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This list outlines the medication covered by Profmed medical aid scheme in respect of the Chronic Disease List (CDL) conditions. It is important that your doctor or pharmacist authorises your condition and the medication by calling SwiftAuth on 0800 132 345. Benefit rules and conditions apply.

Click here to utilise the search functionality or to download the medicine list for your specific condition.

Prescribed Minumum Benefit CDL conditions
Addison's Disease	Asthma
Bipolar Mood Disorder	Bronchiectasis
Cardiac Failure	Cardiomyopathy Disease
Chronic Obstructive Pulmonary Disorder	Chronic Renal Disease
Coronary Artery Disease	Chron's Disease
Diabetes Insipidus	Diabetes Mellitus Type 1 & 2
Dysrhythmias	Epilepsy
Glaucoma	Haemophilia
HIV / Aids	Hyperlipidaemia
Hypertension	Hypothyroidism
Multiple Sclerosis	Parkinson's Disease
Rheumatoid Arthritis	Schizophrenia
Systemic Lupus Erythematosis	Ulcerative Colitis

Other Non-CDL conditions
Relevant Diagnostic & Treatment Pairs (DTPs)

Note: MMAP^® and reference pricing apply on all options.

This programme provides members with 24-hour access to trauma counselling and/or HIV assistance in the event of a trauma, e.g. rape, hijacking, needle-stick injury or any traumatic life-changing event.

In the event that you are a victim of crime, you and your dependants will be entitled to immediate and follow-up trauma counselling. All counselling, whether telephonic or face-to-face consultations, are undertaken by registered psychologists. Where relevant, victims will be accompanied by an appropriate, qualified professional to identity parades and court appearances for emotional support.

The number to call is 011 541 1225, which is situated at International SOS, who will immediately connect you to Lifesense, who manage the programme. 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, whether it be counselling, post-HIV exposure treatment or both.

The Trauma and HIV Assistance Programme provides:

• 24-hour assistance
• Appropriate number of telephonic and face-to-face counselling sessions as determined by case manager
• Immediate access to HIV exposure prophylaxis
• Initial and follow-up HIV testing
• 3-6 months HIV exposure management
• Subject to use of the DSPN

This benefit is available on all options at no cost to members and benefits are paid from risk, provided services are obtained from Lifesense, the DSP. Services obtained from a non-DSP will be subject to co-payments and the protocols of the DSP. This programme is not available to members residing in the SADC Region. However, these members may access counselling or HIV exposure medication cover from the relevant day-to-day benefits available to them on the option they are on.

In all instances where Profmed members require emergency medical transport within South Africa, or  within the country of residence in the SADC Region, it is of vital importance that the emergency number is contacted to access such services. Rest assured that if your circumstances warrant emergency transport, on contacting the emergency transport number, an appropriate form of transportation will be despatched to you and Profmed will settle the full account with no capped limits.

How to obtain assistance within South Africa

• In emergencies where the member can communicate, simply dial 0861 776 363. The consultant receiving the call will guide you further.
   
• In an emergency where someone else calls an ambulance service other than International SOS, where a member is unable to contact International SOS due to the nature of the incident, International SOS must be informed within 48 hours of the incident. The account submitted by the ambulance service will be assessed by International SOS and paid in accordance with the protocols of the Scheme.

Emergency assistance requests from within the SADC Region

SADC Region refers to a group of countries in southern Africa, i.e. Angola, Botswana, Democratic Republic of Congo, Lesotho, Madagascar, Malawi, Mauritius, Mozambique, Namibia, Seychelles, South Africa, Swaziland, Tanzania, Zambia and Zimbabwe.

From within the SADC Region, please call +27 11 541 1225 for emergency medical assistance. If the circumstances permit, International SOS will 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.

This benefit covers members in South Africa while travelling outside the borders of South Africa and members who reside in the SADC Region when travelling outside the borders of their country of residence. SADC Region members may not access this benefit when travelling to South Africa, but will have access to their standard benefits while in South Africa.

This benefit is managed by International SOS, who provides medical assistance to members while travelling.

Members requiring medical assistance outside the borders of South Africa should call International SOS on the international emergency number +27 11 541 1225. If circumstances permit, International SOS will arrange for a suitable, appropriate, local emergency transport organisation to assist you or you will be referred to a local suitably equipped and appropriate medical facility. If suitable facilities are not available where you are situated, appropriate emergency transport will be despatched to evacuate you to South Africa.

Members on all options are covered up to R3 million per beneficiary per journey for a travel period of not longer than 90 days, with no exclusions imposed on age or pre-existing medical conditions. However, members in a general waiting period and/or a condition-specific waiting period are not covered.

Members on the ProActive Plus and ProActive options are not covered for out-of-hospital expenses. Members on the ProPinnacle, ProSecure Plus and ProSecure options are entitled to out-of-hospital cover while travelling internationally provided such cover is offered on their benefit option, but out-of-hospital expenses are subject to an excess of R1 000. Pre-authorisation is required for medical expenses exceeding R1 000. All medical expenses while travelling, whether in-hospital or out-of-hospital, are funded from the R3 million limit.

It is imperative that all members, including members in the SADC Region, authorise their international travel cover prior to departure. International SOS manages this benefit and the number to call is +27 11 541 1225. You will be issued with a document providing details of the cover available to you and how to access treatment while travelling.

Claiming for medical expenses incurred personally

In exceptional cases where you have paid for medical expenses out-of-pocket while travelling, these can be claimed on your return to South Africa. Please submit the original account from the provider together with proof of payment to:

International SOS
P.O.Box 4561
Halfway House
1685.

The Multiply Wellness Programme encourages members to lead a healthy lifestyle by providing incentives (such as discounts on gym membership, points for undergoing preventative medical tests etc.), and rewarding members when certain levels of fitness or wellness are achieved.

All Profmed members have automatic access to Base Multiply, at no cost, which offers a number of exciting rewards and discounts on certain products. Members have the option to upgrade to Full Multiply, which offers a wider range of benefits and rewards at a nominal monthly fee.

Click here for more information or call 0861 100 789.

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 the patient. The benefit provides cover for specified consultations, pathology and radiology.

This benefit includes the influenza and HPV vaccine, and testing for the following dread diseases:

• Breast cancer
• Cervical cancer
• Late onset diabetes
• Prostate cancer
• Cardiac disease

Pre-authorisation is not required, except in the case of mammography for women under 40 years. The Scheme’s pathology designated service providers must be utilised to avoid co-payments.

This benefit is available to members who fall in the high-risk age categories

This benefit is subject to a benefit limit per beneficiary per month and is paid from risk, not from the member’s day-to-day benefits. This benefit covers only oral contraceptives or the injection or the patch, but does not cover intra-uterine devices. Oral contraceptives used for any other purpose than contraception will not be funded.