IN- AND OUT-OF-HOSPITAL ONCOLOGY BENEFITS

ONCOLOGY

In- and -Out-of-Hospital Oncology benefits include cover for shortfalls on oncology treatment. Oncology involves simultaneous treatment for cancer from different doctors who charge above Medical Scheme rates, creating large tariff shortfalls. This can be for oncologists, biological medicines, chemotherapy, radiotherapy, radiology, specialised scans and pathology.

    Oncology Tariff Shortfalls
  • Up to a maximum compensation limit of five times the Medical Scheme tariff fee.
    Oncology Co-payments
  • Subject to a maximum co-payment of 20%, up to a maximum compensation limit of R204 500 per member, per annum.
    Oncology Sub-limits
  • Covers the charges relating to services supplied that have exceeded the oncology sub-limits.

MAXIMUM COMPENSATION FOR ALL GAP COVER BENEFITS*

The total maximum Compensation Limit payable for all Core Benefits and Benefit Extender will be limited to R204 500 (two hundred and four thousand and five hundred rand) per family member, per annum.

  • Includes cover for principal member and six dependants.

* Cover benefits, limits and maximum compensation limit applicable from 1 January 2024.

Terms & Conditions apply.


IMPORTANT TO NOTE:

  • During the first 12 months of membership, a pre-existing condition waiting period applies.
  • During the first 3 months of membership, a general waiting period applies.
  • During the first 12 months of membership, a pregnancy waiting period applies.

Please note the 3 months general waiting period, 12 months pre-existing condition waiting period and 12 months pregnancy waiting period apply to an insured person from the time that such person's cover commences under the policy (to run concurrently if two or more waiting periods are applicable to an insured family member).