CANCER AS A PRESCRIBED MINIMUM BENEFIT

Even though cancer is a Prescribed Minimum Benefit (PMB) in South Africa which many expect would be fully covered by Schemes, it is exactly that a "_minimum_ benefit". According to the Council for Medical Schemes, an autonomous statutory body created by Parliament to regulate medical schemes in South Africa, a PMB is "a set of defined benefits to ensure that all medical scheme members have access to certain minimum health services, regardless of the benefit option they have selected." The aim of a PMB is to provide people with continuous care to improve their health and well-being and to make healthcare more affordable.

COVERING THE COSTS OF CANCER

Even though your medical scheme will cover some of the expenses related to cancer as a PMB, there are limits. Ultimately, your chosen medical aid plan will determine the coverage you can receive for cancer. For example, a more comprehensive plan will have higher treatment limits than a more basic plan.

"A cancer diagnosis can be both emotionally and financially draining on families, and having sufficient medical cover will help mitigate some of the stresses as a person recovers," says Craig Comrie, CEO of Profmed Medical Scheme [1].

Nobody joins a scheme thinking that they will have cancer or another dread disease.

Being a member of a medical scheme could offer some much-needed financial relief for the costs of treating cancer. When joining a medical scheme, weigh up the available plan types and coverage limits to make the right choice for your healthcare needs. Think of joining a medical scheme as investing in a rainy day fund for your health.

COVERING EXPENSES OUT OF YOUR POCKET?

Depending on your medical scheme and plan type, you could be expected to cover some expenses for cancer treatment out of your pocket. Cancer treatments are expensive - there are GP visits, specialist visits, treatments and even surgical procedures to cover. "Cancer treatment costs could vary from R10 000 to R450 000 per year depending on when the cancer is diagnosed and which treatments need to be done. Other treatments can be as much as R2mil per year if using latest biological medicines," adds Comrie.

There may be some co-payments or treatments that won't be covered by your medical scheme, which is why it's best to work with your case manager at your medical scheme to estimate which costs will be covered, and which of these you may need to pay for.

COMMON CANCERS IN SOUTH AFRICA

Cancer diagnoses in South Africa are becoming more prevalent. The most common cancers? Breast cancer, prostate cancer, lung cancer, skin cancer and other soft tissue cancers. Some of these cancers are caused by lifestyle decisions or could be influenced by your family's history.
"With the advancement of technology, cancer can be detected earlier, and treatment could cost less. Up to 60-70% of cancers can be cured."

Treatments vary from one cancer to the next, and as such, so do the costs. Soft tissue cancers, for example, are very costly to treat.

PREVENTION AND FAMILY HISTORY

By working with your GP, knowing your family's medical history, your current health status and life circumstances, you can work out which screening tests would be most beneficial for early detection. When treated early, cancer could be more likely to go into remission, and making conscious changes to your lifestyle may assist you in being healthier.

MAKING SURE YOU ARE COVERED

A medical scheme may help cover the bulk of the costs when treating cancer, which is why it may be wise to look into taking out additional cover to help you and your family should you or a member of your family be diagnosed with cancer. Talk to your financial advisor to find the cover that best suits your needs.