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Profmed ProPinnacle Premium:

dentistry, optometry and wellness (2024)

This page has information on: Costs, Dentistry , Optometry Wellness and Preventative and Other benefits for Profmed ProPinnacle Premium

We also have information on: In-hospital, Out of Hospital, Medicine, Maternity, Cancer, Mental Health and Prosthetics benefits.

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Monthly Costs:

ProPinnacle Premium 2024 prices
Main member: Adult member: Child member:
Total Cost pm:
  • R11,883
  • R11,883
  • R3,565
  • 3
Savings (per year):
  • No savings account option on this plan
  • The scheme might still cover some or all day-to-day claims. See below, and see benefits.
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • Main= R19,615
  • Main+1= R28,961
  • Max per family= R37,690
Children Rates:
  • Child rates up to age 21yrs, unless student, then 28yrs
  • 3
Note:
  • Exclusions: Note that all schemes have extensive exclusions. We've tried to list the major ones, but you must consult with your scheme to get the full list.
  • All treatments and procedures are subject to authorisation and protocols
  • All benefits are listed as an indication only. Please verify with your broker and scheme
♦️View all the other benefits for this plan:♦️
Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics

You can also:
♦️Compare any two plans, side by side | ♦️View all the Profmed plans, with costs and brief summary
.



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Dentistry benefits (2024):

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Profmed: ProPinnacle Premium
Assume scheme pays all these costs, unless otherwise stated
Standard Dentistry:
  • R7,497 per person and R14,994 per family
  • Shared with Standard dentistry, Specialised dentistry and Orthodontics
  • Paid by scheme
Specialised Dentistry:
  • R7,497 per person and R14,994 per family
  • Shared with Standard dentistry, Specialised dentistry and Orthodontics
  • Paid by scheme
In-Hospital Dentistry:
  • Wisdom teeth and treatment for children <8yrs: 100% scheme rate
  • Orthognathic surgery: R38,298 per family
 PMBs are always covered by the scheme, and cannot have sublimits or co-payments imposed. These include fracture of face bones, orbit and/or jaw. You can see a full list of maxillo facial PMB benefits here.
Orthodontics:
  • R7,497 per person and R14,994 per family
  • Shared with Standard dentistry, Specialised dentistry and Orthodontics
  • Paid by scheme
Note:
  • PMBs: Prescribed Minimum Benfits. To read more about PMBs click here
  • DSPs: Designated Service Provders. Where stipulated, you must use specific specific providers to get full benefit.
  • Co-payment: Paid out of pocket, or out of savings account. Sometimes this is refundable to you if you have a gap product
♦️View all the other benefits for this plan:♦️
Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics

You can also:
♦️Compare any two plans, side by side | ♦️View all the Profmed plans, with costs and brief summary
.
.
.

Optometry benefits (2024):

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Profmed: ProPinnacle Premium
Assume scheme pays all these costs, unless otherwise stated
Optometry:
  • Paid from day to day benefit, every 24 months. Sublimits below
  • Frames: R1,437
  • Contacts: R3,389
  • Refractive surgery: R3,902 per person, paid by scheme
Note:
  • This section does not apply to opthamology benefits, which fall under "in-hospital" benefits. Some of those are PMBs, and are paid for in full by your scheme. You can read more about PMBs here.
♦️View all the other benefits for this plan:♦️
Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics

You can also:
♦️Compare any two plans, side by side | ♦️View all the Profmed plans, with costs and brief summary
.
.
.

Wellness/Preventative benefits (2024):

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Profmed: ProPinnacle Premium
Assume scheme pays all these costs, unless otherwise stated
Flu vaccination:
  • Covered
Pneumonia vaccines:
  • Covered
Biometric Screening:
  • Covered
Child Immunisation:
  • Covered
Pap Smear:
  • Covered
Mammogram:
  • Covered, for 40yrs+, every 2 years
PAS Test:
  • Covered
HIV Test:
  • Covered
Other:
♦️View all the other benefits for this plan:♦️
Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics

You can also:
♦️Compare any two plans, side by side | ♦️View all the Profmed plans, with costs and brief summary
.
.
.

Other benefits for 2024:

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

ProPinnacle Premium
International Insurance:
  • In and Out of hospital emergencies: R8 million per person per trip
  • Out of hospital non-emergencies: R10,000 with R2,000 co-payment
  • Glasses:: R3,300
Other:
♦️View all the other benefits for this plan:♦️
Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics

You can also:
♦️Compare any two plans, side by side | ♦️View all the Profmed plans, with costs and brief summary
.

    Important!
  • Unless specified, assume that all benefits are paid are paid at 100% scheme rate
  • No limits or co-payments can apply to treatment of PMBs, which is always unlimited, although subject to strict protocols and scheme rules.
  • "Unlimited" benefits are still subject to authorisation, protocols and sublimits
  • Assume that all benefits need to be pre-authorised

Also see these:




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