Affordable Care Benefit Guide - Sizwe Medical Fund

 
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Affordable Care Benefit Guide - Sizwe Medical Fund
2019
Affordable Care
   Benefit Guide

                   Sizwe Medical Fund is proudly administered by Sechaba Medical Solutions
Affordable Care Benefit Guide - Sizwe Medical Fund
Affordable Care offers comprehensive in-hospital
                                                                   cover, chronic and day-to-day benefits. It offers
                                                                   excellent value for families and individuals who
                                                                   want the freedom to access affordable healthcare.

                                                                          Key Benefits

               OUT OF HOSPITAL BENEFITS                                                 SPECIALIST BENEFITS
                 100% Sizwe rates for medical and                                   100% Sizwe rates for consultations and
                surgical consultations and visits to                                        visits to specialists.
                specialists, subject to availability of
                        day-to-day benefits.

                    IN - HOSPITAL BENEFITS                                               MATERNITY BENEFITS
                  100% of negotiated tariff for                                        100% Sizwe rates for antenatal
              Admission in General Ward, High Care                                 consultations, 9 midwife, GP or Specialist
                 Ward and Intensive Care Unit.                                         antenatal visits per pregnancy.

Sizwe Medical Fund is proudly administered by Sechaba Medical Solutions
Affordable Care Benefit Guide - Sizwe Medical Fund
IN-HOSPITAL BENEFITS
All hospital admissions must be authorised. A co-payment of R1 500 will be applied if pre-authorisation is not
obtained.

  BENEFITS                                                                    PRIVATE HOSPITALS & NURSING HOMES

   ANNUAL LIMIT                            Subject to pre-authorisation and   ADMISSION                  Unlimited at a private hospital
                                           Managed Care Protocols
                                                                              REIMBURSEMENT RATE         100% Sizwe Rate
   PROVIDER                                Any
                  Ambulance services contracted                               CLINICAL LIMITATIONS       None
                       EUROP ASSIST SA
                       Tel: 0860 11 77 99
                                                                               Subject to pre-authorisation and case management
  DENTAL HOSPITALISATION                                                       protocols and PMB unless it is a medical emergency

   REIMBURSEMENT RATE                      100% Sizwe Rate                    PHYSIOTHERAPY

   GENERAL ANAESTHETIC                     Pre-authorisation is required,     REIMBURSEMENT RATE         100% Sizwe Rate
   (children under the age of 5 for        subject to Managed Care
   extensive dental treatment)
                                           Protocols                          MATERNITY

                                           Benefits are availible for the     REIMBURSEMENT RATE         100% Sizwe Rate
                                           removal of impacted teeth                                     Hospitilisation (public or private
                                                                                                         hospital), delivery, post-natal
   LAUGHING GAS IN                         100% Sizwe Rate                                               services and midwifery
   ROOMS                                                                       Subject to registration on the Sizwe Baby Programme
                                                                                        within 24 weeks of falling pregnant.
   CONSCIOUS SEDATION                      100% Sizwe Rate; subject to
   IN ROOMS                                Managed Care Protocols             PATHOLOGY

  Subject to pre-authorisation, Dental Benefit Management                     REIMBURSEMENT RATE         100% Sizwe Rate
       Programme and clinical protocols subject to
                    R1 500 co-payment.                                        BLOOD TRANSFUSION & BLOOD REPLACEMENT PRODUCTS

  GENERAL PRACTITIONER AND MEDICAL SPECIALIST                                 REIMBURSEMENT RATE         100% of the cost of blood
                                                                                                         transfusions and blood
   REIMBURSEMENT RATE                      100% Sizwe Rate for                                           replacement products, limited
                                           consultations and visits                                      to PMBs
                                           in-hospital

Sizwe Medical Fund is proudly administered by Sechaba Medical Solutions
Affordable Care Benefit Guide - Sizwe Medical Fund
IN-HOSPITAL BENEFITS
All hospital admissions must be authorised. A co-payment of R1 500 will be applied if pre-authorisation is not
obtained.

