User login

You are here

Home

PROFMED PROSECURE PLUS 2019

Add to compare
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

M R11 125
M+1 R16 910
Maximum R21 805 per family

In Hospital Benefits
Hospital Rate of Payment: 
100% Negotiated Tariff in general ward
Specialists: 
200% Profmed Tariff
Other healthcare professionals eg. Physio, Occupational, Dietician: 
100% Profmed Tariff M R2 670 Maximum R4 450 per family Subject to day-to-day limit, and 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: 
R445 000 per beneficiary Thereafter, subject to PMB legislation
Medical and Surgical Appliances: 
100% Negotiated Tariff R3 671 per family Subject to day-to-day limit
In Hospital Dentistry: 
100% Negotiated Tariff
Take home Medicine: 
80% Negotiated Tariff Paid from acute medicine benefit, subject to the availability of funds
Rehabilitation, Hospice and Step-down facilities: 
100% Negotiated Tariff R26 255 per family, subject to PMB legislation
Treatment for Mental Health: 
100% Negotiated Tariff R26 255 per family, subject to PMB legislation
HIV / AIDS: 
100% Negotiated Tariff
International Travel Benefit: 
R6 million per beneficiary per journey R1 500 excess per beneficiary per journey on out-of-hospital expenses. Out-of-hospital benefits only available if the claim relates to day-to-day benefits available on this option Spectacles or contact lenses limited
Day-to-day benefits
GP consultations: 

GPs: R462
Specialists: R700
1 consultation per beneficiary,
thereafter subject to available
day-to-day limit

Specialist consultations: 

GPs: R462
Specialists: R700
1 consultation per beneficiary,
thereafter subject to available
day-to-day limit

Acute medicine: 

80% Negotiated Tariff
Paid from acute medicine
benefit, subject to the
availability of funds

Over-the-counter (OTC) Medicine: 

80% of cost
R1 524 per family
Subject to acute medication and
day-to-day limits

Optometry benefits: 
100% Optical Tariff 24-month benefit Subject to day-to-day limit, and PMB legislation
Basic dentistry: 
135% Profmed Tariff
Specialised Dentistry: 
200% Profmed 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
Pregnancy benefits: 
Ultra-sound scans (ante-natal)- 2 scans per pregnancy(Subject to registration on the Maternity programme, pre-authorisation and protocols), 13 visits per pregnancy (Subject to registration on the Maternity programme, pre-authorisation and protocols)
Chronic Conditions
Chronic Conditions: 

39 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.
Other: Allergic Rhinitis (in patients with asthma), Alzheimer’s Disease, Ankylosing Spondylitis, Benign
Prostatic Hypertrophy, Major Depressive Disorder, Obsessive Compulsive Disorder, Oncology Adjunctive
Treatment, Osteoporosis, Paraplegia & Quadriplegia, Pituitary Adenomas/Hyperfunction of Pituitary
Gland, Psoriatic Arthritis, Pulmonary Interstitial Fibrosis, Valvular Heart Disease.
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