How To Claim

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Profmed medical aid’s quick and easy claims procedure

Profmed medical aid scheme aims to make the claims procedure as user-friendly as possible for its members. In most cases claims are submitted electronically by the service provider, i.e. your doctor, dentist, pharmacy, 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 you 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.

Claims procedure for cash or upfront payments with Profmed medical aid scheme

If, for any reason, you should pay upfront for services covered by your benefits, you can claim this payment back from Profmed. When making the payment to the provider, please remember to obtain a detailed account and receipt for your payment.

No claim form is required. You can simply scan and e-mail your claims to claims@profmed.co.za . You can also submit your claims via the Profmed app by taking a photograph of the claim, or browsing for the claim saved in your smart device, and submit. The app can be downloaded for Apple, Android and Windows devices.

Alternatively, you can post your account to:

Profmed Claims Department
Private Bag X1031
Lyttelton
0140.

Profmed cannot accept responsibility for non-receipt of posted claims. Claims must be submitted within four months from date of service. If the Scheme receives a claim after this time, it is considered a stale claim and will not be paid. Please note that faxed claims will NOT be accepted. Faxed claims are generally illegible, which leads to claims being paid incorrectly, or not at all.

Payment of claims

Claims will be reimbursed to you 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.

Claims paid to service providers are paid every second week. Cash claims and claims payable to members are paid weekly.

Click here to download the payment-run dates.

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ELIGIBILITY
Membership of Profmed is only available to persons who have obtained:

  • A degree and/or qualification of four years or more
  • Two three-year degrees
  • A three-year degree with a post-graduate qualification of not less than one year

*Eligibility rules apply.

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