  ONCOLOGY                                                                    ORGAN TRANSPLANT AND RENAL DIALYSIS

   REIMBURSEMENT RATE                      100% Sizwe Rate                     REIMBURSEMENT RATE          100% Sizwe Rate

   BENEFITS                                Overall limit of R331 450 per       BENEFITS                    Restricted to PMBs, subject
                                           family per annum                                                to pre-authorisation, minimum
                                                                                                           benefit package, treatment
                                                                                                           protocols and DSP
  RADIOLOGY AND RADIOGRAPHY

   REIMBURSEMENT RATE                      100% Sizwe Rate                    PROSTHESIS

                                                                              REIMBURSEMENT RATE           100% Sizwe rate,
   SPECIALISED                             Limited to
                                                                                                           Subject to pre-authorisation,
   RADIOLOGY                               R29 960 per family per annum
                                                                                                           treatment protocols, DSPs and
   (MRI/CAT scan/
                                                                                                           PMBs Maximum of 3 cardiac
   Angiogram)                              Subject to pre-authorisation and
                                                                                                           stents and 2 vascular stents per
   pre-authorisation and                   Managed Care Protocols
                                                                                                           family per annum. Annual limit:
   Managed Care Protocols
                                                                                                           R 42 670 for both surgical and
                                                                                                           non-surgical per family.
   INTERVENTIONAL                          Payable from the hospital limit,
   RADIOLOGY                               subject to pre-authorisation and
                                                                              REFRACTIVE SURGERY INCL. RADIAL KERATOTOMY
                                           clinical protocols
                                                                               BENEFIT                     R6 660 per family per annum
  MENTAL HEALTH
                                                                              CLINICAL AND MEDICAL TECHNOLOGIST
   PSYCHIATRIC                             Offering 4 additional out
   HOSPITALISATION                         of hospital visits in lieu of
                                                                               REIMBURSEMENT RATE          100% Sizwe Rate
                                           hospitalisation

                                           Limited to 21 days per              BENEFITS                    Member :         R1 600
                                           beneficiary including                                           Member +1+:      R2 800
                                           psychiatrist consultations
                                           and 6 in-hospital clinical         AUXILIARY SERVICES
                                           psychologists subject to PMBs
                                                                              REIMBURSEMENT RATE           100% Sizwe Rate
   ALCOHOLISM,                             3 days withdrawal treatment
   DRUG ADDICTION,                         and up to 21 days In-Patient
                                                                              BENEFITS                     Subject to pre–authorisation
   NARCOTISM                               rehabilitation
                                                                                                           and PMBs

                                                                                  Speech Therapists, Podiatrists, Occupational
                                                                                Therapists, Social Workers, Dietician, Audiologists,
                                                                                 Homeopathy, Clinical Technologist, Educational
Sizwe Medical Fund is proudly administered by Sechaba Medical Solutions       Psychologist, Biokineticist and Registered Counsellors.
Affordable Care Benefit Guide - Sizwe Medical Fund
OUT OF HOSPITAL BENEFITS
The following services are covered subject to day-to-day benefits; General Practitioners, Specialists excluding
Psychiatrists, Physiotherapists, Radiologists, Pathologists and Acute Medicines.

 OVERALL DAY-TO-DAY LIMIT                                      GENERAL PRACTITIONERS

 REIMBURSEMENT RATE          100% Sizwe Rate                   REIMBURSEMENT RATE      100% Sizwe Rate

                             Member                R10 380                             Member               7
                             Member +1             R14 880                             Member +1           14
                             Member +2             R17 120                             Member +2           16
 BENEFITS                                                      VISITS
                             Member +3             R18 630                             Member +3           18
                             Member +4             R20 880                             Member +4           20
                             Member +5             R23 140                             Member +5           21
                             Member +6+            R25 250                             Member +6+          22

