If you’re diagnosed with cancer and once we have approved your cancer treatment, you are covered by the Oncology Programme. We do not limit your cancer treatment costs. We cover the first part of your approved cancer treatment over a 12-month cycle in full.
On Executive and Comprehensive plans we cover the first R400 000 and on Priority, Saver, Smart and Core plans we cover the first R200 000. If your treatment costs more than the cover amount, you will need to pay 20% of the additional costs. Cancer treatment that is a Prescribed Minimum Benefit (PMB), is always covered in full if you use service providers who we have an agreement with. For KeyCare plans we cover cancer treatment, if it is a PMB, in our network or a state facility. If you choose to use any other provider, we will only cover 80% of the Discovery Health Rate (DHR). All cancer-related health care services are covered up to 100% of the Discovery Health Rate (DHR). You might have a co-payment if your health care professional charges above this rate.
Prescribed Minimum Benefits (PMB)
Cancer treatment that is a Prescribed Minimum Benefit (PMB), is always covered in full. On the KeyCare plans we cover cancer treatment in our network, or in a state facility if you are on KeyCare Start. If you choose to use any other provider, we will only cover up to 80% of the DHR.
Advanced Illness Benefit
Members with cancer have access to a comprehensive palliative care programme. This programme offers unlimited cover for approved care at home.
Extended Oncology Benefit
On the Executive and Comprehensive plans you also have extended cover in full for a defined list of cancers and treatments that meet the Scheme’s criteria.
Oncology Innovation Benefit
On the Executive and Comprehensive Plans you have cover for a defined list of innovative cancer medicines that meet the Scheme’s criteria. You will need to pay 25% of the cost of these treatments.