Gap Cover for Profmed

December 18, 2021

You may be one of the many South Africans on a medical aid who has seen their hospital bills not being paid in full. Gap cover for Profmed is to help you pay those hospital bills that you thought your medical aid would pay.

You also might be one of the many South Africans who has seen the absolute necessity of a very important insurance product – gap cover.

Even on a Medical Aid, you’re Responsible for Bills

Nobody on a medical aid can afford to be without gap cover. This is because even some of the best medical aids aren’t going to pay your hospital bills in full. You need to know that you, as the medical aid member, will be paying for the part that your medical aid isn’t going to pay.

Gap Cover for Profmed

Profmed is a restricted medical aid scheme. Professionals who have a minimum of a 4-year degree or equivalent can join this medical aid. Profmed’s medical and healthcare benefits are offered at affordable rates and lower rates are made available to students.

Profmed offers different plans – Pro Pinnacle, Pro Secure Plus, Pro Secure, Pro Active Plus and Pro Active. Some of the Profmed tariffs you’ll come across are –

  • Profmed Dental Tariff 135%
  • Procedures – 120% of tariff for doctors and specialists
  • 200% – 300% of tariff paid to doctors and specialists for consultations and procedures


Fusion Gap Fills the Shortfall with Profmed Plans – Gap Cover for Profmed

You’ll notice when you look at Profmed’s different plans that Kaelo Xelus provides a gap cover product which is referred to as Fusion Gap. You’ll also see that the benefits of this gap cover product are included with the 2018 plans that Profmed shows.

For instance, with their Pro Active Plus Plan, you’ll see the payout rate for specialists is 200% of the scheme tariff. They also say that Fusion Gap pays up to 700% scheme rate for specialists and other providers.

It’s simple really – the cost of private healthcare is beyond most people’s reach. Look at Profmed as an example. Their Pro Active Plan is R1 528 a month in 2018 – a huge chunk out of anyone’s salary. Their Pro Pinnacle Plan is R6 668 per month in 2018. Even with huge premiums like this, you’re not going to get all your bills paid in full. Time spent in the hospital will see you getting massive medical bills.

Specialists are free to charge whatever fee they want, and if this fee is more than what your medical aid pays according to price tariff guidelines, you’ll have to pay the shortfall.

There was a time when medical gap cover was a nice optional extra to have. But in 2018 and beyond it has become a critical bit of insurance. It is there to help you with the soaring private medical expenses we’re seeing in 2018.
We’ve all heard talk that medical schemes are ‘not for profit’. This is music to a medical aid member’s ears, but the truth is you’d be naive to think that they aren’t profit motivated. They are very much so, after all, they have to pay good salaries to everyone who works for them.

If you can’t Beat ‘Em, Join ‘Em – Gap Cover for Profmed

Nothing is going to change anytime soon, and if you belong to a medical aid, you’d be wise to invest in medical gap cover if you don’t want to face being financially crippled by huge hospital bills headed your way.


If you want a Gap Cover Quote, Complete and submit the form on this page.

All info was correct at time of publishing