PMBS INCLUDE ONLY ‘TREATABLE’ CANCERS

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.