What should I do if I am diagnosed with cancer?

Phone Medihelp on 086 0100 678 and a consultant will assist you in registering 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 for 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?

For cancer which does not qualify for PMB, Medihelp offers a benefit amount per option (the Necesse option covers only PMB cancer treatment) while non-PMB bone marrow/stem cell transplants are only covered on the Plus option.

How do I get my oncology medicine?

Oncology medicine benefits are subject to the Medihelp Oncology Reference Price (MORP). Your medicine must be arranged as part of your treatment programme and must comply with the rules of your specific benefit option. Once your medicine has been authorised, you can arrange for delivery to your preferred address.

Prime network options

Medihelp’s designated service providers for oncology medicine for members on the Prime network options are Dis-Chem Oncology and Medipost.