ProSecure Plus

1. Benefits paid from risk:

Hospitalisation

  • Doctor’s consultations and procedures paid at Profmed Premium Tariff (300% of Profmed Tariff)
  • Private wards for maternity post-delivery

Preventative Care from designated service providers

Oral contraceptives

Chronic medication

  • Cover for 40 chronic conditions, with benefit limits

Post-trauma and HIV Exposure Management from designated service providers

2. Day-to-day medical aid benefits:

  • Doctor’s consultations
    - Procedures and consultations paid at Profmed Specific Tariff **
  • Acute medication
  • Radiology and pathology
  • Over-the-counter medication
  • Optical
  • Dentistry
  • Maternity

3. Additional benefits included in this medical aid option are:

** Consultations: GPs = R290
  Specialists = R390
     Procedures: Profmed Tariff plus 20% for GPs and specialists.

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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
Menopause (HRT)
Multiple Sclerosis
Parkinson's Disease
Post Organ Transplant (DTPs)
Rheumatoid Arthritis
Schizophrenia
Systemic Lupus Erythematosis
Ulcerative Colitis
Other Non-CDL Conditions
Alzheimer's Disease
Ankylosing Spondylitis
Benign Prostatic Hypertrophy
Major Depressive Disorder
Obsessive Compulsive Disorders
Oncology Adjunctive Treatment
Osteoporosis
Paraplegia and Quadriplegia
Pituitary Adenomas / Hyperfunction of Pituitary Gland
Psoriatic Arthritis
Pulmonary Interstitial Fibrosis
Valvular Heart Disease


 

What is Post-trauma Management?

The post-trauma benefit is offered on all options and provides cover for trauma and HIV exposure as a result of crime, and HIV exposure resulting from occupational injuries,e.g. needle-stick injury.

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 one-on-one consultations, are undertaken by registered psychologists.

Should it become evident during the initial call to the helpline that you could potentially be exposed to HIV infection, the psychologist handling the call will direct you to the appropriate HIV management personnel. Alternatively, you may call the HIV helpline directly. Post-exposure prophylaxis medication will immediately be dispatched to you. They will inform you of the process over the next three to six months, managing and monitoring your HIV risk and treatment.

The post-trauma benefit provides:

  • 24-hour assistance
  • Initial telephonic counselling immediately after the trauma occurs
  • Two follow-up counselling sessions with a registered psychologist
  • Immediate access to HIV exposure prophylaxis
  • Initial and follow-up HIV testing
  • 3-6 months HIV exposure management
  • Also available in the SADC Region

Although it is recommended that you contact the helpline as soon as possible after experiencing trauma, this benefit can still be accessed within 14 days after the incident.

Follow-up investigations, treatment or consultations resulting from this benefit are not paid from this benefit but are funded from the relevant chronic, day-to-day or other benefits in terms of the rules, limits and protocols of the option the member has chosen.

Post-trauma assistance:

Counselling

  • 0800 611 298

HIV

  • 0860 906 090 (o/h)
  • 071 786 4520 (a/h)


 

In all instances where Profmed members require emergency medical transport within South Africa, or members who are resident or working 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.


 

When travelling outside South Africa, members have access to international medical cover knowing that all emergency and unexpected medical expenses are taken care of. This international cover includes cover in the SADC region and is provided by International SOS and underwritten by ACE Insurance Limited.

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 the closest most appropriate medical facility.

Members on the ProSecure Plus, ProSecure, ProActive Plus and ProActive options are entitled to R5 million cover, while members on the ProPinnacle option are entitled to cover of R10 million. Cover is limited to a maximum travel duration of 90 days. At no additional cost, pre-existing conditions are covered for a travel duration of up to 31 days. Thereafter, pre-existing condition buy-up cover is available.

Cover must be activated by calling 011 541 1225. You will be provided with a policy document containing the terms, conditions and exclusions applicable.

Optional baggage and inconvenience cover may be purchased directly from ACE at the member's expense.


 

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 vaccine for influenza, 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 new benefit provides funding up to a maximum of R100 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.



 
Click here to view the 2011 Conversion factor for Medical Practitioners