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Profmed ProPinnacle Premium:
cancer, maternity and mental health (2024)

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

We also have information on: In-hospital, Out of hospital, Medicine, Dentistry, Optometry, Other/Extra Benefits, Wellness and Preventative and Prosthetics

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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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Cancer/ Oncology benefits for 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
Overall coverage (in and out of hospital):
  • R718,112 per person
  • Biological drugs: 80% price, plus dispensing fee. From above limit.
 Treatment required for PMB conditions is always paid by scheme, with no co-payment, if you follow the protocols. Most cancers are PMBs! More info here

Most schemes require use of specific providers (DSPs) for oncology treatment.
♦️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
.
.
.

Maternity benefits for 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
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.
Consultations:
  • Paid from day to day benefit
  • Consults: 13 consults
  • Lactation consult: 1 per pregnancy
  • Nutrition consultation: 1 per pregnancy
  • Nuchal Translucency Non-Invasive Pre-Natal Test:: sstrong>1 per pregnancy
  • Ante natal classes: R1,129 per family
Scans:
  • 2 x 2D scans
Note:
♦️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
.
.
.

Mental Health benefits for 2024:

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(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
In-hospital:
  • In-hospital: R42,367 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
Out-of-hospital:
  • Paid by scheme from in-hospital limit
Trauma:
  • Covers certain day-to-day claims that form part of the recovery following specific traumatic events, such as near drowning, poisoning, severe allergic reaction and external and internal head injuries.
  • PMB conditions are covered for in and out of hospital treatment. 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
Note:
  • PMBs: Prescribed Minimum Benefits. Here is a list of PMB conditions: Mental Illness.
  • 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
.

    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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