What do I do if I am diagnosed with cancer?
Contact Medihelp at 086 0100 678 and a consultant will assist you to register on the Medihelp Oncology Management Programme, since all oncology treatment must be pre-authorised.
Once registered on the programme, you will be referred to an oncologist in the Independent Clinical Oncology Network (ICON), who will provide you with the appropriate treatment plan.
Will I have benefits for oncology?
All Medihelp’s benefit options offer benefits for oncology that qualifies as prescribed minimum benefits (PMB). To qualify for PMB, the cancer must:
- only be present in the organ in which it originated
- show no evidence of distant metastatic spread to other organs, and
- show no permanent/irreparable damage to the organ it originated in or any other organ.
If none of the above applies, there must be a well-demonstrated and documented five-year survival rate for the condition of more than 10% after treatment.
What happens if my cancer does not qualify for PMB?
Medihelp’s medical aid plans cover non-PMB cancer, and benefits differ according to your plan. Non-PMB bone marrow/stem cell transplants do not qualify for benefits.
How do I get approval for oncology?
All oncology benefits are based on ICON’s treatment protocols, depending on your benefit option. Your ICON oncologist will complete a form and submit it to Medihelp with a proposed oncology plan. When the plan is approved, your oncology plan is registered and you will receive a letter from Medihelp with details about the approved benefits.
How do I get my oncology medicine?
Medihelp’s designated service providers for oncology medicine is Dis-Chem Oncology or Medipost. Your medicine must be arranged as part of your treatment programme and adhere to the rules of your specific benefit option. Once your medicine has been authorised, you can arrange for delivery to your preferred address.
Oncology medicine benefits are subject to the Medihelp Oncology Reference Price (MORP).