Profmed ProPinnacle (Premium): 2027 contributions and benefits

At a glance

Plan type: Comprehensive plan
Hospitals: Any private hospital
Hospital and specialists: 300% of Scheme tariff
Day-to-day costs: Day-to-day benefits
Chronic conditions: 58
Cancer: R773 000 a year
Children you pay for: Up to 3
Children on the plan to age: 28

Plan type: Comprehensive plan
Hospitals: Any private hospital
Hospital and specialists: 300% of Scheme tariff
Day-to-day costs: Day-to-day benefits
Chronic conditions: 61
Cancer: R805 900 a year
Children you pay for: Up to 3
Children on the plan to age: 28

Monthly contributions

2027 rates take effect on 1 January 2027. You pay for up to 3 children.

Member	2026	2027	Change
Main member	R14 634	R16 080	+9.9%
Adult dependant	R13 574	R14 920	+9.9%
Child	R4 390	R4 825	+9.9%

Benefits

Profmed has published its full 2027 rules, but we hold only the main rows so far. A row without a 2027 entry shows the 2026 rule, marked.

Benefits in force for 2026.

In hospital

Hospitals

Any hospital

Hospitals

Any hospital

Profmed Benefits at a Glance 2027, p2

Specialists in hospital

300% of Scheme tariff. A specialist who charges more leaves a shortfall.

Profmed Information Guide, p4

Specialists in hospital

300% of Scheme tariff. A specialist who charges more leaves a shortfall.

Profmed Schedule of Benefits 2027, p6

Chronic and cancer

Chronic conditions

58 conditions (the 27 on the Chronic Disease List plus others the scheme adds).

Chronic conditions

61 conditions (the 27 on the Chronic Disease List plus others the scheme adds).

Profmed Benefits at a Glance 2027, p3

Cancer

Up to R773 000 a year.

Profmed Schedule of Benefits 2026, p11

Cancer

Up to R805 900 a year.

Profmed Schedule of Benefits 2027, p7

Dialysis

Through National Renal Care, Life Healthcare and Mediclinic.

Profmed Information Guide

Dialysis

2027 not in our records yet. 2026: Through National Renal Care, Life Healthcare and Mediclinic.

Profmed Information Guide (2026)

Day to day

Maternity

Maternity Programme, paid from the scheme’s risk benefits, not savings.

Profmed Maternity Benefits Brochure

Maternity

Maternity Programme, paid from the scheme’s risk benefits, not savings.

Profmed Schedule of Benefits 2027, p22

Children on the plan

As dependants up to age 28.

Children on the plan

As dependants up to age 28.

Profmed Benefits at a Glance 2027

GP visits

300% Profmed Tariff

Profmed Schedule of Benefits 2026, p20

GP visits

300% Profmed Tariff

Profmed Benefits at a Glance 2027, p2

Specialist visits

300% Profmed Tariff

Profmed Schedule of Benefits 2026, p20

Specialist visits

300% Profmed Tariff

Profmed Benefits at a Glance 2027, p2

Prescribed medicine (acute)

80% Single Exit Price plus dispensing fee

Profmed Schedule of Benefits 2026, p21

Prescribed medicine (acute)

80% Single Exit Price plus dispensing fee

Profmed Benefits at a Glance 2027, p2

Basic dentistry

135% Profmed Tariff

Profmed Schedule of Benefits 2026, p23

Basic dentistry

135% Profmed Tariff

Profmed Benefits at a Glance 2027, p2

Eyes (optometry)

100% Optical Tariff

Profmed Schedule of Benefits 2026, p22

Eyes (optometry)

100% Optical Tariff

Profmed Benefits at a Glance 2027, p2

Basic X-rays

80% Negotiated Tariff

Profmed Schedule of Benefits 2026, p21

Basic X-rays

80% Negotiated Tariff

Profmed Benefits at a Glance 2027, p2

Blood tests (pathology)

80% Negotiated Tariff

Profmed Schedule of Benefits 2026, p21

Blood tests (pathology)

80% Negotiated Tariff

Profmed Benefits at a Glance 2027, p2

Full benefit list

Every benefit we hold for ProPinnacle (Premium), in Profmed’s own wording, from its 2026 documents. Profmed’s full 2027 list is not in our records yet.

In hospital

Hospital stay and theatre

100% Negotiated Tariff in general ward

Profmed Schedule of Benefits 2026, p10

Day procedures

Not covered. using any hospital of your choice for hospitalisation and treatment

Profmed Schedule of Benefits 2026, p4

Surgery and anaesthetics

300% Profmed Tariff

Profmed Schedule of Benefits 2026, p10

Medicine on discharge

Paid from acute medicine benefit, subject to the availability of funds

Profmed Schedule of Benefits 2026, p10

MRI, CT and PET scans

100% Negotiated Tariff in-hospital

Profmed Schedule of Benefits 2026, p10

Cancer treatment

R773 000 per beneficiary

Profmed Schedule of Benefits 2026, p11

Specialised (biological) medicine in hospital

80% Single Exit Price plus dispensing fee Subject to benefit limit

Profmed Schedule of Benefits 2026, p11

Organ and stem cell transplants

100% Negotiated Tariff

Profmed Schedule of Benefits 2026, p11

Dialysis

100% Negotiated Tariff

Profmed Schedule of Benefits 2026, p11

Step-down and sub-acute care

R19 700 per beneficiary

Profmed Schedule of Benefits 2026, p12

Mental health admissions

R45 600 per family

Profmed Schedule of Benefits 2026, p12

Internal prostheses

100% Negotiated Tariff R59 300 per family

Profmed Schedule of Benefits 2026, p13

Birth (in hospital)

