Are you Comprehensively Covered for Cancer? 4 Questions to Ask

Are you Comprehensively Covered for Cancer? 4 Questions to Ask
Are you Comprehensively Covered for Cancer? 4 Questions to Ask

Cancer can happen to anyone and having the right medical cover in place should it happen to you is essential. But there’s a tendency to think that even if we have the most basic of medical aid cover, then we’re fully protected should we get cancer – unfortunately that’s not always true.

While all medical aids are obliged to cover the treatment costs of certain cancers that are listed as Prescribed Minimum Benefits (PMB), the Rand amount they will cover per year differs depending on how comprehensive your medical aid is. Not all cancers have the same treatment protocols and prognosis either, so it’s worth asking some important questions when you examine your medical cover to see how financially covered you are, should you be diagnosed with cancer:

  • When is cancer a PMB?

There are two types of cancer: one type affects the solid organs (like the liver), and the other affects non-solid organs and systems, such as your blood or lymphatic system. Cancer of solid organs qualifies as a PMB if it is deemed to be treatable. If it can’t be treated, even if it has not spread beyond the organ in which it originated, it is not seen as a PMB, and a medical aid does not have to pay for its treatment. However, there are also various cancers of non-solid organs and systems that qualify as PMB conditions whether they’re treatable or not, such as acute leukaemia, multiple myeloma, lymphomas and chronic leukaemia.

  • What must my medical aid cover for cancer as a PMB?

Your medical aid is obliged to cover the cost of a cancer diagnosis, as well as treatment and care at a PMB level. This could include things like consultations, radiology, surgery, pathology, chemotherapy and radiation therapy. Certain options make a specific benefit available for treatment in excess of the PMB level of care, so check these details of your oncology benefit on your medical aid plan, and weigh up whether you think it’s likely to be sufficient or not for you and your family.

  • Do I have a history of any types of cancers in my family?

Certain types of cancer can be hereditary, such as cancer of the prostate, breast, colon and ovaries. If your parents or other immediate family members like siblings have had these kinds of cancer, you may be more at risk of contracting them, so it may be worth checking your medical aid to see whether these specific cancers are covered for you, and up to what limit. Some medical aid schemes, like Fedhealth, offer preventative care benefits including important health screenings like mammograms, which can help detect breast cancer early so that it can be treated.

  • Do I need to use specific service providers if I get cancer?

In order to cap the potential expenditure on cancer treatments, medical aid schemes can insist that you choose from a pre-determined list of health providers in terms of where you’ll get your treatment. This means that you may have an oncologist in mind who you really want to use, but they may not be on the approved list by your medical aid, so you won’t be covered. For this scenario, you’ll need to weigh up the financial costs you’ll incur if you want to go with a specific provider, instead of choosing one that’s within your scheme’s network (and that they will pay for).

Being diagnosed with cancer is a scary thought, and even scarier if you’re not covered properly for treatment. If you think you’re at risk of developing a certain type of cancer – perhaps it runs in the family, or you have other health complications that may put you in a vulnerable category – it’s worth checking to see what kind of coverage your particular medical aid plan offers in this area, plus whether they offer the relevant screening tests. If necessary, you can change plans or even providers to have the financial support (and peace of mind) in place for any potential cancer treatment before you actually need it.