 SPECIALISTS                                                   ACUTE MEDICINES

 REIMBURSEMENT RATE          100% Sizwe Rate                   REIMBURSEMENT RATE      100% Sizwe Rate

                             Member                4                                   Within day to day
                             Member +1             8
                                                                                       Member		            R3 610
                             Member +2             9
 VISITS                                                        BENEFITS                Member +1           R5 500
                             Member +3             10
                                                                                       Member +2           R6 500
                             Member +4             11
                                                                                       Member +3           R6 990
                             Member +5             12
                                                                                       Member +4           R8 000
                             Member +6+            13
                                                                                       Member +5           R8 250
    Subject to referral by a GP, with the exception of:                                Member +6+          R8 500
    Follow-up visits, Emergencies, Gynaecologist and
    Paediatrician visits for babies up to the age of 12        PHYSIOTHERAPY
                          months.
                                                               REIMBURSEMENT RATE      100% Sizwe Rate
 RADIOLOGY AND RADIOGRAPHY

 REIMBURSEMENT RATE          100% Sizwe Rate                   BENEFITS                Paid from day to day limit
                                                                    DID YOU KNOW?
 BENEFITS                    Subject to clinical                    Sizwe Medical Fund has a Solvency Ratio of 52%
                                                               PATHOLOGY
                             protocols
                                                               REIMBURSEMENT RATE       100% Sizwe Rate

 SPECIALISED                 Subject to an overall combined
                                                               BENEFITS                 Subject to Managed Care
 RADIOLOGY                   in and out of hospital limit of
                                                                                        Protocols
 (MRI/CAT scan/              R29 960 per family per annum
 Angiogram)
 pre-authorisation and
 Managed Care Protocols
Affordable Care Benefit Guide - Sizwe Medical Fund
OUT OF HOSPITAL BENEFITS
The following services are covered subject to day-to-day benefits; General Practitioners, Specialists excluding
Psychiatrists, Physiotherapists, Radiologists, Pathologists and Acute Medicines.

MENTAL HEALTH                                                   SPECIALISED DENTISTRY

 REIMBURSEMENT RATE       100% Sizwe rate                       REIMBURSEMENT RATE         100% Sizwe Rate

 BENEFITS                 subject to R9 050 per family          BENEFITS                   Subject to pre-authorisation
                                                                                           and Managed Care Protocols
                          Limited to Psychiatrists, Clinical
                          and Counselling Psychologists         CROWNS AND BRIDGES         1 Crown per family per year
                          relating to mental health.
                          Benfit excludes services
                          covered under the auxiliary           DENTURES METAL             2 partial frames (an upper and
                          benefit                                                          a lower) per beneficiary in a 5
                                                                                           year period, limited to 1 family
 DENTISTRY                                                                                 member per annum

 REIMBURSEMENT RATE        100% Sizwe Rate
                                                                ORTHODONTIC                Pre-authorisation and clinical
                                                                TREATMENT                  protocols- restricted to
                           2 general check-ups a year per                                  beneficiaries aged between 9
                           beneficiary once in six months.                                 and 18 years (35%
                           Motivation may be requested                                     co-payment)
 LIMIT PER BENEFICIARY     for extensive restorative treat-
                           ment plans (fillings)                     Subject to Dental Management Programme -
                                                                      accessed through DENIS - 0860 109 556.
 ROOT CANAL                Subject to Managed Care
                           Protocols                            OPTICAL BENEFITS ACCESSED THROUGH (PPN)
 TREATMENT
                                                                REIMBURSEMENT RATE         100% Sizwe Rate
 PLASTIC DENTURES          1 set of plastic dentures, full or
                           partial (an upper and a lower)
                                                                CYCLE                      2 years
                           per beneficiary in a 4-year
                           period; subject to
                           pre-authorisation                    BENEFITS                   Limit per beneficiary

