Profmed ProSecure B medical aid plan: 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:
ProSecure B
Quick Overview
Main: Adult: Child:
Total Cost pm: R3,201 R2,964 R1,250
Savings (per year): No savings option on this plan
Extended Fund: RM = R10,570
M1 = R16,066
M2+= R20,717
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
Children: Pay for all children
  • Scheme rate is generally 120%, 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
  • R422,000 cancer cover
  • 39 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

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IN HOSPITAL PROCEDURES:
ProSecure B
Benefits Gap benefits
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.
Hospital Choice:
  • Unlimited
  • N/A
Specialised Radiology:
  • 2 per family, in or out of hospital
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: R13,635 per person
  • Wound care treatment at home: R3,700 per person
Casualty:
  • If does not result in hospitalisation: from day-to-day benefit
Other:
  • Post-hospital rehabilitation: R49,680 at DSP
  • Post-hospital physio: R2,114 per person and R3,384 per family
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OUT OF HOSPITAL BENEFITS:
ProSecure B
Benefits Gap benefits
GP consultations:
  • Paid from day-to-day 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
Childcare:
  • Immunisations are covered by scheme
  • No benefit
Specialists consultations:
  • From day-to-day benefit
Pathology:
  • From day-to-day benefit
General radiology:
  • From day-to-day benefit
Specialised radiology:
  • 2 per family, in or out of hospital at 80% scheme rate
Supplementary Services: (Physio, etc)
  • R2,537 per person and R4,228 per family unless PMB
  • From day-to-day benefit unless PMB
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MATERNITY BENEFITS:
ProSecure B
Benefits Gap benefits
Hospital stay:
  • GPs: 120% of scheme rate for procedure, and R439 for consult
  • Specialists: 120% of scheme rate for procedure, and R665 for consult
Consultations:
  • 13 consults paid from day-to-day benefit
Scans:
  • 2x 2D scans paid from day-to-day benefit
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CANCER (ONCOLOGY):
ProSecure B
Benefits Gap benefits
Overall coverage (in and out of hospital):
  • R422,800 per person. Thereafter, only PMBs
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DENTISTRY:
ProSecure B
Benefits Gap benefits
Dentistry:
  • Out of hospital: R5,507 per person and R11,100 per family. Not subject to day-to-day limit
  • Orthognathic surgery: no benefit
Orthodontics:
  • See above
Maxillo Facial Surgery:
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MEDICATION:
ProSecure B
Benefits Gap benefits
Chronic:
  • No. of chronic conditions covered: 39
  • and:
    • M =R15,750
    • M1= R25,790
    • M2+=R35,725
Acute (presrcibed) medication:
    80% of single exit price, limited to
  • M= R3,435
  • M1R5,142
  • M2= R5,676
  • M3R5,887
  • M3+= R6,342
  • From day-to-day benefit
Over-the-counter:
  • 20% co-payment
  • R1,448 per family
  • From acute medication and day-to-day limit
Birth Control:
  • R1,734 per person, for oral, patches, injections, implants and IUDs
On Discharge:
  • 7 day supply, 20% co-payment and from acute medicine benefit
Biological:
  • No benefit
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OPTOMETRY:
ProSecure B
Benefits Gap benefits
Optometry:
  • From day-to-day benefit
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MENTAL HEALTH:
ProSecure B
Benefits Gap benefits
In-hospital:
  • R24,945 per person. Thereafter PMB only.
Out-of-hospital:
  • R6,342 per person. Subject to above limit, and PMBs only. Paid by scheme.
Trauma:
  • Telephone and face to face counselling, as appropriate
  • HIV post-exposure: 2 doctor consults, 30 days PEP medication, pathology and management
  • Paid by scheme
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OTHER BENEFITS:
ProSecure B
Benefits Gap benefits
General Appliances:
  • Internal appliances: R48,622 per family
  • Cochlear implants: R93,016 per family
  • External appliances: R13,213 per family
  • No benefit
1.1. Hearing Aids:
  • Additional R6,236 per family, paid by scheme every 2 years
  • No benefit
1.2. Wheelchairs:
  • R3,488 per family
  • Includes braces, wheelchairs, walking frames and crutches
  • From day-to-day benefit
  • No benefit
Dialysis:
  • Unlimited, at State chronic provider
HIV:
  • No benefit
Emergency Transport:
  • No benefit
International Insurance:
  • R6 million per person per journey
  • R1,100 co-payment for out-of-hospital expenses (only available if available locally on this option)
  • No benefit
Other:
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WELLNESS/PREVENTATIVE BENEFITS:
ProSecure B
Benefits Gap benefits
Flu vaccination:
  • Covered
  • No benefit
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
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PROSTHETICS:
ProSecure B
Benefits Gap benefits
Overal Limit:
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