, affordable medical aid to the nation.

Medical Aid Plans Offered by Sizwe

Sizwe offers five medical aid plans ranging from a new-generation savings-orientated plan to a plan that offers full, comprehensive benefits.

  1. Sizwe Medical PlansSavings Care Plan Flexible with a 15 percent savings portion. This “new-generation” medical aid plan does not have an overall in-hospital limit and is valid for both private and public hospitals, “subject to clinical protocols”. Both chronic medicines and Prescribed Minimum Benefit (PMB)-defined chronic medicine and HIV (also as per PMB) are covered. Maximum radiology benefits for the family are R21 236, and basic radiology, GPs, specialists, medication, dentistry and optical costs all come out of savings.
  2. Gomomo Care This is an entry-level, very basic medical aid plan that provides low-income earners with excellent value. It has a good network of doctors and will provide unlimited hospitalisation subject to accepted clinical protocols. This option has been designed for people who earn less than R8 000 a month, although those who earn a little more are able to take it.
  3. Primary Care Advertised as the “most affordable traditional plan” offered by Sizwe, this plan offers unlimited private hospital care within the Sizwe network, as well as benefits that accrue in addition to normal day-to-day benefits. Chronic conditions defined by the legislated PMBs are included, along with maternity and wellness benefits.
  4. Affordable Care This is a middle-of-the-road medical aid plan that offers unlimited in-hospital cover and generous benefits. It also covers chronic conditions in addition to those prescribed by law. One of the most popular benefits is that you are able to choose any doctor, specialist or hospital in South Africa.
  5. Full Benefit Plan The top-of-the-range medical aid product offered by Sizwe this plan includes chronic condition cover and unlimited cover for hospitalisation. There is also freedom of choice when it comes to healthcare providers, and there are a number of benefits that relate to oncology, dental, optical, maternity and other healthcare services.

Sizwe Medical PlansSizwe contributions for medical aid plans range from just R650 for individual principal members earning less than R6 000 if the Gomomo option is chosen, to R3 490 for a principal member earning under R16 800 (for the Full Benefit Plan) or R4 310 if the principal member earns more than this figure.

Sizwe Offers Chronic and Wellness Benefits Too

When it comes to medication for chronic illnesses, including those that are defined as PMB, conditions must be pre-authorised, and treatment is subject to protocols within the Sizwe network. Cover is provided for PMB chronic conditions on the Primary Care plan, and additional benefits accrue on both the Full Benefit and Affordable Care options.

Sizwe also has benefits for HIV/AIDS patients that include consultations, medication, counselling, and cover of the cost of blood test that are required to monitor the illness.

Recognising that chronic conditions including diabetes, high blood pressure, mental health disorders and respiratory disease can all be managed without hospitalisation, the company has appointed wellness consultants to help members make lifestyle changes and ultimately live a more healthy life. A number of wellness benefits are included in all but the Gomomo Care and Savings Care plans.