      Subject to Dental Management Programme -                  FRAMES                     R840
       accessed through DENIS - 0860 109 556.
                                                                SINGLE FOCUS LENSES        R185 per lens

                                                                BI-FOCAL LENSES            R400 per lens

                                                                MULTI-FOCAL LENSES         R735 per lens

                                                                CONTACT LENSES             R1 580
                                                                   Optical Service Provider (PPN) Tel: 0861 103 529
                                                                                 Email: info@ppn.co.za
Affordable Care Benefit Guide - Sizwe Medical Fund
OUT OF HOSPITAL BENEFITS
The following services are covered subject to day-to-day benefits; General Practitioners, Specialists excluding
Psychiatrists, Physiotherapists, Radiologists, Pathologists and Acute Medicines.

 AUXILIARY SERVICES                                         MATERNITY

 REIMBURSEMENT RATE         100% Sizwe Rate                 REIMBURSEMENT RATE            100% Sizwe Rate

 BENEFITS                   Risk Benefit                    ANTE-NATAL                    9x GP/ Midwife/ Specialists
                                                            CONSULTATIONS                 visits with an additional 2
 ANNUAL LIMIT PER FAMILY    Member 		         R1 590                                      Gynaecologist / Obstetrician
                                                                                          visits

 LIMITS PER FAMILY          Member +1+        R 2 790       PREGNANCY SCANS               2x 2D scans
                                                                                          2x Haemoglobin measurement
                                                                                          tests
    Speech Therapists, Podiatrists, Occupational
                                                                                          1x Blood Grouping test,
        Therapists, Social Workers, Dieticians,                                           1x VDRL test for Syphilis
  Audiologists, Homeopathy, Education Psychologist,                                       2x HIV Elisa tests,
      Biokineticist and Registered Counsellors.                                           1x Full Blood count
                                                                                          12x Urine Tests,
                                                                                          Vitamins worth R100 paid from
                                                                                          day-to-day benefit (once off)
                                                                     Subject to registration on maternity
                                                               programme within 24 weeks of falling pregnant.

CHRONIC BENEFITS
Subject to Pre-authorisation and registration on the chronic medicine programme; 100% negotiated tariff at
Designated Service Prover/ Preferred Provider Network subject to formulary and clinical protocols.
CHRONIC MEDICATION                                          HIV/AIDS

 REIMBURSEMENT RATE        100% Sizwe Rate                   REIMBURSEMENT RATE            100% Sizwe Rate

 BENEFITS                  Cover for 27 PMB chronic          BENEFITS                      No Limits but, subject to
                           conditions                                                      treatment protocols and PMBs

                           Member             R5 840            Members are encouraged to register on the HIV/AIDS
                           Member +1          R11 700          Management Programme. This benefit includes relevant
                           Member +2          R17 560        consultations, counselling, medication and the cost of blood
 NON PMB                                                                     tests for monitoring purposes.
                           Member +3          R23 410
                           Member +4          R29 260
                           Member +5          R35 130
                           Member +6+         R40 990
PREVENTATIVE BENEFITS

 PREVENTATIVE CARE                                                          OTHER BENEFITS

  REIMBURSEMENT RATE                      100% Sizwe Rate                   APPLIANCES              Member:         R1 590
                                                                                                    Member+1+:      R2 970
  CONSULTATION BENEFITS                   R1 550 per family per annum
                                                                            NON-MOTORISED           R3 320 per family
                                                                            WHEELCHAIR              Once in every 4 years
  SCREENING TESTS                         Limited to R270 per beneficiary
                                          per annum incl: Blood sugar,
                                          Cholesterol, Blood Pressure,      HEARING AIDS            R12 660 per family
                                          Body Mass Index, HIV Testing                              One unit per beneficiary every
                                                                                                    3 years
 WELLNESS SCREENING TESTS
                                                                            PRIVATE NURSE           R7 150 per family
  REIMBURSEMENT RATE                      100% Sizwe Rate                                           subject to pre-authorisation

