Profmed ProPinnacle Savvy:
in-and-out of hospital benefits (2025)

This page has overview information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Profmed ProPinnacle Savvy. Please consult and verify with the scheme or your broker for full benefits, and an explanation of all the "fine print".

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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.

In-hospital Procedures (2025):

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

Profmed: ProPinnacle Savvy
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
GPs and Specialists:	GPs: 300% scheme rate Specialists: 300% scheme rate	Gap Cover: Can push payout up to 700% scheme rate (Plans coming soon)
Hospital Choice:	Network hospital Day procedure: Day network
Penalty for using other hospital:	non-network long stay hospitals: R12,500 penalty non-network day hospitals: R5,000 penalty	Gap Cover: Can cover the penalty in full (Plans coming soon)
Co-payments:	Note: A co-payment is a fee your medical aid can insist you pay, regardless of how much the doctor/charges. It's not the same as an "excess" payment (which is when a doctor charges more than the medical aid rate). If you use a DSP (designated service provider), you never have to pay a co-payment for protocol treatment of a PMB (Prescribed Minimum Benefit). More info here There might be other co-payments if you don't use a DSP, especially if you are being treated for a PMB or when buying medicine.	Gap Cover: Can cover most co-payments (Plans coming soon)
Specialised Radiology:	MRI, radio-isotope and CT scans: 2 scans per family, in and out of hospital PET Scans: as required, for oncology, with protocols	Gap Cover: Can cover most co-payments and increase sublimits (Plans coming soon)
Scopes:	Paid by scheme if done in network doctor's rooms	Gap Cover: Can cover most co-payments and increase sublimits (Plans coming soon)
Supplementary Services: (Physio, etc)	300% scheme rate Physio: 100% scheme rate Physio, post-operative: R3,329 per person and R5,547 per family
Transplants:	100% scheme rate
Dialysis:	100% scheme rate
Exclusions:	NB: See scheme's rules for all exclusions. All schemes have plenty!	Gap Cover: Coming soon
Alternatives to hospitals:	Rehabilitation: R87,157 per family Home nursing or sub-acute: R18,837 per person Wound treatment: R7,272 per person
Casualty/ER:	From day-to-day benefit	Gap Cover: Can cover ER claims (Plans coming soon)
Other:	COVID pathology, pre-admission: R500
PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider

Out-of-hospital Procedures (2025):

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

Profmed: ProPinnacle Savvy
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
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 family when you complete preventative screening Benefit can be used for: GP consults, dental consultations, supplementary services, wellbeing assessment
PMBs out of hospital:	All schemes 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 PMB benefits must never be paid from your savings account 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.
GP consultations:	GPs and specialists: 300% scheme rate Procedures: 300% scheme rate Telemedicine: 3 consults per person All from day-to-day benefit
Childcare:	Newborn hearing test Immunisations	Gap Cover: Can pay for child ER visits (Plans coming soon)
Specialists consultations:	GPs and specialists: 300% scheme rate Procedures: 300% scheme rate Telemedicine: 3 consults per person All from day-to-day benefit
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: 2 scans per family Shared with in-hospital benefit, and with 80% scheme rate out-of-hospital PET Scans: as required, for oncology, with protocols. Paid at 100% scheme rate. Paid by scheme, not from day-to-day benefits	Gap Cover: Can pay co-payments and increase sublimits (Plans coming soon)
Scopes:	Paid by scheme if done in network doctor's rooms	Gap Cover: Can pay co-payments and increase sublimits (Plans coming soon)
Supplementary Services: (Physio, etc)	Supplementary services: R3,278 per person and R5,711 per family Alternative health practitioners: R2,855 per family and R846 sublimit for homeopathic medication From day-to-day benefit
General Appliances:	Insulin pumps: 1 every 48 months Home oxygen Stoma Above paid from External Prosthesis and Appliances limit: R23,694 per family Orthopaedic braces wheelchairs, walking frames and crutches: R5,751 per family, from day-to-day benefit
1.1. Hearing Aids:	R7,510 per person. 1 pair every 24 months Paid by scheme
1.2. Wheelchairs:	Wheelchairs, braces, walking frames and crutches: R5,751, from day-to-day benefit
PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider

Medication Benefit (2025):

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

Profmed: ProPinnacle Savvy
Assume scheme pays all these costs, unless otherwise stated
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 family when you complete preventative screening Benefit can be used for: GP consults, dental consultations, supplementary services, wellbeing assessment
Chronic:	27 PMB conditions: Covered. You can see the full PMB list here. An additional 32 non-PMB conditions
Acute (prescribed) medication:	M= R11,318 M1= R15,126 M2= R16,184 M3+= R17,877 Maximum R21,156 per family From day-to-day benefit , at 80% cost
Over-the-counter:	R2,221 per family, from acute medicine benefit
Birth Control:	Oral, patches, injections, implants and intra-uterine devices: R2,021 per person, not from day-to-day benefit
On Discharge:	7 days supply at 80% scheme rate, from Acute Medicine benefit
Biological:	20% co-payment, and paid from Oncology limit
View 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.
PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider