Profmed Medical Aid offers flexible medical insurance options suitable for various income levels. Whether you’re looking for affordable coverage or premium benefits, Profmed provides a range of plans to meet your needs. Here’s an updated overview of Profmed’s offerings, including the latest benefit options and premium details.
Overview of Profmed Medical Aid
Profmed Medical Aid is designed to cater to individuals across different income brackets. For those with a monthly income below R11,000, proof of income is required to qualify for specific plans. Premiums start at R1,548 and can go up to R9,491 for the primary member. Dependents, including adult children over 21 and younger children, can also be included under the policy.
Premiums and Dependents
Adult Dependents:
- Monthly premiums range from R1,548 to R8,804.
Child Dependents:
- Premiums start from R735 and go up to R2,847 for children under 28 who are studying. Proof of dependency and annual study documentation are required for those over 21.
Profmed Medical Aid Options
Profmed offers a variety of plans under both the Savvy and Premium benefit options. Here’s a breakdown of each plan and its benefits:
1. Savvy Option
The Savvy option provides a range of coverage based on income levels. Members are required to use designated service provider networks (DSPNs) and may face co-payments if opting for non-network facilities.
Income Bracket: R0 – R7,000
- ProPinnacle: R8,542
- ProSecure Plus: R4,866
- ProSecure: R2,868
- ProActive Plus: R2,275
- ProActive: R821
Income Bracket: R7,001 – R11,000
- ProPinnacle: R8,542
- ProSecure Plus: R4,866
- ProSecure: R2,868
- ProActive Plus: R2,275
- ProActive: R1,407
Income Bracket: Over R11,001
- ProPinnacle: R8,542
- ProSecure Plus: R4,866
- ProSecure: R3,987
- ProActive Plus: R2,275
- ProActive: R1,887
Benefits of Savvy Plans:
ProActive Savvy Plan:
- Hospitalisation: 100% cover of the Savvy tariff for hospital ward accommodation, theatre, recovery rooms, intensive care, and emergency visits.
- Medication: 100% cover for in-hospital medications; outpatient medicines are covered subject to PMB legislation.
- Medical Services: Includes full coverage for radiology, pathology, donor costs, dialysis, and oncology treatment up to specified limits.
ProActive Plus Savvy Plan:
- Hospitalisation: Covers up to 100% of the Savvy tariff for all major hospital services, including additional coverage for surgery and GP consultations.
- Medication: Includes 80% coverage for outpatient medicines.
- Medical Services: Enhanced coverage for radiology, pathology, and oncology treatment, with specified limits on costs.
ProSecure Savvy Plan:
- Hospitalisation: Covers 100% of the Savvy tariff for hospital services.
- Medication: Covers 80% of the negotiated tariff for outpatient medicines.
- Medical Services: Includes comprehensive coverage for donor costs, dialysis, and oncology treatment.
ProSecure Plus Savvy Plan:
- Hospitalisation: Covers up to 100% of the Savvy tariff for all hospital-related services.
- Medication: Includes 80% coverage for medicines taken out of hospital.
- Medical Services: Enhanced coverage for oncology treatment and chemotherapy, including consultations and drugs.
ProPinnacle Savvy Plan:
- Hospitalisation: Provides extensive coverage up to 100% of the Savvy tariff for all hospital-related services, including private ward accommodation.
- Medication: Covers 80% of the negotiated tariff for medicines taken out of hospital.
- Medical Services: Highest level of coverage for donor costs, dialysis, and oncology treatment.
2. Premium Option
The Premium option offers the most extensive coverage with fixed premiums:
- ProPinnacle: R9,491
- ProSecure Plus: R5,407
- ProSecure: R4,429
- ProActive Plus: R2,528
- ProActive: R2,098
Benefits of Premium Plans:
- Hospital and Day-to-Day Cover: Comprehensive coverage for hospitalisation, including general practitioners, specialists, and emergency services.
- Additional Benefits: Includes dental care, chronic medication, optometrist services, trauma and HIV assistance, and more.
Traditional vs. New-Generation Medical Schemes
Profmed operates as a traditional medical scheme, offering clear and defined benefits with straightforward coverage limits. This traditional model contrasts with newer-generation schemes, providing greater certainty and peace of mind regarding benefits.
Advantages of Profmed Medical Aid
- Diverse Coverage Options: A range of plans to suit various needs and income levels.
- Dependents Covered: Ability to add dependents at competitive premiums.
- Cancer Treatment: All options cover cancer treatment comprehensively.
- Affordable Premiums: Competitive pricing across different plans.
Disadvantages of Profmed Medical Aid
- Limited Dental Coverage: Most plans offer minimal dental-related expenses.
- Co-Payments: Additional costs may apply for using non-network facilities.
Conclusion
Profmed Medical Aid provides a broad spectrum of coverage options at competitive prices, making it an appealing choice for many South Africans. Whether opting for the affordable Savvy plans or the more comprehensive Premium options, Profmed offers tailored solutions to meet diverse healthcare needs. For more information on specific plans and to verify network facilities, visit Profmed’s official website or contact their client services.