  BENEFITS                                Mammogram every 2 years for       CHIROPRACTORS           R1 370 per beneficiary
                                          females over 40

                                          Papsmear every 2 years for
                                          females over 21 years             FEMALE CONTRACEPTIVES

                                          Prostate-Specific Antigen         REIMBURSEMENT RATE      100% Sizwe Rate
                                          (PSA): once per year for males
                                          over 40 years
                                                                            BENEFITS                R2 760 per family per annum
                                          Family Limit - R2 130 per
                                                                                                    Subject to pre-authorisation and
                                          annum
                                                                                                    Managed Care Protocols

 VACCINATIONS

  REIMBURSEMENT RATE                      100% Sizwe Rates

  BENEFITS                                Flu Vaccine
                                          Pneumococcal Vaccine
                                          HPV Vaccine
                                          Immunistaions for children 6
                                          years and younger subject to
                                          family limit

Sizwe Medical Fund is proudly administered by Sechaba Medical Solutions
IMPORTANT CONTACT DETAILS

Hospital Pre-Authorisation,
Hospital Benefit Management Programme
Tel:     0860 101 176

Dental Benefit Management
Tel:     0860 109 556
Fax:     0866 770 336
Email: sizweenq@denis.co.za

Wellness Programme –
Helpline For Asthma, Cardiovascular Disease,
Diabetes and Mental Health
Tel:      0860 103 454
Fax:      011 221 5238
Email: wellnessqueries@sizwemedfund.co.za

HIV/AIDS Management Programme
Tel:     0860 103 454
Fax:     011 221 5235/56

EUROP Assistance SA, Medical Emergencies,
24-Hour Ambulance Services and Medical Advice
Tel:     0860 117 799

Sizwe Baby Programme
Fax:    011 221 5218
Email: sizwebaby@healthychoices.com

Tip-Offs Anonymous Fraud Line
Tel:      0 800 204 702
Fax:      0800 007 788
Email: sizwemedical@tip-offs.com

Chronic Medication Programme
Tel:     0860 103 455 / 011 353 0030
Fax:     011 353 0352 / 0076
Email: chronic@sizwe.co.za
The healthcare you
                                                                          deserve at a price you
                                                                          can afford.

CONTRIBUTIONS

 AFFORDABLE CARE OPTION
 Income Bracket                                Main Member                    Adult       Child
 R0 - R16 833                                  R3 065                         R2 816      R772
 R16 834 – R32 499                             R3 188                         R2 927      R804
 R32 500 +                                     R3 418                         R3 272      R868

We count a maximum of three children when we calculate the monthly contributions.

DISCLAIMER:
Our 2019 benefits and contributions are subject to approval by the Council of Medical Schemes. This brochure is
for information purposes only and does not supersede the rules of the Fund. A full set of rules is available on our
website: www.sizwe.co.za

Sizwe Medical Fund is proudly administered by Sechaba Medical Solutions
PRESCRIBED MINIMUM BENEFITS (PMBs)

PMBs are not subject to annual benefit limits, except for such limits as may be prescribed in terms of the
regulations; Prescribed Minimum Benefits are subject to Pre-authorisation, Minimum Benefit Package, Designated
Service Providers and Treatment Protocols.

 PRESCRIBED MINIMUM BENEFITS (PMBs)                                                               ADDITIONAL NON-CDL’s
 Addison’s disease                                            Haemophilia                         Allergic Rhinitis
 Asthma                                                       Hyperlipidaemia                     Anaemia: Vitamin B12 Defect
 Bipolar Mood Disorder                                        Hypertension                        Anti-phospholipid Syndrome
 Bronchiectasis                                               Hypothyroidism                      Aplastic Ananemia
 Cardiac failure                                              Multiple sclerosis                  Benign Prostatic Hypertrophty
 Cardiomyopathy                                               Parkinson’s disease                 Endocarditis
 Chronic obstructive pulmonary disease                        Rheumatoid arthritis                Gout
 Chronic renal disease                                        Schizophrenia                       Hypoathyroidism
 Coronary artery disease                                      Systemic Lupus Erythematosus        Iron Defiency Anaemia
 Crohn’s disease                                              Ulcerative colitis                  Osteo-Arthritis
 Diabetes insipidus                                           HIV/AIDS                            Stroke
 Diabetes mellitus types 1 & 2                                ADDITIONAL PMBs
 Dysrhythmias                                                 Major Depression

