Profmed medical aid scheme aims to make the claims procedure as user-friendly as possible for its members. In most cases claims are submitted by the service provider, i.e. your doctor, dentist, pharmacist, etc. However, you must check all claims submitted on your behalf to ensure that the service has indeed been rendered to you. In this way you will notice if there are any inaccurate claims against your benefits. If there does appear to be a problem, please contact the service provider and enquire about the claim submitted on your behalf. You must then contact Profmed medical aid scheme and point out the irregularities.
If, for any reason, you should pay upfront for services covered by your benefits, you can claim this payment back directly from Profmed. Here we refer to providers who request upfront or cash payments or who offer a cash discount, which in turn will ensure that your benefits stretch further. When you pay cash, please remember to request a detailed account and a receipt for your payment.
No claim form is required. You simply have to check the details on your account and post the original account and receipt to:
Profmed Claims Department
Private Bag X1031
Claims must be submitted within four months from the date of service.
Please be aware that claims that are sent through by fax, e-mail or as copies will NOT be accepted. Faxed, e-mailed and photocopied claims are generally illegible, which leads to claims being paid incorrectly, or not at all.
You will be reimbursed by means of a direct payment into your bank account. Due to fraud, cheques will not be issued. Please provide Profmed with your bank account details, if you have not already done so.