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.

1. Is my cancer treatment covered by the Prescribed Minimum Benefits (PMBs)?

Yes. If the type of cancer you have is listed on the standard PMB list of conditions and you use health care providers in our network, we will cover your cancer treatment in full, regardless of the plan you are on. Read more about PMBs and how they work.

Does Discovery cover my cancer treatment if it’s not a PMB-listed condition?

Yes. If you are diagnosed with a treatable cancer, and once we have approved your treatment plan, you are covered by our Oncology Programme. This programme provides cover of up to R400 000 for all your cancer-related costs (for Executive and Comprehensive plans) and of up to R200 000 (for Priority, Saver, Smart and Core plans) over a 12-month period. Read more about our Oncology Programme.

2. What will happen if my costs exceed the rand amount I’m covered for?

If your treatment costs amount to more than your cover amount before the 12-month cover period is up, we will cover your expenses at up to 80% of the Discovery Health Rate. If you use a doctor, specialist or hospital that we have a payment arrangement with, you won’t pay more than 20% of the costs. If you choose doctors or specialists outside of our network, we will still cover up to 80% of the costs at the Discovery Health Rate. For KeyCare plan members, we cover cancer treatment classified as a PMB in our network or in a state facility.

3. Am I covered for surgery too?

Yes. We cover your pre-authorised hospital admissions from your Hospital Benefit and not the rand-capped Oncology Programme. Below is a breakdown of the costs we cover based on the plan you are on.

Cancer-treating specialists (out of hospital)

All health plans except KeyCare

Any cancer specialist who is part of our Premier Rate payment arrangement. For specialists on other payment arrangements you may have a co-payment.

KeyCare Plans

Any cancer specialist who is part of KeyCare ICON network.

Cancer-treating GPs

All health plans except KeyCare

Any GP who is on the Discovery Health GP Network and is a member of the South African Oncology Consortium (SAOC).

KeyCare Plans

Primary or Secondary chosen GP who is part of the KeyCare Network.

In-hospital admissions

All health plans except KeyCare

Any hospital at the agreed rates. Where your health plan restricts you to a specific list of hospitals like the Delta network, Smart network and Coastal options, you must use those facilities for full cover. If you do not have cover on your plan (and once your plan benefits have run out), then you should use any KeyCare network hospital or a state hospital that is contracted with us.

KeyCare Plans excluding KeyCare Access

Any KeyCare network hospital or a state hospital that is contracted with us. Members on a KeyCare Access plan only have access to a state facility.

In-hospital specialist consultations

Executive Plan and Classic Series

All specialists who we have a payment arrangement with us, and any specialist practising in a state hospital that is contracted with us.

KeyCare Plans

Any specialist participating in a KeyCare Specialist Network, any cancer specialist in the KeyCare ICON network, and any specialist practising in a state hospital that is contracted with us.

All other health plans

All specialists who are part of our Premier Rate payment arrangement, and any specialist practising in a state hospital that is contracted with us.

Medication for your cancer care

All health plans except KeyCare

Certain approved specialised treatment must be obtained from our designated pharmacy service provider.

KeyCare Plans

All approved cancer-related treatment must be obtained from the designated pharmacy service provider.


4. Are there any Hospice benefits included in my cover?

  • Yes. If you are diagnosed with an advanced form of cancer or are not responding to treatment, we provide you with access to a multi-disciplinary palliative care team that includes doctors, nurses, social workers, home-based nursing and care worker services, as well as cover for Hospice services.
 
 

Let us focus on the cost, while you focus on your health

We understand that the ever-increasing costs of treating cancer can be a significant financial burden. That is why we are committed to providing comprehensive cover that allows you to focus your energy on your health - instead of on medical bills.

Visit www.discovery.co.za to get a quote on our comprehensive benefit options today.

 
 
 
 
 
 

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