Peace of mind when you need it most
We provide intelligent benefits to discerning members. Over and above the evidence-based and clinically appropriate treatment our members enjoy, we provide additional assistance and programmes designed to support your health and wellness needs, whether you’re at home or travelling overseas. These additional benefits are available on all ten of Profmed’s medical aid benefit options.
The chronic medication covered by the Scheme forms part of the legislated 270 PMB medical conditions. The Chronic Medication benefit provides cover for the medication required to treat chronic conditions. The consultations and procedures (DTPs) related to these conditions are paid from the available day-to-day benefit. DTPs are the Diagnostic and Treatment Pairs required to diagnose and manage chronic conditions.
Chronic medication is medication used for more than a month for the 26 Chronic Disease List (CDL) conditions available on all options and the additional conditions listed for each option in the Schedule of Benefits.
Your doctor or pharmacist must authorise your condition as clinical data and information must be provided to accurately classify the condition. No forms need to be completed. Your doctor or pharmacist must call Chronic Authorisations on 0800 132 345.
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This benefit covers oral contraceptives and patches, the injection, implants and intra-uterine devices. Oral contraceptives used for any purpose other than contraception will not be funded. This benefit is available on all options, subject to a benefit limit per beneficiary, and is paid from risk.
If you have a medical emergency and reside within the SADC Region, please contact International SOS on +27 11 541 1225. Depending on your situation, International SOS will either arrange for a suitable, appropriate local emergency transport organisation to assist you, or you will be referred to a local suitably-equipped medical facility. If suitable facilities are not available where you are situated, appropriate emergency transport will be dispatched to evacuate you to the closest most appropriate facility.
Countries in the SADC Region are Angola, Botswana, Comores, Democratic Republic of Congo, Lesotho, Madagascar, Malawi, Mauritius, Mozambique, Namibia, Seychelles, South Africa, Swaziland, Tanzania (including Zanzibar), Zambia and Zimbabwe.
Profmed does not have relationships with emergency transport providers outside South Africa. Therefore, members living in Namibia must contact International SOS on +27 11 541 1225 should they require emergency medical assistance or transportation within Namibia. However, should that call-out result in admission to hospital in Namibia, authorisation must be obtained directly from Profmed and not through International SOS.
Admissions on weekends, after working hours or on public holidays must be authorised on the next working day. If the member is incapable of fulfilling this requirement, it is the responsibility of the hospital to obtain authorisation.
The number to call for pre-authorisation from outside RSA is +27 12 679 4145.
Profmed has partnered with Netcare 911 to provide emergency medical assistance to members within South Africa. The number to call is 082 911.
Rest assured that if your circumstances warrant emergency transport, an appropriate form of transportation will be dispatched to you with no capped limits, provided that services are obtained through Netcare 911, Profmed’s designated service provider.
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Hospitalisation refers to admission for treatment or a procedure that can only be undertaken in-hospital. Hospitalisation for the sole purpose of undergoing radiology or pathology investigations will not be funded. Deposits are not required on admission to hospital. Members on the Savvy options are required to make use of hospitals on the Savvy hospital network. A co-payment applies for voluntary use of a non-network hospital on the Savvy options.
Cover for hospitalisation includes the cost of hospital facilities, such as ward fees and theatre fees, as well as materials and medicines (excluding medicine taken home on discharge). These fees are controlled either by legislation, in the case of medicine, or negotiation between Profmed and the various hospitals and hospital groups. Hospitalisation costs do not include the fees charged by the treating doctor and other healthcare practitioners.
Before a beneficiary can be admitted to hospital for an elective procedure, it is the member’s responsibility to obtain pre-authorisation at least 7 days prior to the hospital event by calling Pre-authorisations on 0861 776 363.
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Members on all options are covered up to R6 million per beneficiary per journey for a travel period of not longer than 90 days. You do not need to activate cover prior to departure. International SOS is Profmed’s designated service provider for international medical assistance. Before accessing medical treatment, please call +27 11 541 1225. Out-of-hospital treatment must be paid up-front and can be claimed retrospectively, subject to available benefits and a R1 500 co-payment.
For the purpose of applying for visas, members travelling overseas can request an embassy letter on the Profmed App.
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Multiply is a wellness and rewards programme that supports your efforts to lead a healthy lifestyle.
All Profmed members have automatic access to Multiply Starter, at no cost, which offers a number of exciting rewards and discounts on certain products. You then have the option to upgrade to Multiply Provider or Multiply Premier, which offer a wider range of benefits and rewards at a nominal monthly fee. Multiply can be reached on 0861 100 789.
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Profmed Baby will provide you with support to make your pregnancy an enjoyable journey. Once you’ve registered on the programme, you will receive a gift of your choice, updates on the stages of your pregnancy every trimester and you can connect and share information and ideas with other moms.
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As part of our commitment to your wellbeing, this benefit encourages the early detection of the most frequently diagnosed high-risk diseases. Early treatment reduces the risk of complications and is more likely to secure a better prognosis for patients. This benefit also provides cover for vaccinations to prevent the onset of disease.
Pre-authorisation is not required. In the case of mammography, women under 40 years who are pre-disposed to breast cancer my access this benefit subject to motivation. The Scheme’s pathology designated service providers must be utilised to avoid co-payments.
The relevant tariff codes as provided in the Schedule of Benefits must reflect on preventative care claims to ensure claims are paid from the correct benefit.
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This programme provides members with 24-hour access to trauma counselling and HIV assistance in the event of a trauma, such as rape, hijacking, needle-stick injury or any traumatic life-changing event. This benefit is not subject to the day-to-day limit and is available on all options.
If you require assistance, call 0861 776 363. All calls and treatment are dealt with in the strictest confidence. You will be assigned a case manager, who will ensure you receive the correct treatment.