Profmed ProPinnacle Savvy medical aid plan: 2019

View all plans in this scheme.
Please note that these benefits are still being updated as more information is made available to us. Always consult with your broker before making final decisions regarding your healthcare cover.

ProPinnacle Savvy
2018 Costs:
Total Cost pm:

Main member:

R6,668

Adult:

R6,185

Child: (Pay for all)

R2,000
Savings Account:
  • No savings option on this plan
Extended Fund: RM = R16,912
M1 = R25,050
M2+= R32,555
R R
2019 Costs:
Total Cost pm:

Main member:

R6,661
(%)

Adult:

R6,179

Child: (Pay for all)

R1,998
Savings (per year):
  • No savings option on this plan
Extended Fund: RM=R17,800
M1=R26,365
M1+=R34,265
R R
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In brief (2018):
  • Scheme rate is generally 300%, and most day-to-day expenses are paid from fund
  • Some specialised radiology out of hospital paid by scheme, with a co-payment
  • Preventative benefits such as mammograms and pap smears
  • R634,000 cancer cover, incl biological meds
  • 57 chronic conditions covered
  • Travel insurance benefit
  • Diagnosis and treatment of the 270 PMBs is always paid by scheme, in and out of hospital, according to protocols.
See full benefits below

IN HOSPITAL PROCEDURES:
ProPinnacle Savvy
Scheme Benefits: Gap Benefits:
Specialists: 2019 Benefits coming soon! 2019 Benefits coming soon!
Hospital Choice: 2019 Benefits coming soon! 2019 Benefits coming soon!
Specialised Radiology:
  • 2 per family, in or out of hospital
  • No benefit
Supplementary Services: (Physio, etc) 2019 Benefits coming soon! 2019 Benefits coming soon!
Transplants: 2019 Benefits coming soon! 2019 Benefits coming soon!
Co-payments: 2019 Benefits coming soon! 2019 Benefits coming soon!
Alternatives to hospitals: 2019 Benefits coming soon! 2019 Benefits coming soon!
Casualty: 2019 Benefits coming soon! 2019 Benefits coming soon!
Other: 2019 Benefits coming soon! 2019 Benefits coming soon!
Note:
  • Gap cover is an add-on to your medical aid, not a stand alone product
  • Gap cover has a maximum benefit payout of R150,000 per person per year for all gap benefits (except dread disease and premium waiver benefits which do not count towards the R150,000 limit)
  • Gap only supplements payment for procedures approved or authorised by your medical aid, and does not cover “penalties” (such as if, for example, you choose a non-DSP doctor for your procedure when the plan required a DSP doctor)
We will email you a quote for this and two other comparable plans. FREE.
We can help you with unpaid claims, finding a gap, general advice, plan changes, cheaper options and more. FREE.

All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme.
The gap benefits listed are for AskAdam gaps, unless otherwise stated. Actual benefits depend on gap choice option.