 Epilepsy                                                     HRT (Hormone Replacement Therapy)

 Glaucoma

Sizwe Medical Fund is proudly administered by Sechaba Medical Solutions
COMPLAINTS ESCALATION PROCESS
  At Sizwe Medical Fund, we continuously strive to ensure that our service and communication to you, our valued
  member is of the highest standard. Occasionally errors do occur and there could be times when you are not satisfied
  with the service you receive. Please feel free to lodge any queries or complaints and we will attempt to resolve these
  as quickly and effectively as possible. In our added efforts to improving our communication with you our valued
  member, the scheme has enhanced the query and escalation process.

                                           MEMBER                                                                 MEMBER
                                   Member is given a reference                                            If query is not resolved,
                                     number to quote on all                                            member can escalate to the
                                  commuications going forward.                                        Principal Officer. The Principal
                                   QUERY RESOLUTION MAY                                               Officer will attend to the query
                                    TAKE UP TO 72 HOURS                                                        within 24 hours

                                                                                      MEMBER                                                  MEMBER
          MEMBER
                                                                             At this stage it’s either the                         If the Principal Officer fails to
     If a member is not
                                                                           query is resolved or Member                                    resolve the query:
satisfied with the response
                                                                            follows up with Call Centre                               The member may further
   from the Call Centre.
                                                                              with reference number                               escalate to the Complaints and
                                                                                                                                         Disputes Resolution
                                                                                                                                         Committee (CDRC)

  Should your query not be resolved, then you have the options outlined to further assist you. Note that the steps above require a reference numbers
  that you would be given to you on your initial query. Ensure that you have utilised one of the contact methods above before embarking on the
  escalation process. Email your query with a reference number to escalations@sizwemedfund.co.za.

  IF YOUR QUERY HAS NOT BEEN ATTENDED TO, THEN THE MATTER CAN BE ESCALATED FURTHER TO THE COMPLAINTS AND DISPUTES
  RESOLUTION COMMITTEE (CDRC), ALL THE ABOVE ACTIONS MUST BE TAKEN BEFORE ESCALATION. CDRC ESCALATIONS TO BE SENT TO
  PRINCIPAL.OFFICER@SIZWEMEDFUND.CO.ZA
 Sizwe Medical Fund is proudly administered by Sechaba Medical Solutions
GLOSSARY
Acute Medicines: Medicines for short-term illnesses and medical problems.               MMAP: This refers to the Maximum Medical Aid Price which is the maximum price Sizwe
                                                                                        Medical Fund is prepared to pay for specific categories of generic medicine.
Adult Dependant: A dependant from the age of 21 who is not a full-time student
or financially dependent on their parent, and is in receipt of an income more than      Occupational therapy: Mental or physical activity designed to help you recover from an
the state pension. Adult rate will be charged.                                          injury or a disease.

