PPS Gap Cover Review 2026
PPS Gap Cover fills the shortfall between what your medical scheme pays and what specialists actually charge — but unlike most gap cover products, it's only available to members of a specific medical scheme. Verified against PPS's own 2025 brochure and FAQ documents in July 2026.
Who can get it
Only Profmed medical scheme members are eligible — this is not open to the general public or members of other medical schemes. Individual and family cover options exist, with no maximum entry age.
Cover limits
- Overall annual limit: R230,000 per insured person per calendar year (combined limit for core benefits).
- Non-network hospital co-payments: up to R16,000, maximum 2 claims/year.
- Casualty treatment after accidental injury: R25,400/year.
- Internal prosthesis cover: R44,000/year.
- Intra-ocular lenses: R6,500/lens/year.
- Robotic procedure cover: R37,600/year.
- Enhanced Cancer Cover: R30,000, with an optional Extended Cancer Cover add-on of R120,000 or R240,000.
Premiums (2025 rates)
- Individuals: under 35 — R253/month; 35–54 — R452/month; 55–64 — R567/month; 65+ — R711/month.
- Families: all lives under 65 — R567/month; one or more lives 65+ — R711/month.
- Optional Extended Cancer Cover: R112/month (R120,000 benefit) or R186/month (R240,000 benefit).
These premiums are valid for 2025 and may increase from 1 January 2026 — confirm the current rate before applying.
How to apply
Contact Profmed New Business at degree@profmed.co.za or 0800 334 733, or reach the policy administrator Zestlife on 021 180 4220. No medical exam is required, and cover starts on the 1st of the month following application. The policy is underwritten by Guardrisk Insurance Company Limited and administered by Zestlife.
