PMBS IN­CLUDE ONLY ‘TREAT­ABLE’ CAN­CERS

Weekend Argus (Saturday Edition) - - GOODPOSTER -

The pre­scribed min­i­mum ben­e­fits (PMBs) cover only what are de­fined as “treat­able” can­cers.

The PMBs are ben­e­fits that your med­i­cal scheme must by law pro­vide, and the treat­ment must be paid for in full. How­ever, med­i­cal schemes are en­ti­tled to list providers you must use in or­der to en­joy full cover for the PMBs and to lay down pro­to­cols for the treat­ment of a PMB con­di­tion as long as the treat­ment is not of a lower qual­ity than that which than that at which your scheme will re­im­burse them. If you re­quire ra­di­a­tion af­ter the surgery, you should be cov­ered by an op­tion with high-level ben­e­fits, be­cause this is usu­ally viewed as an in-hos­pi­tal treat­ment. But if the is avail­able from a state fa­cil­ity.

The PMB reg­u­la­tions dis­tin­guish be­tween can­cers that af­fect non-solid or­gans and sys­tems, and can­cers of the solid or­gans.

In terms of the reg­u­la­tions, many can­cers of the non-solid or­gans and sys­tems, such as leukaemia, are PMBs whether or not they are re­garded as treat­able. A can­cer that af­fects a solid or­gan is a PMB only if it is “treat­able”.

A can­cer is re­garded as treat­ment has to be funded from your day-to-day ben­e­fits, you may face a se­ri­ous short­fall.

Eedes says the five weeks of ra­di­a­tion that may be re­quired af­ter breast surgery or a lumpec­tomy for “treat­able” when: it af­fects only the or­gan of ori­gin; there is no ev­i­dence that it has spread to other or­gans (metastatic spread); and it has not caused in­cur­able dam­age to the or­gan in which it orig­i­nated or to any other life-sup­port­ing or­gan.

If all th­ese pro­vi­sions are not met, a can­cer is re­garded as “treat­able” when there is sci­en­tific ev­i­dence that more than 10 per­cent of peo­ple with a sim­i­lar can­cer sur­vive on treat­ment for at least five years. stage zero breast can­cer could cost be­tween R60 000 and R70 000. Af­ter such treat­ment, you will need reg­u­lar and pos­si­bly ex­pen­sive screen­ing, but you may be able to up­grade your op­tion be­fore you need the screen­ing.

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