Profmed Medical Aid is a medical insurance policy that is available to people of all income levels. However, individuals that apply for any medical aid that requires a monthly income below R11,000.00 must submit proof of income.
Premiums for Profmed medical aid start from R1,407.00 and can reach upwards of R9,491.00 for the primary member. Dependents can be added to the medical aid and according to the medical aid dependents are individuals over the age of 21.
Adult dependents can be added to ProMed medical aid for a monthly premium ranging from R1,548.00 to R8,804.00. Child dependents can also be added to the plan and dependents under the age of 28 who are studying pay child rates.
Child premiums start from R735.00 per month, with a maximum premium of R2,847.00. Dependents over the age of 21 who are studying must provide proof of dependency as well as annual proof of study in order to claim child rates.
Members of ProfMed medical aid can choose from a variety of plans. Below, we discuss the available plans and what members get from each one.
ProfMed Medical Aid Options
ProfMed Medical Aid offers the Savvy and Premium plans. Each medical aid plan covers a specific number of medical procedures up to a certain limit. ProfMed Medical Aid offers the following medical aid options:
Savvy Option
The Savvy medical aid option categorizes its coverage based on individual income. Those with a monthly income that ranges between R0 – R7,000.00 get the least coverage. Members can choose to be covered under proactive, proactive plus, prosecure, prosecure plus or propinnacle.
For those that are between R0.00 to R7,000.00 0 per month they can get the Savvy option for the following amounts per member:
| ProPinnacle | ProSecure Plus | ProSecure | Proactive Plus | ProActive | |
| Principal Member | R8,542.00 | R4,866.00 | R2,868.00 | R2,275.00 | R821.00 |
| Adult Dependent | R7,924.00 | R4,503.00 | R2,868.00 | R2,115.00 | R1,032.00 |
| Child dependent | R2,563.00 | R1,897.00 | R1,300.00 | R888.00 | R628 |
Individuals that earn between R7,001.00 to R11,000.00 have special rates. Premiums on for those that earn between R7,001.00 to R11,000.00 are as follows:
| ProPinnacle | ProSecure Plus | ProSecure | Proactive Plus | ProActive | |
| Principal Member | R8,542.00 | R4,866.00 | R2,868.00 | R2,275.00 | R1,407.00 |
| Adult Dependent | R7,924.00 | R4,503.00 | R2,868.00 | R2,115.00 | R1,548.00 |
| Child dependent | R2,563.00 | R1,897.00 | R1,300.00 | R888.00 | R629.00 |
Individuals that earn over R11,001 per month pay slightly higher premiums for the proactive and ProSecure covers. There are the rates of Individuals that earn R11,001.00 and higher in monthly income:
| ProPinnacle | ProSecure Plus | ProSecure | Proactive Plus | ProActive | |
| Principal Member | R8,542.00 | R4,866.00 | R3,987.00 | R2,275.00 | R1,887.00 |
| Adult Dependent | R7,924.00 | R4,503.00 | R3,691.00 | R2,115.00 | R1,744.00 |
| Child dependent | R2,563.00 | R1,897.00 | R1,557.00 | R888.00 | R735.00 |
Since the Savvy option comes with a number of plans to choose from, we will discuss the benefits of each plan as follows:
ProActive Savvy Plan
Hospitalization benefits:
Hospital ward accommodation up to 100% of the Savvy tariff in the general ward.
Up to 100% of the Savvy tariff is covered for theatre and recovery rooms.
Up to 100% of the Savvy tariff amount is covered for intensive care and high care.
Emergency room visits and hospital facility fees that result in hospitalisation can total up to 100% of the negotiated tariff.
Medication in hospital benefits:
- Medicines and materials used in hospitals and theatre up to 100% of the Savvy tariff.
- Medicines taken out of the hospital on discharge (subject to PMB legislation).
- General Practitioner and Specialists in hospital:
Surgery and in-hospital procedures are covered up to 100% of the specific tariff.
100% specific tariff cover for consultations by a GP or specialist while hospitalised.
Radiology and pathology in hospital:
- Radiology and pathology while hospitalised are covered for up to 100% of the negotiated tariff.
- Pathology pre-admission is covered for 1 pathology test per beneficiary and to a maximum amount of R850.00 per beneficiary.
- MRI, radio-isotope and CT scans are covered by the plan for up to 100% of the negotiated tariff in-hospital. Limited to 2 investigations per family in-hospital.
Other Major Medical Services:
- Donor costs are covered by the plan to a maximum of 100% of the negotiated tariff.
- Peritoneal dialysis and haemodialysis are covered by the plan to a maximum of 100% of the negotiated tariff.
- Oncology treatment is covered to a maximum of R233,078.00 per beneficiary; thereafter, it is subject to PMB legislation.
