16 August 2021
Individuals diagnosed with cancer often describe the absolute shock on receiving the news. The natural sense of anxiety which follows can however, decrease knowing your medical aid will cover the best course of cancer treatment required.
All Medical Aids Provide a Cancer Treatment Benefit
All medical aids must cover the treatment costs of certain cancers which are Prescribed Minimum Benefits (PMB). Some also offer cover for NON-PMB cancers. This cover is normally provided as a fixed Rand value. The more comprehensive your medical aid option, the higher the Rand value provided. If your cancer is a PMB, your scheme must continue paying for cancer treatment regardless of whether the oncology benefit has been exhausted or not. Although all medical aids must cover these treatment costs, they may impose restrictions requiring the member to make use of specific Designated Service Providers when receiving treatment. Most medical aids require members to make use of ICON (Independent Cancer Organisation Network) providers, irrespective of whether you have a PMB or NON-PMB cancer.
When is Cancer a PMB?
There are two types of cancer. Cancer of the solid organs (such as the liver); and cancer that affects non-solid organs and systems. Cancer of solid organs qualifies as PMB if it is “treatable”. If treatment is not possible, even if it has not spread beyond the organ, it is not a PMB. A medical aid does not have to pay for its treatment as a PMB. There are also various cancers of non-solid organs and systems that qualify as PMB conditions, whether they are treatable or not. Such as: acute leukaemia, lymphomas, multiple myeloma and chronic leukaemia.
Treatment of PMB Cancers: What Your Medical Aid Covers
Medical aids must cover the cost of diagnosis as well as treatment regardless of the option you are on. Depending on the type of cancer and limitation in the PMB treatment guidelines, these services could possibly include consultations, surgery, specialised radiology, pathology, chemotherapy and radiation therapy.
Treatment of Non-PMB Cancers: What Your Medical Aid Covers
Most medical aids have an oncology sub-limit benefit for NON-PMB cancers. This means that the medical aid will cover the treatment costs of NON-PMB cancers up to a stipulated amount. Treatment costs are thereafter, partially paid for, depending on the medical aid option.
Check out our Extended Cancer Cover policy which is an optional Gap Cover policy benefit. This benefit will pay out either R100 000 or R200 000 on first time diagnosis of cancer.
If you are interested in a detailed explanation of the cancer treatment provided by your Medical Aid option, please contact HealthMax Medical Aid Advisory Division.
The information contained in this communication, including attachments, is not to be construed as advice in terms of the Financial Advisory and Intermediary Services Act of 2002 (“FAIS”) as the writer is neither an appointed representative of Zestlife, nor a licensed financial services provider as contemplated in FAIS. Please consult your Financial Adviser or Zestlife should you require advice of a financial nature and/or intermediary services.