AIDS: Acquired Immune Deficiency Syndrome.                                              Oncology: Is a branch of medicine that deals with the prevention, diagnosis, and
                                                                                        treatment of cancer.
Child Dependant: A child dependant is considered an adult dependant and
will be billed at an adult rate from the age of 21 unless: The child is between         Pharmacy Advised Therapy (PAT): Medicine recommended by your pharmacist and
the ages of 21 and 24 years, is a full-time student, in which case a letter must        which falls within the self-medication category.
be submitted from an accredited learning institution confirming that they are
registered as a full-time student. The child is mentally or physically disabled;        Pre-authorisation: Obtaining permission from Sizwe Medical Fund before receiving
The child is still financially dependent on the matter, in which case an affidavit is   treatment.
required.
                                                                                        Preferred Provider: A provider recommended by Sizwe Medical Fund that offers cost-
Chronic Benefit Entry Criteria: Diagnostic tests to confirm a chronic illness, e.g.     effective treatment to members.
blood tests or ECG reports, etc.
                                                                                        Prescribed Minimum Benefits (PMBs): The Registrar of Medical Schemes requires all
Chronic Disease List: A list of chronic illnesses that are covered in terms of          medical schemes to offer a number of minimum benefits to all its members.
legislation.
                                                                                        Reference Pricing: This refers to a medicine cost control mechanism used by schemes
Chronic Medicines: Medicines used to manage conditions as listed on the                 and assists schemes to manage the high costs of medicines. Members are given a
Sizwe chronic conditions list.                                                          formulary list of medicines that are paid for by the Scheme. Where a member chooses a
                                                                                        medicine off the formulary, the reference price refers to the co-payment between the cost
Conservative Dentistry: Simple dental services, such as fillings, tooth removal         of the formulary medicine and the non-formulary medicine.
(extractions) and teeth cleaning.
                                                                                        Rehabilitation: Treatment to help you get back to a normal life following injury or disease.
Consultation: A visit to your doctor, surgeon or other service provider to obtain a
diagnosis and/or treatment.                                                             SAOPA Rates: The tariff charged by the South African Orthoptic and Prosthetic
                                                                                        Association.
CT and MRI Scans: CT scans, uses X-rays, MRI scans use powerful magnetic
fields and radio frequency pulses to produce detailed pictures of organs, soft          Sizwe Rates: The rate negotiated by Sizwe Medical Fund with groups of providers.
tissues, bone and other internal body structures.

Day-to-day Benefit: A combined out of hospital benefit which may be used by             Specialised Dentistry: Reconstructive surgery providing, for example, caps, crowns and
any registered family member in respect of GPs, Specialists, Acute medicines,           bridges. This typically requires the services of a dental technician.
Pathology, Radiology and Physiotherapy.
                                                                                        Top-up cover: When in hospital, it is the difference between Sizwe rates and the amount
Dental Benefit Management Programme: A behind-the-scenes cost and quality               charged by practitioners. Top-up cover pays up to 200% over the Sizwe rate. Top-up cover
programme managed by Dental Information Systems (Denis).                                comes into effect immediately when you are admitted to hospital. Only available on the Full
                                                                                        Benefit care option and must be claimed within three months of hospitalisation.
Designated Service Provider: Providers of medical services with whom Sizwe
has negotiated special rates.                                                           Treatment Protocols: The rules and processes that are followed for treating a specific
                                                                                        condition.
Formulary: A list of medicines that will be paid by Sizwe Medical Fund
according to the specific chronic illness and option chosen.                            UPFS Rates: Uniform Patient Fee Schedule - the tariffs charged by public hospitals.

Generic: A medicine that has the same ingredients and which works the same as
a well-known brand medicine.

HIV: Human Immunodeficiency Virus.

Medical Emergency: An emergency medical condition means the sudden and,
at the time, unexpected onset of a health condition that requires immediate
medical treatment and/or an operation. If the treatment is not available, the
emergency could result in weakened bodily functions, serious and lasting
damage to organs, limbs or other body parts, or even death.
CONTACT DETAILS

                              JOHANNESBURG                                      POLOKWANE
                                 222 Smit Street,             Regus 58-60 Landros Mare Street,
                                  Braamfontein,                 Thabakgolo Building, 3rd Floor,
                            Johannesburg, 2001.                      Polokwane, Limpop, 0700.
                                  011 725 0040                                   015 101 0546
                                                                                 015 101 0547

