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About Profmed

Profmed’s vision is to address the healthcare needs of South Africa’s professionals. This is achieved through the tailored and comprehensive design of benefits that suit the specific requirements of professionals. With over 60 years’ experience, Profmed is one of the longest established medical schemes in South Africa but we are as relevant today as we were 60 years ago.

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Profmed Benefits

Profmed medical aid scheme offers ten excellent options. You can choose from one of our five Premium options or one of our five Savvy hospital network options. We provide affordable medical cover that is designed for the unique needs of the professional and your particular life stage. Choose a benefit option that suites you or your family and that takes into consideration your personal needs and your financial position.

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›Prescribed Minimum Benefits

Prescribed Minimum Benefits

What are Prescribed Minimum Benefits (PMBs)?

PMBs are a set of defined benefits that ensure all medical scheme members have access to certain minimum healthcare services, regardless of the benefit option they have selected.

The Medical Schemes Act stipulates that schemes must cover the costs related to the diagnosis, treatment and care of:

Funding for treatment and consultations is identified by the ICD-10 code that is provided by the medical practitioner on the claim.

Authorisation of Chronic conditions

Authorisation is required for the 26 chronic conditions, and the additional conditions covered by Profmed, listed per option on Profmed’s Chronic Disease List (CDL), in order to qualify for funding from the Chronic Medication benefit. Your doctor or pharmacist must authorise your chronic condition by calling Chronic Authorisations on 0800 132 345. These conditions are covered on all of Profmed’s options, but benefits will be more or less restrictive depending on the option that the member has chosen.

Chronic Authorisations: 0800 132 345

Chronic medication is funded from the Chronic Medication benefit, subject to available funds. The consultations, radiology and pathology related to these chronic conditions are funded from the available day-to-day benefits. Once day-to-day benefits are depleted, benefits will continue to be funded from risk, and in terms of the PMB legislation.