Are you covered by your medical aid for cancer treatments?
Is it just us, or does if feel like cancer is becoming more and more prevalent these days? Almost everyone you speak to either has cancer or knows someone who has it. No matter your age or health, no one can hide from this terrible disease.
For those of you who have been directly, or indirectly, affected by the illness you will also know how high the costs of treatment are, ranging from doctors, to surgery, to chemo and radiation, which is why you need to check whether or not your medical aid covers you for cancer treatments.
We have put together a list of important questions you may want answered.
Is there such a thing as medical cover for cancer?
According to research, most South African medical aids offer an oncology benefit on more comprehensive schemes with the benefit limit ranging from approximately R100 000 to R400 000. It is important to find out from your medical aid if your scheme includes this oncology benefit or if you will need to take out extra cover.
What happens if I exceed the benefit limit?
If the form of cancer you have falls under the oncology benefits Prescribed Minimum Benefit (PMB), then your medical aid is liable to carry on paying for treatments, even if your limit has been reached. If your form of cancer is not on the list and your oncology benefit runs out, then the medical aid usually pays for the treatments but at cost. This means that there will be a co-payment for the treatment. Check with your medical aid to see what your scheme will cover.
What qualifies a form of cancer to be a PMB?
Only cancer of solid organs (such as kidneys, lungs etc.) and those forms that can be treated qualify as a Prescribed Minimum Benefit. If your form of cancer cannot be treated, the medical aid will not pay for its treatments as according to the PMB rules, however normal oncology benefits still apply.
What do you mean my cancer is “treatable”?
Medical aid schemes see cancer as “treatable” if it has not:
- Spread to other organs (distant or adjacent)
- Done permanent damage to the organ in which it originated
But my form of cancer is not in a solid organ? What now?
Certain forms of cancer that are not in solid organs such as leukemia, lymphoma and myeoloma, sometimes qualify as PMBs, however, you need to check with your medical aid.
My cancer qualifies as a PMB; what will medical aid pay for?
- Doctor consultations
- Specialised radiology
Your medical aid scheme may expect you to only use certain health care providers so make sure you check with them first.
Is pre-authorisation necessary for treatments?
Before you go for any cancer related treatments it is important to get pre-authorisation first. You should also enquire as to how much your scheme will pay.
Are there any hospice benefits included in my cover?
If you become terminally ill and need the assistance of hospice, most medical schemes and hospital plans will cover you for a certain amount or for a certain number of days. Once again, make sure that you understand all the fine print of your scheme.