100% Negotiated Tariff in general ward

Profmed Schedule of Benefits 2026, p26

Travel cover

R8 million per beneficiary per journey

Profmed Schedule of Benefits 2026, p27

Planned PMB procedures

100% Negotiated Tariff

Profmed Schedule of Benefits 2026, p13

HIV/AIDS

HIV/AIDS

Profmed Schedule of Benefits 2026, p19

Fertility treatment

Not covered. Benefits for healthcare services related to infertility in respect of ART, IVF, GIFT, ZIFT and ICSI

Profmed Scheme Rules 2026, p55

Planned PMB procedures

R5 600 per beneficiary per eye

Profmed Schedule of Benefits 2026, p13

Day to day

GP visits

300% Profmed Tariff

Profmed Schedule of Benefits 2026, p20

Specialist visits

300% Profmed Tariff

Profmed Schedule of Benefits 2026, p20

Psychologist and counselling visits

300% Profmed Tariff

Profmed Schedule of Benefits 2026, p21

Basic X-rays

80% Negotiated Tariff

Profmed Schedule of Benefits 2026, p21

Blood tests (pathology)

80% Negotiated Tariff

Profmed Schedule of Benefits 2026, p21

MRI, CT and PET scans

80% Negotiated Tariff out-of-hospital

Profmed Schedule of Benefits 2026, p21

Casualty visits

100% Negotiated Tariff

Profmed Schedule of Benefits 2026, p21

Prescribed medicine (acute)

80% Single Exit Price plus dispensing fee

Profmed Schedule of Benefits 2026, p21

Over-the-counter medicine

80% of cost

Profmed Schedule of Benefits 2026, p21

Medical appliances

100% Negotiated Tariff

Profmed Schedule of Benefits 2026, p22

Medical appliances

100% Negotiated Tariff

Profmed Schedule of Benefits 2026, p22

Hearing aids

Additional for Hearing aids only: R7 800

Profmed Schedule of Benefits 2026, p22

Physiotherapy and other therapists

100% Profmed Tariff

Profmed Schedule of Benefits 2026, p22

Auxiliary services

100% Profmed Tariff

Profmed Schedule of Benefits 2026, p22

Alternative healthcare

80% of cost

Profmed Schedule of Benefits 2026, p22

Eyes (optometry)

100% Optical Tariff

Profmed Schedule of Benefits 2026, p22

Basic dentistry

135% Profmed Tariff

Profmed Schedule of Benefits 2026, p23

Specialised dentistry

135% Profmed Tariff

Profmed Schedule of Benefits 2026, p23

Contraceptives

Maximum R2 100 per beneficiary

Profmed Schedule of Benefits 2026, p16

Maternity care (out of hospital)

100% Profmed Tariff

Profmed Schedule of Benefits 2026, p25

Chronic medicine (Chronic Disease List)

58 conditions covered and relevant DTPs

Profmed Schedule of Benefits 2026, p20

Chronic medicine (other conditions)

58 conditions covered and relevant DTPs

Profmed Schedule of Benefits 2026, p19

Care after a hospital stay

100% Profmed Tariff

Profmed Schedule of Benefits 2026, p13

Procedures in the doctor’s rooms

300% Profmed Tariff

Profmed Schedule of Benefits 2026, p10

Screening and prevention

Screening and prevention

100% Negotiated Tariff

Profmed Schedule of Benefits 2026, p15

Conditions

The Chronic Disease List conditions are Prescribed Minimum Benefits on every medical aid. How each one works on a medical aid:

Profmed also names these on ProPinnacle (Premium)’s 2026 chronic list:

Others on its list have no page of ours yet.

Questions about ProPinnacle (Premium)

Answered from Profmed’s documents.

How does Profmed describe ProPinnacle (Premium)?

In Profmed’s own words (Profmed Benefits at a Glance 2027, p2): “Comprehensive hospital and day-to-day cover for complete peace of mind”

How much does ProPinnacle (Premium) cost in 2027?

From 1 January 2027: R16 080 a month for the main member, R14 920 for an adult dependant and R4 825 for a child. You pay for up to 3 children.

How much is ProPinnacle (Premium) going up for 2027?

For the main member, from R14 634 to R16 080 a month, +9.9%.

What is the difference between ProPinnacle (Premium) and ProPinnacle (Savvy)?

ProPinnacle (Savvy) uses Profmed’s hospital network; ProPinnacle (Premium) lets you use any hospital. In 2027 the main member pays R16 080 on ProPinnacle (Premium) and R14 875 on ProPinnacle (Savvy).

Does ProPinnacle (Premium) pay for GP visits and day-to-day costs?

It has day-to-day benefits; the fact sheet above lists what we hold.

How many chronic conditions does ProPinnacle (Premium) cover?

61: the 27 on the Chronic Disease List and others the scheme adds.

Until what age can children stay on as dependants?

Up to age 28.

Will I have a shortfall if my specialist charges more?

ProPinnacle (Premium) pays specialists in hospital at 300% of the Scheme tariff. If a specialist charges more than that, the difference is a shortfall. Gap cover is the product that pays shortfalls.

Compare my picks →On this plan? Get help with it →ProPinnacle (Savvy) →All Profmed plans →Profmed 2027 price changes →Gap cover →

Factual information from Profmed Medical Scheme’s published documents. It is not advice. Compiled by Eldon de Waal, CFA, the licensed advisor behind AURA. Catalogue v175, built 2026-10-19.