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PROFMED PROACTIVE 2019

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Medical Aid Year: 
2019
Day to day Benefits: 

Annual overall day-to-day limit
Available only through
relevant available day-to-day sub-limits, where applicable

See
Section 5E
Subject
to PMB
legislation

In Hospital Benefits
Hospital Rate of Payment: 
100% Negotiated Tariff in general ward
Specialists: 
100% Specific Tariff
Other healthcare professionals eg. Physio, Occupational, Dietician: 
Subject to PMB legislation
Radiology and pathology: 
100% Profmed Tariff
MRI and CT scans: 
100% Profmed Tariff 2 investigations per family in- or out-of-hospital
ICU and High Care: 
100% Negotiated Tariff
Dialysis: 
100% Negotiated Tariff
Oncology / Cancer: 
R222 500 per beneficiary Thereafter, subject to PMB legislation
Medical and Surgical Appliances: 
Subject to PMB legislation
In Hospital Dentistry: 
100% Negotiated Tariff Specific cases only*
Take home Medicine: 
Subject to PMB legislation
Rehabilitation, Hospice and Step-down facilities: 
100% Negotiated Tariff R19 691 per family, subject to PMB legislation
Treatment for Mental Health: 
100% Negotiated Tariff R19 691 per family, subject to PMB legislation
HIV / AIDS: 
100% Negotiated Tariff
International Travel Benefit: 
R6 million per beneficiary per journey No benefit for out-of-hospital expenses
Day-to-day benefits
GP consultations: 

GPs and specialists at GP
rate: R462
1 consultation per beneficiary

Specialist consultations: 

GPs and specialists at GP
rate: R462
1 consultation per beneficiary

Acute medicine: 

Subject to PMB legislation

Over-the-counter (OTC) Medicine: 

No benefit

Optometry benefits: 
Subject to PMB legislation
Basic dentistry: 
135% Profmed Tariff
Specialised Dentistry: 
100% Specific Tariff
MRI and CT Scans (Out of Hospital): 
100% Profmed Tariff 2 investigations per family in- or out-of-hospital
Radiology and Pathology: 
100% Profmed Tariff
Chronic Conditions
Chronic Conditions: 

26 conditions plus relevant DTPs
CDLs: Addison’s Disease, Asthma, Bipolar Mood Disorder, Bronchiectasis, Cardiac Failure,
Cardiomyopathy Disease, Chronic Obstructive Pulmonary Disorder, Chronic Renal Disease, Coronary
Artery Disease, Crohn’s Disease, Diabetes Insipidus, Diabetes Mellitus Types 1 & 2, Dysrhythmias, Epilepsy,
Glaucoma, Haemophilia, HIV/AIDS, Hyperlipidaemia, Hypertension, Hypothyroidism, Multiple Sclerosis,
Parkinson’s Disease, Rheumatoid Arthritis, Schizophrenia, Systemic Lupus Erythematosus, Ulcerative Colitis.
DTPs: Relevant chronic conditions listed in the 270 PMBs, e.g. hormone replacement therapy
(Menopause), immuno-suppressive therapy (Post-Organ Transplants).

Preventative Care Benefits
Preventative Benefits: 

Prostate Specific Antigen (PSA)
Males 40 years and older. Subject to PMB legislation.
Pathology
(Subject to use of the DSPN)
(Tariff code 4519)

100% Negotiated Tariff
1 investigation per
beneficiary

Pap smear or liquid-based cytology
Females 18 years and older. Subject to PMB legislation.
Pathology
(Subject to use of the DSPN)
(Tariff code 4566 – Pap smear.
Tariff codes 4559 and
4560 – liquid-based cytology
reimbursed per tariff code 4566)

100% Negotiated Tariff
1 investigation per
beneficiary

Mammograms
Females 40 years and older. Available to females younger than 40 years pre-disposed to breast cancer, subject to motivation. Subject to
PMB legislation.
Radiology 100% Profmed Tariff
1 investigation per
beneficiary

Medical Aid Plan Name Term: 
Any