Note: We are updating 2024 benefits as they are released. Some plans show old benefits until schemes release new plans.

Profmed ProPinnacle Savvy:
in-and-out of hospital benefits (2024)


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Monthly Costs:

ProPinnacle Savvy 2024 prices
Main member: Adult member: Child member:
Total Cost pm:
  • R10,695
  • R9,921
  • R3,209
  • 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= R19,615
  • Main+1= R28,961
  • Max per family= R37,690
Children Rates:
  • Child 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:♦️
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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In-hospital Procedures for 2024:

Profmed: ProPinnacle Savvy
Assume scheme pays all these costs, unless otherwise stated
non-Network Specialists:
  • 300% scheme rate
network Specialists:
  • 300% scheme rate
non-Network GPs:
  • 300% scheme rate
network GPs:
  • 300% scheme rate
Hospital Choice:
  • Network hospital
Day Hospitals:
Penalty for using other hospital:
  • R12,500 co-payment
Other Co-payments:
Specialised Radiology:
  • MRI, radio-isotope and CT scans: 2 scans per family, in and out of hospital
Supplementary Services: (Physio, etc)
  • 300% scheme rate
Transplants:
  • 100% scheme rate
Dialysis:
  • 100% scheme rate
Exclusions:
Alternatives to hospitals:
  • Rehabilitation: R84,619 per family
  • Home nursing or sub-acute: R18,288
  • Wound treatment: R7,060 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:♦️
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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.

Out-of-hospital Procedures for 2024:

Profmed: ProPinnacle Savvy
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= R19,615
  • Main+1= R28,961
  • Max per family= R37,690
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: 300% scheme rate
  • Procedures: 300% scheme rate
  • Telemedicine: 3 consults per person
  • All from day-to-day benefit
Childcare:
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 20% co-payment out-of-hospital
  • Paid by scheme, not from day-to-day benefits
Supplementary Services: (Physio, etc)
  • Supplementary services: R3,183 per person and R5,545 per family
  • Alternative health practioners: R2,772 per family and R821 sublimit for homeopathic medication
  • From day-to-day benefit
General Appliances:
  • Orthopaedic braces wheel chairs, walking frames and crutches: R5,751 per family.
  • From day-to-day benefit
1.1. Hearing Aids:
  • Paid by scheme from "External Prosthetic" benefit, R23,004 per family
  • Additional R4,416 for hearing aids.
  • 1 pair every 24 months
1.2. Wheelchairs:
  • Wheelchairs, braces, walking frames and crutches: R5,360, from day-to-day 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:♦️
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
.

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.

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Medication Benefit for 2024:

Profmed: ProPinnacle Savvy
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= R19,615
  • Main+1= R28,961
  • Max per family= R37,690
Chronic:
  • An additional 32 non-PMB conditions
Acute (presrcibed) medication:
  • M= R10,988
    M1= R14,686
    M2= R15,713
    M3+= R17,356
    Maximum R20,540 per family
  • From day-to-day benefit, at 80% cost
Over-the-counter:
  • R2,156 per family, from acute medicine 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:
  • 20% co-payment, and paid from Oncology limit
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:♦️
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
.

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.


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