- Chemotherapy consultation with a GP is covered for R519.00, and for R780.00.
- Chemotherapy procedures are covered for 100% of the specific tariff.
- Chemotherapy drugs, excluding adjunctive treatment, are covered 100% for a single exit price plus dispensing fee.
Proactive Plus Savvy Plan
Hospitalisation benefits:
Hospital ward accommodation up to 100% of the Savvy tariff in the general ward.
Theatre and recovery room cover up to 100% of the Savvy tariff.
Intensive care and high care cover up to 100% of the Savvy tariff amount.
Emergency room visits and facility fees at hospitals that result in hospitalisation are covered up to 100% of the negotiated tariff.
Medication in hospital benefits:
Medicines and pharmaceuticals used in hospitals and operating rooms up to 100% of the Savvy tariff.
Medicines taken out of the hospital upon discharge are covered at 80% of the negotiated tariff.
General Practitioners and Specialists in the hospital:
Surgery and in-hospital procedures are covered up to 200% of the Profmed tariff.
200% Profmed tariff cover for consultations by a GP or specialist while hospitalized.
Radiology and pathology in the hospital:
- Radiology and pathology while hospitalized are covered for up to 100% of the negotiated tariff.
- Pathology pre-admission is covered for 1 pathology test per beneficiary and to a maximum amount of R850.00 per beneficiary.
- MRI, radio-isotope, and CT scans are covered by the plan for up to 100% of the negotiated tariff in-hospital. Limited to 2 investigations per family in-hospital.
Other Major Medical Services
- The plan covers donor costs up to 100% of the negotiated tariff.
- The plan covers peritoneal dialysis and haemodialysis up to 100% of the negotiated tariff.
- Oncology Treatment is covered up to R233,078.00 per beneficiary, after which it is subject to PMB legislation.
- Chemotherapy consultations at GPs are covered for R519.00 and R780.00, respectively.
- Chemotherapy procedures are 100% covered under the specific tariff.
- Chemotherapy drugs, excluding adjunctive therapy, are 100% covered for a single exit price plus dispensing fee.
ProSecure Savvy Plan
Hospitalisation benefits:
- Hospital ward accommodation is covered up to 100% of the Savvy tariff in the general ward.
- Theatre and recovery room cover are up to 100% of the Savvy tariff.
- Intensive care and high care cover is up to 100% of the Savvy tariff amount.
- Emergency room visits and facility fees at hospitals that result in hospitalisation are covered up to 100% of the negotiated tariff.
Medication in hospital benefits:
- Medicines and materials used in hospitals and theatres are covered up to 100% of the Savvy tariff.
- Medicines taken out of the hospital on discharge are covered for 80% of the negotiated tariff.
General Practitioners and Specialists in the hospital:
- Surgery and in-hospital procedures are covered by up to 100% of the specific tariff.
- Consultations by a GP or Specialist while hospitalised are covered up to 100% of the specific tariff.
Radiology and pathology in hospital
- While hospitalised, radiology and pathology are covered for up to 100% of the negotiated tariff.
- Pathology pre-admission is covered for one pathology test per beneficiary up to a maximum of R850.00.
- In-hospital MRI, radio-isotope, and CT scans are covered by the plan for up to 100% of the negotiated tariff.
General Practitioners and Specialists in hospitals
- Surgery and in-hospital procedures are covered by up to 100% of the specific tariff.
- Consultations by a GP or Specialist while hospitalized are covered up to 100% of the specified tariff.
- Radiology and pathology in hospitals:
- While hospitalized, radiology and pathology are covered for up to 100% of the negotiated tariff.
- Pathology pre-admission is covered for one pathology test per beneficiary up to a maximum of R850.00.
- In-hospital MRI, radio-isotope, and CT scans are covered by the plan for up to 100% of the negotiated tariff.
Other Major Medical Services
- The plan covers donor costs up to 100% of the negotiated tariff.
- The plan covers peritoneal dialysis and haemodialysis up to 100% of the negotiated tariff.
- Oncology Treatment is covered up to R466,155.00 per beneficiary, after which it is subject to PMB legislation.
- Chemotherapy consultations with GPs are covered for R519.00 and R780.00, respectively.
- Chemotherapy procedures are 100% covered under the specific tariff.
- Chemotherapy drugs, excluding adjunctive therapy, are 100% covered for a single exit price plus dispensing fee.
ProSecure Plus Savvy Plan
Hospitalisation benefits:
- Hospital ward accommodation up to 100% of the Savvy tariff in a general ward.
- Theatre and recovery room coverage up to 100% of the Savvy tariff.
- Intensive care and high care coverage up to 100% of the Savvy tariff amount.
- Emergency room visits and facility fees at hospitals that result in hospitalization up to 100% of the negotiated tariff.
Medication in hospital benefits
- Medicines and materials used in hospitals and theatre up to 100% of the Savvy tariff.
- Medicines taken out of the hospital on discharge are covered for 80% of the negotiated tariff.
General Practitioners and Specialists in hospitals:
- Surgery and in-hospital procedures are covered up to 200% of the Promed tariff.
- Consultations by a GP or Specialist while hospitalized are covered up to 200% of the Profmed tariff.
Radiology and pathology in hospitals
- Radiology and pathology while hospitalized are covered for up to 100% of the negotiated tariff.
- Pathology pre-admission is covered for 1 pathology test per beneficiary and up to a maximum amount of R850.00 per beneficiary.
- MRI, radio-isotope, and CT scans are covered by the plan for up to 100% of the negotiated tariff in the hospital.
Other Major Medical Services
- The plan covers donor costs up to a maximum of 100% of the negotiated tariff.
- The plan covers peritoneal dialysis and haemodialysis to a maximum of 100% of the negotiated tariff.
- Oncology Treatment is covered up to a maximum of R466,155.00 per beneficiary, after which it is subject to PMB legislation.
- Chemotherapy consultations with GPs are covered for R519.00 and R780.00.
- Chemotherapy procedures are covered at 100% of the specific tariff.
- Chemotherapy drugs, excluding adjunctive treatment, are 100% covered for a single exit price plus dispensing fee
ProPinnacle Savvy Plan
Hospitalisation benefits:
- Hospital ward accommodation is covered up to 100% of the Savvy tariff in a private ward.
- Theatre and recovery room expenses are covered up to 100% of the Savvy tariff.
- Intensive care and high care expenses are covered up to 100% of the Savvy tariff.
- Emergency room visits and facility fees resulting in hospitalisation are covered up to 100% of the negotiated tariff.
Medication benefits in hospital
- Medicines and materials used in hospitals and theatre are covered up to 100% of the Savvy tariff.
- Medicines taken out of the hospital on discharge are covered for 80% of the negotiated tariff.
General Practitioner and Specialists in hospital:
Surgery and in-hospital procedures are covered up to 300% of the Profmed tariff.
Consultations by a GP or Specialist while hospitalised are covered up to 300% of Profmed tariff.
Radiology and pathology in hospital
Radiology and pathology while hospitalised are covered for up to 100% of the negotiated tariff.
Pathology pre-admission is covered for 1 pathology test per beneficiary, to a maximum amount of R850.00 per beneficiary.
MRI, radio-isotope and CT scans are covered by the plan for up to 100% of the negotiated tariff in-hospital.
Other Major Medical Services:
- Donor costs are covered by the plan, up to a maximum of 100% of the negotiated tariff.
- Peritoneal dialysis and haemodialysis are covered by the plan, up to a maximum of 100% of the negotiated tariff.
- Oncology Treatment is covered to a maximum of R699,233.00 per beneficiary; thereafter, it is subject to PMB legislation.
- Chemotherapy consultation at a GP is covered for 300% of ProMed tariff.
- Chemotherapy procedures are covered for 300% of Profmed tariff.
- Chemotherapy drugs, excluding adjunctive treatment, are covered for 100% for a single exit price plus dispensing fee.
Premium Option
The premium option has no minimum or maximum cover amount and offers the most benefits of either option. The premium plans include Proactive, Proactive Plus, ProSecure, ProSecure Plus, and ProPinnacle.
Premiums on the Premium Medical aid option are fixed as follows:
| ProPinnacle | ProSecure Plus | ProSecure | Proactive Plus | ProActive | |
| Principal Member | R9,491.00 | R5,407.00 | R4,429.00 | R2,528.00 | R2,098.00 |
| Adult Dependent | R8,804.00 | R5,002.00 | R4,101.00 | R2,351.00 | R2,016.00 |
| Child Dependent | R2,847.00 | R2,107.00 | R1,731.00 | R985.00 | R850.00 |
Benefits under the premium option include:
- Hospital-related costs
- Medical-related costs
- Dental-related costs
- Chronic medication and hospitalisation
- Day-to-day cover
- General practitioners and specialists
- Acute medication
- Optometrist services
- Trauma and HIV assistance, and more.
Advantages of ProfMed Medical Aid
- There are different covers to choose from.
- Policyholders can add dependents to the cover.
- Cancer treatment is covered by all options.
- Children can be covered at a very low premium.
- Premiums on the Profmed Medical Aid plans are very competitive.
Disadvantages of ProMed Medical Aid
- Dental-related expenses are covered to the minimum by most plans available.
Conclusion
When compared to other medical aid plans in South Africa, the cost of ProfMed medical options, including the executive option, is very low. The coverage also includes detailed pricing, making it simple for people to purchase a medical aid plan.
