Profmed ProPinnacle Premium:
cancer, maternity and mental health (2025)

This page has information on: Costs, Maternity, Oncology, Mental Health for Profmed ProPinnacle Premium

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Terminology:

• 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
• All schemes have extensive exclusions. We've tried to list the non-common ones here, but please consult your scheme or broker to get the full list.

Monthly Costs (2025)

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

Monthly Costs (2026)

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

Cancer/ Oncology benefits (2025):

(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
Overall cancer coverage (in and out of hospital):	R739,655 per person Biological drugs: 80% price, plus dispensing fee. From above limit. Note: Most cancers are PMBs, and treatment is paid in full by scheme. More info here Most schemes require use of specific providers (DSPs) for oncology treatment.	Gap Cover: Can cover the penalty in full (Plans coming soon)

Maternity benefits (2025):

(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
Hospital stay:	Delivery fee: 300% scheme rate Usually covered for 2 nights for natural birth, and 3 nights for C-sections. All newborns receive immediate full medical aid cover at birth, even if parents are on a waiting period.	Gap Cover: Can cover most shortfalls (Plans coming soon)
Consultations:	Paid from day to day benefit Antenatal and postnatal, GP and specialist: 13 consults Antenatal and postnatal, midwife: 13 consults Lactation consult: 1 per pregnancy Nutrition consultation: 1 per pregnancy Antenatal classes: R1,163 per family
Scans:	2 x 2D scans Nuchal Translucency Non-Invasive Prenatal Test: : 1 per pregnancy
Note:	If you are pregnant and don't have medical aid, your pregnancy will most likely be excluded for new cover, but your baby will be covered from birth. Read more about pregnancy cover if you don’t have medical aid.

Mental Health benefits (2025):

(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
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= R20,203 Main+1= R29,830 Max per family= R38,820 Other Day-to-Day Funds: Amplifire: R2,500 per adult when you complete preventative screening Benefit can be used for: GP consults, dental consultations, supplementary services, wellbeing assessment
FYI:	Mental Health PMB conditions are covered for in and out of hospital treatment, even on "hospital" plans. For a full list see here. Example of PMB condition: Acute stress disorder accompanied by recent significant trauma, including physical or sexual abuse. Treatment includes hospital admission for psychotherapy / counselling up to 3 days, or up to 12 outpatient psychotherapy / counselling contacts. Scheme will pay this in full, if you use a DSP.
In-hospital:	In-hospital: R43,638 per family PMBs: Covered in full at DSP, up to 21 days admission, paid from above limit but not limited to it Alcoholism/Drug Addiction: 21 days admission, paid from above limit but not limited to it	Gap Cover: Can cover most co-payments and increase sublimits (Plans coming soon)
Out-of-hospital:	PMBs: R7,395 per family, from in-hospital limit
Other:	.

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