                                                                                                                          EMALAHLENI (WITBANK)
                                                                                                                          71 Mandela Drive
                         NATIONAL                                                                                         Cnr. Plumer and Mandela Drive
                        CALL CENTRE                                                                                       Emalahleni, 1034.
                                                                                                                          013 690 3342
                                                                                                                          013 690 3187
                         Monday to Friday
                           8am- 5pm

                    0860 100 871
                         queries@sizwe.co.za

                                                                                                                                  DURBAN
                                                                                                                                  7th Floor Royal Towers
                                                                                                                                  30 Dorothy Nyembe Street
                                                                                                                                  Durban, 4000
                                                                                                                                  031 304 4829
                                                                                                                                  031 304 4839

                                                                                                                      WELKOM
                                                                                                                      Corner House
                                                                                                                      Corner Buiten & Graaf Street
                                                                                                                      Welkom CBD, 9459
                                                                                                                      057 353 1475
                                                                                                                      057 353 1478
                                                                                                  PORT ELIZABETH
                                                                                                  Ground Floor, Block E
         CAPE TOWN                                                                                Southern Life Gardens
         Ground Floor Shop 13                                                                     70 – 2nd Avenue
         Norton Rose House                                                                        Newton Park
         8 Riebeek Street                                                                         Port Elizabeth, 6000
         Cape Town, 8000                                                                          041 503 1000
         021 402 9600                                                                             041 503 1302
         021 418 1400
Sizwe Medical Fund is proudly administered by Sechaba Medical Solutions
Our practical assistance includes Debt Assist, Legal Assist and Emergency
Home Assist services for our members and their families. Zest Rewards                                                                    ©

Program is committed to providing real value to its members everyday.

ASSISTANCE SERVICES
                                                                                                               YOUR W ELLNESS | SORTED

HOME EMERGENCY ASSIST                                                   LEGAL ASSIST
All Emergency Home Assist including electrical,                         Legal Aid Assistance with qualified lawyers for all
plumbing and locksmiths services including call out                     members including perusal of documents and advice
fees and labour for 1st hour free of charge to the client.              and consultations. Limited to 30 minutes per
                                                                        consultation.
DEBT ASSIST
Credit report review/Debt counselling/Mediation                         WILLS AND TRUST
services/ Voluntary debt review/Administration order                    Assist with drafting, safekeeping of wills,
assist and reduction of monthly payments in terms of                    Interpretation of wills and assistance in finalising a will
the NCR regulations.                                                    and estate administration.

BAIL PROTECT                                                            SOS ASSIST
Maximum amount of bail per incident is R3 000. An                       GPS location based service for emergency notifications
attorney will get to Police station within 4 hours.                     to programmed numbers, Hospitals, chemists and
                                                                        doctors including a TrackMe Service.
                                         GYM MEMBERSHIP
                                         Zest Members Qualify For Discounted Gym Membership Fees At Planet
                                         Fitness & Affiliated Gyms with over 250 branches nationwide

                                          DISCOUNT PARTNERS
                                          Nationwide Discounts retail partners including Shoprite Checkers

                                          MONTHLY FEE
                                          Exclusive to Sizwe Medical Fund members at a low low price. Additional
                                          members R20 per person.

                                                         R34       pm           R66        pm         R110             pm

                                                              Single            Couple Plan            Family Plan
                                                             Member              Main + Adult          Main + Adult+
                                                                                                          3 Kids

                                               TO SIGN UP
                                               SIMPLY CALL OUR CALL CENTRE ON 0860 937 800 OR
                                               SMS “ACTIVE” TO 49212
Affordable Care    Sizwe Medical Fund is regulated by the Council for Medical Schemes.

   Benefit Guide                    Sizwe Medical Fund number 1486, administered by
                                                   Sechaba Medical Solutions (Pty) Ltd;
                                                   registration number 1978/001109/07,
                       an accredited administration and managed care service provider.
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