Being diagnosed with cancer is shocking to say the least but the thought of the financial implication can add to the stress. Without medical aid, you will have to opt for cancer care in a government facility unless you have the cash to pay for treatment out of your own pocket. Oncologist feess, cancer surgery to remove the tumour, chemotherapy and radiotherapy (radiation treatments) are expensive if you are looking towards the private health sector in South Africa. Medical aid is the only way to afford the care that you need and want with such a life-threatening condition.
A medical aid hospital plan will pay for the cancer surgery including the hospital stay, theatre time and doctor’s fees. However, you need to establish at the outset whether your oncologist charges NHRPL (National Health Reference Price List) rates which medical aids cover in full or private rates. Some medical aids do cover private rates of 200% to 300% of NHRPL when you are hospitalised but many do not not. This means you will have to pay the difference out of your own pocket unless you have medical aid gap cover. Remember that medical care for cancer does not end after the tumour has been surgically removed and you will still need to see an oncologist and go for regular investigations for a period thereafter.
Some cancers cannot be completely cured with surgery alone. Anti-cancer drugs that destroy cancer cells may be necessary even after surgery has removed the growth. These drugs are known as chemotherapy. Medical aids cover chemotherapy but it is important to get the full details from the scheme. If you are on a hospital plan only then you medical aid will pay for outpatient chemotherapy to a certain point although it may not be as extensive as comprehensive medical cover. New experimental drugs may not be covered either in full or in part without a motivation from the oncologist.
The use of high energy beams (radiation) to destroy a malignant tumour (cancer) is known as radiotherapy. Medical aids cover radiation treatments but certain limits may be applicable which is usually included with the annual oncology benefit. Some medical aid plans may have preferred providers and facilities if you want complete cover and this applies to most diseases, not only cancer. It is important to discuss these implications with your medical aid to ensure that you can benefit from full cover for your cancer treatment.
Tests and Scans
Diagnostic investigation is ongoing in cancer. You need to undergo various investigations prior to diagnosis, assessment before treatment and regular monitoring thereafter. Most of these diagnostic investigations can be very expensive and may need to be done repeatedly for various reasons. These tests and scans for cancer are covered within your annual oncology benefit on most medical aid plans. However, you doctor may need to do other investigations to assess the complications associated with cancer treatments and this may not be covered by your oncology benefit in every case.
The information in this article is a general guideline to medical aid cover for cancer and related tests and treatments. Your medical aid may have specific criteria and policies that applies to cancer and needs to be clarified with the scheme.