All Medihelp’s benefit options offer comprehensive benefits for oncology that qualifies for Prescribed Minimum Benefits (PMB).
In some cases, the treatment will not qualify for PMB and the oncology will then be funded from the available benefits offered by your benefit option. In these cases, Medihelp will allow you to interchange to the comprehensive Medihelp Plus benefit option within 60 days after first being diagnosed. Read more.
Click here to view Medihelp’s benefits for oncology.
All oncology treatment should be pre-authorised by Medihelp.
Certain types of cancer qualify for PMB. In these cases, unlimited benefits are granted without any co-payments, provided that your oncologist is part of the SAOC or ICON and your treatment plan is aligned with the SAOC’s or ICON's treatment plans and protocols.
Cancer should comply with the following criteria to qualify for PMB:
- The cancer must involve only the organ of origin;
- There must be no evidence of distant metastatic spreading to adjacent organs;
- There must be no irreversible and irreparable damage to the organ of origin or any other organ; or
- If none of the above applies, there must be a well-demonstrated five-year survival rate of greater than 10% after treatment of the relevant condition, according to literature.
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If the cancer does not meet the criteria for PMB, it will not qualify for PMB.
Some of Medihelp’s benefit options offer benefits for oncology to treat cancer that does not qualify for PMB, with the Medihelp Plus benefit option offering the most comprehensive benefits. Click here to view Medihelp’s benefits for oncology.
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Medihelp’s oncology benefits are based on four types of treatment plans or protocols, depending on the benefit option on which you are registered:
The OncoPlus protocol offers the most comprehensive benefits, while the benefits of the OncoPrime and ICON protocols are based on basic oncology treatment. If your benefit option does not provide adequate coverage for cancer treatment, you can apply to upgrade to the Medihelp Plus benefit option within 60 days after the first diagnosis.
Your oncology treatment must follow the protocols applicable to your benefit option, and you must receive treatment from an oncologist within the SAOC or ICON. If not, you will be required to make a co-payment on the total oncology account.
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If you or one of your dependants are diagnosed with cancer for the first time and your benefit option does not provide adequately for the cancer treatment, you can apply within two months (60 days) after the first diagnosis to upgrade to the Medihelp Plus benefit option. This is the only benefit option that offers unlimited benefits for oncology treatment in the SAOC network according to the OncoPlus treatment plans. However, co-payments will be applicable if treatment deviates from this framework. When you upgrade to Medihelp Plus, the following guidelines are important:
- The application to upgrade must reach Medihelp within 60 days after the first diagnosis;
- Upgrading is only allowed to the Medihelp Plus benefit option;
- The member as well as all his/her dependants must upgrade to Medihelp Plus;
- Upgrading will take place in consultation with Medihelp’s medical adviser, who will decide if the cancer meets the criteria according to Medihelp’s Rules;
- All existing waiting periods and late-joiner penalties will still apply; and
- Upgrading will be effective from the month following the month in which Medihelp approved your application for upgrading.
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