ProPinnacle

Medical Aid Year:

2020

Day to day Benefits:

Doctors’ consultations and procedures paid at 300% Profmed Tariff, Acute medication, Over-the-counter medication, Radiology & pathology, Optical, Dentistry dentists paid at 135% Profmed Tariff, Maternity benefits2 extended day-to-day benefits enhance...

In Hospital Benefits

Hospital Rate of Payment:

Hospitalisation ››doctors’ consultations and procedures paid at 300% Profmed Tariff ››private wards ››maternity - hospitalisation in private wards both ante-natal and post-delivery - enhanced fees for midwives

Hospitals:

Savvy options require use of the hospital Designated Service
Provider Network (DSPN). Voluntary use of a non-DSP will result in
a co-payment

Upfront Payments to hospitals:

No co-payments for hospitalisation on the Premium options

Dialysis:

Unlimited peritoneal dialysis and haemodialysis

Oncology / Cancer:

Oncology - PET Scans: Bloch & Partners at Morningside Clinic (applies to greater Johannesburg region only) Oncology - Radiation Therapy: Netcare (participating facilities

In Hospital Dentistry:

dentists paid at 135% Profmed Tariff

Rehabilitation, Hospice and Step-down facilities:

Alcohol and Drug Rehabilitation: South African National Council on Alcoholism and Drug Dependence (SANCA), Physical Rehabilitation: Life Healthcare

HIV / AIDS:

3 - 6 months’ HIV exposure management, Subject to the use of the DSPN

International Travel Benefit:

R6 million per beneficiary per journey ›› R1 500 excess on out-of-hospital expenses

Day-to-day benefits

GP consultations:

Specialist consultations:

Acute medicine:

Optometry benefits:

Basic dentistry:

dentists paid at 135% Profmed Tariff

MRI and CT Scans (Out of Hospital):

80% benefit, paid from risk

Chronic Conditions

Chronic Conditions:

58 chronic conditions plus
relevant DTP

Total Contributions

ProPinnacle

Medical Aid Plan Name Term:

Any

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