We have set up a special cancer care programme, called the Oncology Programme, to help our members who are diagnosed with cancer.
We work with the patient and the doctor to make sure that the treatment is affordable and works as it should. We pay for approved cancer treatment from the Oncology benefit and some claims from the Insured Out-of-Hospital Benefit.
If you are diagnosed with cancer, you have to register for the Oncology Programme to get these benefits.
Oncology treatment that is part of the Prescribed Minimum Benefits is always covered in full, with no co-payment if a health professional is used who has a payment arrangement with the Scheme.
Members are covered for the Oncology Programme according to their benefit option's benefits:
- For members registered on the Comprehensive and Classic Options, we cover approved cancer treatment from the date of diagnosis over a 12 month rolling period up to a limit.
- On the Standard Option, members will only have access to Oncology PMB level of care, paid at 100% of the Remedi Rate for health professionals who do not have a payment arrangement with the Scheme. You might have a co-payment if your healthcare professional charges more than this rate. Health professionals who have a payment arrangement with the Scheme will be funded at the agreed rate. Benefits are made available over a 12 month rolling period from the date of diagnosis.
We also cover the radiology and pathology that are approved for the member's cancer treatment.
PET Scans
PET scans are covered up to the limit for oncology benefits for 12 months from the first treatment. You have to get authorisation and use one of our designated service providers; or you may have a co-payment.
Stem-cell transplants
This benefit is covered in full, up to the overall annual limit if you have registered on the Oncology Programme and use our designated service providers. Bone marrow transplant costs including donor search fees and procurement fees do not add up to the 12-month Rand limit for cancer treatment. If you choose to use a provider that is not one of our designated service providers, we will only fund the stem-cell transplant at the Remedi Rate up to the overall annual limit.
We also have dedicated experienced consultants to help you with many aspects of your cancer treatment. They offer support services and access to reliable information on cancer and what steps you can take to fight and manage the disease.