Profmed ProActive Plus Premium:
in-and-out of hospital benefits (2025)

What's on this page:

This page has information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Profmed ProActive Plus Premium.

Monthly Costs (2025)

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

ProActive Plus Premium 2025 prices
Main member: Adult member: Child member:
Total Cost pm:
  • R3,286
  • R3,028
  • R1,280
  • Pay for all children
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= R4,548
  • Main+1= R6,452
  • Max per family= R8,039
Children Rates:
  • Up to age 21yrs, unless student, then 28yrs
  • Pay for all children
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:
In-hospital | 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.

Find all other open medical aid plans here.
.

In-hospital Procedures (2024):

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

Profmed: ProActive Plus Premium
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
non-Network Specialists:
  • 175% scheme rate
Scheme rate is set by Profmed
network Specialists:
  • 175% scheme rate
non-Network GPs:
  • 175% scheme rate
network GPs:
  • 175% scheme rate
Hospital Choice:
  • Any hospital
Day Hospitals:
  • Specified day procedures: Day Procedure Network, or R5,000 co-payment
Penalty for using other hospital:
  • Use of non-Day Procedure Network: R5,000 penalty
 You don't pay a penalty if admission was unavoidable due an emergency
Other Co-payments: * There might be other co-payments if you don't use scheme-chosen provider for some services.

* Treatment required for PMB level care is always paid by scheme, with no co-payment, if you follow the protocols.
That means that these co-payments might not apply in your case! More info here
Specialised Radiology:
  • MRI, radio-isotope and CT scans: 2 scans per family
 No limits or co-payments for PMB level care and/or for emergency
Scopes: No limits or co-payments for PMB level care and/or for emergency
Supplementary Services: (Physio, etc)
  • 175% scheme rate
 No limits or co-payments for PMB level care and/or for emergency
Transplants:
  • 100% scheme rate
Dialysis:
  • 100% scheme rate
Exclusions: Exclusions:
  • Note: All schemes have extensive exclusions. We've tried to list the major ones here, but please consult your scheme or broker to get the full list.
 * Treatment required for PMB level of care is always paid by scheme, if you follow the protocols. It cannot be excluded. More info here.

Alternatives to hospitals:
  • Rehabilitation: R28,126 per family
  • Home nursing or sub-acute: R13,164
  • Wound treatment: R3,4699 per person
Casualty:
  • From day-to-day benefit
Other:
    COVID pathology, pre-admission: R500
Note:
  • PMBs: Prescribed Minimum Benefits. You can read more about PMBs, see a list of all PMB conditions or read more what "PMB only" benefit means.
  • 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:
In-hospital | 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.

Find all other open medical aid plans here.
.

Out-of-hospital Procedures (2024):

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

Profmed: ProActive Plus Premium
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
Summary of day-to-day benefits:
Main Member: Adult: Child:
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= R4,548
  • Main+1= R6,452
  • Max per family= R8,039
PMBs out of hospital:
  • All medical aids must pay for the diagnosis, treatment and management of all PMB conditions, in or out of hospital. You can see a full list of the conditions here.
  • This can include consults with specialists, blood or other tests, radiology and medicine
  • The benefit is paid by the scheme, and not out of your savings account
  • If you have no day-to-day funds, you still have cover for PMBs
  • Schemes usually impose the use of specific providers for treatment of PMBs. Read more about that here.
  • See our Guide to PMBs for more information.
General info: .
GP consultations:
  • GPs and specialists: R580
  • Procedures: 100% scheme rate.
  • Telemedicine: 3 consults per person
  • All from day-to-day benefit
 Treatment required for PMB conditions is always paid paid by scheme, with no co-payment, if you follow the protocols. More info here
Childcare:
Specialists consultations:
  • GPs and specialists: R580
  • Procedures: 100% scheme rate.
  • Telemedicine: 3 consults per person
  • All from day-to-day benefit
 Treatment required for PMB conditions is always paid paid by scheme, with no co-payment, if you follow the protocols. More info here
Pathology:
  • 80% scheme rate, paid from day-to-day benefit
General radiology:
  • 80% scheme rate, paid from day-to-day benefit
Specialised radiology:
  • MRI, radio-isotope and CT scans: R6,000 per family
  • Paid by scheme, not from day-to-day benefits
 Scans required for PMB level care are paid paid by scheme, with no co-payment, if you follow the protocols. More info here
Scopes: No limits or co-payments for PMB level care and/or for emergency
Supplementary Services: (Physio, etc)
  • PMBs only
General Appliances:
  • PMBs only
1.1. Hearing Aids:
  • No benefit
1.2. Wheelchairs:
  • No benefit
Note:
  • PMBs: Prescribed Minimum Benefits. 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:
In-hospital | 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.

Find all other open medical aid plans here.
.

All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme. The benefits listed here are an indication only. Please verify all benefits and their conditions with the scheme.

Medication Benefit (2024):

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

Profmed: ProActive Plus Premium
Assume scheme pays all these costs, unless otherwise stated
Summary of day-to-day benefits:
Main Member: Adult: Child:
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= R4,548
  • Main+1= R6,452
  • Max per family= R8,039
Chronic: . You might be required to use specific pharmacies and be limited to specific medicines
Acute (presrcibed) medication:
  • M= R718
    M1= R1,027
    Maximum R1,335 per family
  • From day-to-day benefit, at 80% cost
Over-the-counter:
  • From acute medcicine benefit
Birth Control:
  • Oral, patches, injections, implants and intra-uterine devices: R1,962 per person, not from day-to-day benefit
On Discharge:
  • 7 days supply at 80% scheme rate, from Acute Medicine benefit
Biological:
  • PMBs only
Treatment that is required (by law) for PMB conditions is always paid paid by scheme, with no co-payment, if you follow the protocols. More info here.)
Note:
  • Schemes have very strict rules about where you can get your medicine to get full benefit. We do not list the requirements here, so confirm with your scheme before you collect your medicine.
  • Formulary: A pre-defined list of approved medicines. Each plan has a different list, and might not pay for non-listed medicine. Confirm with your scheme whether your required medicine is covered by them.
  • 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:
In-hospital | 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.

Find all other open medical aid plans here.
.

All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme. The benefits listed here are an indication only. Please verify all benefits and their conditions with the scheme.


Psssttt….

Medical Aid Tips

Squeeze the most out of your medical aid!

Every Friday, we help 10,000+ South Africans with tips and exclusive healthcare deals.

Come join us, and find out things your medical aid does not want you to know!

    Built with Kit


    Coming Soon