Your guide to Prescribed Minimum Benefits and oncology benefits
In South Africa, all medical schemes are required to cover Prescribed Minimum Benefits (PMBs) without requiring co-payments or savings from members, even if treatment is out-of-hospital. Most cancers are covered under PMBs.
PMBs are health conditions that medical schemes, like Discovery Health Medical Scheme, are legally required to include as standard cover for members. PMB-listed conditions typically consists of three parts: a list of chronic diseases, a further list of 270 medical conditions, and medical emergencies that fall under PMBs.
Cancer and PMBs – we've got you covered
Regardless of the plan you are on, Discovery Health Medical Scheme will cover cancer that is classified as a PMB in full. This means that if your cancer condition meets the criteria mentioned below, we will pay for costs related to your diagnosis and treatment.
- The first step is to check that your condition is part of the listed PMBs. This list can be found here.
- Your treatment must be defined as PMB level of care.
- You must use a doctor, specialist or other healthcare provider who we have a payment arrangement with. If, however, you involuntarily need the services of a non-designated service provider, such as in the case of an emergency, we will pay your costs in full.
Cancers included on the PMB list
- Cancer of eye and orbit
- Cancer of oral cavity, pharynx, nose, ear, and larynx
- Cancer of lung, bronchus, pleura, trachea, mediastinum and other respiratory organs
- Cancer of retroperitoneum, peritoneum, omentum and mesentery
- Cancer of the gastro-intestinal tract including oesophagus, stomach, bowel, rectum, anus
- Cancer of liver, biliary system and pancreas
- Cancer of bones
- Cancer of breast
- Cancer of skin, excluding malignant melanoma
- Cancer of endocrine system, excluding thyroid
- Cancer of soft tissue, including sarcomas and malignancies of the adnexa
- Cancer of thyroid
- Cancer of penis and other male genital organs
- Cancer of prostate gland
- Cancer of testis
- Cancer of urinary system including kidney and bladder
- Cancer of cervix
- Cancer of ovary
- Cancer of uterus
- Cancer of vagina, vulva and other female genital organs nos
We’re with you every step of the way
For more information, visit www.discovery.co.za or read more on the DHMS Oncology Programme here.
All medical information found on this website including content, graphics and images, is for educational and informational objectives only. Discovery Health publishes this content to help to empower cancer patients and their families by promoting a better understanding of a cancer diagnosis. The views expressed by all of the contributing healthcare providers are their independent, professional medical opinions, aimed at supporting patients. These views do not necessarily constitute the views of Discovery Health.
The Discovery Health Medical Scheme is an independent non-profit entity governed by the Medical Schemes Act, and regulated by the Council for Medical Schemes. It is administered by a separate company, Discovery Health (Pty) Ltd, an authorised financial services provider.
Related articles
Discovery Health Medical Scheme’s Oncology Programme
From the cost of doctors, to surgery, chemotherapy and radiation, everyone affected by cancer understands how significant the financial impact of cancer treatment can be. This article answers the most pertinent questions about how Discovery Health Medical Scheme provides holistic support to its members diagnosed with cancer.
A serious illness can be life-changing. That’s why we are here for you, every step of the way.
A cancer diagnosis is a life-changing event that impacts many aspects of a person’s life. Learn more about how Discovery offers support and provides cover for treatment and unexpected expenses.
Are you adequately covered for a cancer diagnosis?
A cancer diagnosis has both physical, emotional, and also financial implications. How can you be sure that you are adequately covered ahead of a cancer diagnosis? The answer lies in a combination of medical scheme cover and life insurance.