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OUT OF HOSPITAL BENEFITS (non-PMB):
ProPinnacle Savvy
Scheme Benefits Gap benefits
Main: Adult: Child:
Savings /yr: No savings option on this plan
Extended Fund: RM = R16,912
M1 = R25,050
M2+= R32,555
R R
General info: 2019 Benefits coming soon! 2019 Benefits coming soon!
GP consultations: 2019 Benefits coming soon! 2019 Benefits coming soon!
Childcare: 2019 Benefits coming soon!
  • No extra benefit available
Specialists consultations: 2019 Benefits coming soon! 2019 Benefits coming soon!
Pathology: 2019 Benefits coming soon! 2019 Benefits coming soon!
General radiology: 2019 Benefits coming soon! 2019 Benefits coming soon!
Specialised radiology: 2019 Benefits coming soon! 2019 Benefits coming soon!
Supplementary Services: (Physio, etc) 2019 Benefits coming soon! 2019 Benefits coming soon!
We will email you a quote for this and two other comparable plans. FREE.
We can help you with unpaid claims, finding a gap, general advice, plan changes, cheaper options and more. FREE.
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MATERNITY BENEFITS:
ProPinnacle Savvy
Scheme Benefits Gap benefits
Hospital stay: 2019 Benefits coming soon! 2019 Benefits coming soon!
Consultations: 2019 Benefits coming soon! 2019 Benefits coming soon!
Scans: 2019 Benefits coming soon! 2019 Benefits coming soon!
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We can help you with unpaid claims, finding a gap, general advice, plan changes, cheaper options and more. FREE.
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CANCER (ONCOLOGY):
ProPinnacle Savvy
Scheme Benefits Gap benefits
Overall coverage (in and out of hospital): 2019 Benefits coming soon! 2019 Benefits coming soon!
We will email you a quote for this and two other comparable plans. FREE.
We can help you with unpaid claims, finding a gap, general advice, plan changes, cheaper options and more. FREE.
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DENTISTRY:
ProPinnacle Savvy
Scheme Benefits Gap benefits
Standard Dentistry: 2019 Benefits coming soon!
Specialised Dentistry: 2019 Benefits coming soon! 2019 Benefits coming soon!
In-Hospital Dentistry: 2019 Benefits coming soon!
Orthodontics: 2019 Benefits coming soon!
Maxillo Facial Surgery: 2019 Benefits coming soon! 2019 Benefits coming soon!
We will email you a quote for this and two other comparable plans. FREE.
We can help you with unpaid claims, finding a gap, general advice, plan changes, cheaper options and more. FREE.
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MEDICATION:
ProPinnacle Savvy
Scheme Benefits Gap benefits
Chronic: 2019 Benefits coming soon! 2019 Benefits coming soon!
Acute (presrcibed) medication: 2019 Benefits coming soon! 2019 Benefits coming soon!
Over-the-counter: 2019 Benefits coming soon! 2019 Benefits coming soon!
Birth Control: 2019 Benefits coming soon! 2019 Benefits coming soon!
On Discharge: 2019 Benefits coming soon! 2019 Benefits coming soon!
Biological: 2019 Benefits coming soon! 2019 Benefits coming soon!
We will email you a quote for this and two other comparable plans. FREE.
We can help you with unpaid claims, finding a gap, general advice, plan changes, cheaper options and more. FREE.
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OPTOMETRY:
ProPinnacle Savvy
Scheme Benefits Gap benefits
Optometry: 2019 Benefits coming soon! 2019 Benefits coming soon!
We will email you a quote for this and two other comparable plans. FREE.
We can help you with unpaid claims, finding a gap, general advice, plan changes, cheaper options and more. FREE.
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MENTAL HEALTH:
ProPinnacle Savvy
Scheme Benefits Gap benefits
In-hospital: 2019 Benefits coming soon! 2019 Benefits coming soon!
Out-of-hospital: 2019 Benefits coming soon! 2019 Benefits coming soon!
Trauma: 2019 Benefits coming soon! 2019 Benefits coming soon!
We will email you a quote for this and two other comparable plans. FREE.
We can help you with unpaid claims, finding a gap, general advice, plan changes, cheaper options and more. FREE.
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OTHER BENEFITS:
ProPinnacle Savvy
Scheme Benefits Gap benefits
General Appliances: 2019 Benefits coming soon!
  • No benefit
1.1. Hearing Aids: 2019 Benefits coming soon!
  • No benefit
1.2. Wheelchairs: 2019 Benefits coming soon!
  • No benefit
Dialysis: 2019 Benefits coming soon! 2019 Benefits coming soon!
HIV: 2019 Benefits coming soon!
  • No benefit
Emergency Transport: 2019 Benefits coming soon!
  • No benefit
International Insurance: 2019 Benefits coming soon!
  • No benefit
Other: 2019 Benefits coming soon! 2019 Benefits coming soon!
We will email you a quote for this and two other comparable plans. FREE.
We can help you with unpaid claims, finding a gap, general advice, plan changes, cheaper options and more. FREE.
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WELLNESS/PREVENTATIVE BENEFITS:
ProPinnacle Savvy
Scheme Benefits Gap benefits
Flu vaccination: 2019 Benefits coming soon!
  • No benefit
Pneumonia vaccines: 2019 Benefits coming soon!
  • No benefit
Back Rehabilitation Programme: 2019 Benefits coming soon!
  • No benefit
Biometric Screening: 2019 Benefits coming soon!
  • No benefit
Child Immunisation: 2019 Benefits coming soon!
  • No benefit
Pap Smear: 2019 Benefits coming soon!
  • No benefit
Mammogram: 2019 Benefits coming soon!
  • No benefit
PAS Test: 2019 Benefits coming soon!
  • No benefit
HIV Test: 2019 Benefits coming soon!
  • No benefit
Other: 2019 Benefits coming soon!
  • No benefit
We will email you a quote for this and two other comparable plans. FREE.
We can help you with unpaid claims, finding a gap, general advice, plan changes, cheaper options and more. FREE.
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PROSTHETICS:
ProPinnacle Savvy
Scheme Benefits Gap benefits
Overal Limit: 2019 Benefits coming soon!
  • An additional R40,000 per sublimit, per event
Sub-limits: 2019 Benefits coming soon!
  • An additional R40,000 per sublimit, per event
We will email you a quote for this and two other comparable plans. FREE.
We can help you with unpaid claims, finding a gap, general advice, plan changes, cheaper options and more. FREE.

    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