Understanding Cancer Prescribed Benefits
In South Africa, all medical schemes must by law cover the cost of Prescribed Minimum Benefits (PMBs) without requiring co-payments or savings from members, even if treatment is received out of hospital. Most cancers are covered under PMBs.
PMBs are health conditions that medical schemes, like LA Health, are legally required to include as standard cover for members. PMB-listed cover consists of a list of chronic diseases, an additional list of 270 medical conditions as well as medical emergencies that fall under PMBs.
Cancer and PMBs - we've got you covered!
Regardless of the option you are on, LA Health Medical Scheme will cover cancer that is classified as a PMB in full. This means that if your cancer condition meets the criteria mentioned below, we will pay for costs related to your diagnosis and treatment.
- The first step is to check that your condition is part of the listed PMBs. This list can be found here.
- Your treatment must be defined as PMB level of care.
- You must use a doctor, specialist or other healthcare provider who we have a payment arrangement with. If, however, you're in a position where you're forced to use the services of a non-designated service provider, such as in the case of an emergency, we will pay your costs in full.
Cancers included on the PMB list
- Cancer of eye and orbit
- Cancer of oral cavity, pharynx, nose, ear, and larynx
- Cancer of lung, bronchus, pleura, trachea, mediastinum and other respiratory organs
- Cancer of retroperitoneum, peritoneum, omentum and mesentery
- Cancer of the gastro-intestinal tract including oesophagus, stomach, bowel, rectum and anus
- Cancer of liver, biliary system and pancreas
- Cancer of bones
- Cancer of breast
- Cancer of skin, excluding malignant melanoma
- Cancer of endocrine system, excluding thyroid
- Cancer of soft tissue, including sarcomas and malignancies of the adnexa
- Cancer of thyroid
- Cancer of penis and other male genital organs
- Cancer of prostate gland
- Cancer of testis
- Cancer of urinary system including kidney and bladder
- Cancer of cervix
- Cancer of ovary
- Cancer of uterus
- Cancer of vagina, vulva and other female genital organs NOS (not otherwise specified)
We're with you every step of the way
For more information on the LA Health Oncology Programme, read here.