Profmed: ProActive B 2018

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.

COSTS and OVERVIEW:
ProActive B
2018 costs In brief:
What’s new in 2018?
Main: Adult: Child:
Cost 2018: R1,138 R1,138 R510
Cost 2017: (R) (R) (R)
Gap (optional): KaeloXelus: R350 per family
(R600 per family if anyone is 60yrs+)
Overal Limit: Unlimited
PMBs: Day-to-day expenses for PMBs (eg. cancer) are always paid for by the scheme, according to protocols. Find out more
Savings: No savings option on this plan
Children: Pay for all children
We did not profile Profmed in 2017
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Avoid bills! Get up to: 800% scheme rate;  R12,800 per ER visit; unlimited cancer cover;  

co-payments paid and cash payout for hospital stay. R350pm per family


IN HOSPITAL PROCEDURES:
ProActive B
2017 v 2018 benefits Gap benefits Notes
Payout Rate for Specialists:
  • 120% scheme rate (procedures)
  • Consultations: R439 for GPs and R655 for Specialists
Fusion Gap:
  • Up to 620% scheme rate for specialists and other providers
  • In case of admission related to accident:
    -R300 per day, for days 1-13
    -R600 per day for days 14-20
    -R1,200 per day for days 21-30
  • R350pm per family. More Info or download application below.

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Hospital Choice:
  • Unlimited
  • N/A
Specialised Radiology:
  • 2 per family
Fusion Gap:
  • No benefit
Supplementary Services: (Physio, etc)
  • Physio: 100% scheme tariff
Fusion Gap:
  • Up to 620% scheme rate for specialists and other providers
Transplants:
  • Donor: only PMBs, and only if recipient is Profmed member
  • N/A
Co-payments:
  • N/A
  • N/A
Alternatives to hospitals:
  • Treatment in registered sub-acute facility or at home: R11,627 per person
  • Wound care treatment at home: R3,065 per person
Casualty:
  • No benefit, unless PMB or if results in hospital admission
Other:
  • Post-hospital rehabilitation: R24,840 at DSP
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OUT OF HOSPITAL BENEFITS:
ProActive B
2017 v 2018 benefits Gap benefits Notes
GP consultations:
  • No benefit, unless PMB
  • Out of hospital treatment for conditions that are PMBs is always paid for by the scheme (not out of savings), but according to protocols


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Childcare:
  • Immunisations are covered by scheme
  • No benefit
Specialists consultations:
  • Shared with GP benefits, see above
Pathology:
  • No benefit, unless PMB
General radiology:
  • No benefit, unless PMB
Specialised radiology:
  • No benefit, unless PMB
Supplementary Services: (Physio, etc)
  • No benefit, unless PMB
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MATERNITY BENEFITS:
ProActive B
2017 v 2018 benefits Gap benefits Notes
Hospital stay:
  • GPs: 120% of scheme rate for procedure, and R439 for consult
  • Specialists: 120% of scheme rate for procedure, and R665 for consult

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Consultations:
  • No benefit, unless PMB
Scans:
  • No benefit, unless PMB
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CANCER (ONCOLOGY):
ProActive B
2017 v 2018 benefits Gap benefits Notes
Overall coverage (in and out of hospital):
  • R211,400 per person. Thereafter, only PMBs
All oncology benefits are assessed on a case-by-case basis, and are subject to protocols, preferred providers and scheme rules. Benefit covers out-of-hospital treatment too, like chemotherapy.
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DENTISTRY:
ProActive B
2017 v 2018 benefits Gap benefits Notes
Dentistry:
  • Out of hospital: R550 per person and R1,585 per family
  • In-hospital: children younger than 8yrs and removal of impacted teeth
  • Orthognathic surgery: no benefit

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Orthodontics:
  • See above
Maxillo Facial Surgery:

Avoid bills! Get up to: 800% scheme rate;  R12,800 per ER visit; unlimited cancer cover;  

co-payments paid and cash payout for hospital stay. R350pm per family

MEDICATION:
ProActive B
2017 v 2018 benefits Gap benefits Notes
Chronic:
  • No. of chronic conditions covered: 27

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Acute (presrcibed) medication:
  • No benefit, unless PMB
Over-the-counter:
  • No benefit
Birth Control:
  • R1,734 per person, for oral, patches, injections, implants and IUDs
On Discharge:
  • No benefit, unless PMB
Biological:
  • No benefit
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OPTOMETRY:
ProActive B
2017 v 2018 benefits Gap benefits Notes
Optometry:
  • No benefit, unless PMB

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MENTAL HEALTH:
ProActive B
2017 v 2018 benefits Gap benefits Notes
In-hospital:
  • R18,709 per person. Thereafter PMB only.

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Out-of-hospital:
  • R6,342 per person. Subject to above limit, and PMBs only.
Trauma:
  • Telephone and face to face counselling, as appropriate
  • HIV post-exposure: 2 doctor consults, 30 days PEP medication, pathology and management
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OTHER BENEFITS:
ProActive B
2017 v 2018 benefits Gap benefits Notes
General Appliances:
  • Internal appliances: R48,622 per family
  • Cochlear implants: R61,306 per family
  • No benefit

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1.1. Hearing Aids:
  • No benefit
  • No benefit
1.2. Wheelchairs:
  • No benefit
  • No benefit
Dialysis:
  • Unlimited, at State chronic provider
HIV:
  • No benefit
Emergency Transport:
  • No benefit
International Insurance:
  • R6 million per person per journey
  • No benefit for out of hospital expenses
  • No benefit
Other:
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WELLNESS/PREVENTATIVE BENEFITS:
ProActive B
2017 v 2018 benefits Gap benefits Notes
Flu vaccination:
  • Covered
  • No benefit

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Pneumonia vaccines:
  • Covered for 65yrs+
  • No benefit
Back Rehabilitation Programme:
  • No benefit
Biometric Screening:
  • No benefit
Child Immunisation:
  • Covered
  • No benefit
Pap Smear:
  • Covered for 18yrs+
  • No benefit
Mammogram:
  • Covered for 40yrs+ and those pre-disposed to breast cancer
  • No benefit
PAS Test:
  • Covered for 40yrs+
  • No benefit
HIV Test:
  • No benefit
Other:
  • Lipogram blood test, for 40yrs+
  • Fasting blood sugar test, for 40yrs+
  • HPV vaccine, for 9-27yrs
  • No benefit

Avoid bills! Get up to: 800% scheme rate;  R12,800 per ER visit; unlimited cancer cover;  

co-payments paid and cash payout for hospital stay. R350pm per family

2017 v 2018 benefits Gap benefits Notes
Overal Limit:
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Sub-limits:
  • An additional R40,000 per sublimit, per event

    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