Cover for cancer
As a Discovery Health Medical Scheme member, you have comprehensive cover for cancer. If you are diagnosed with cancer and once we have approved your cancer treatment, you are covered by the Oncology Care Programme.
Registering for the Oncology Care Programme
If you are diagnosed with cancer, you need to register on the Oncology Care Programme. In order to register, you or your treating doctor must send us a copy of your laboratory results confirming your diagnosis to DCO_Oncology@discovery.co.za.
Your cancer specialist will need to send us your treatment plan for approval before starting treatment. We will only fund your cancer treatment from the Oncology Benefit if we have approved your treatment plan.
How we cover Oncology
We cover your approved cancer treatment over a 12-month cycle. This 12-month cycle is individualised depending on when you are diagnosed with cancer.
Oncology and Prescribed Minimum Benefits (PMB)
Cancer treatment that is a Prescribed Minimum Benefit (PMB), is always covered in full, when you use our designated service providers (DSP).
All Prescribed Minimum Benefit (PMB) treatment costs add up to your cover amount for your plan. If your treatment costs more than the cover amount, we will continue to cover your Prescribed Minimum Benefit (PMB) cancer treatment in full.
Your cover amount depends on the plan you choose. We will cover:
The first R500 000 of your approved cancer treatment on Executive and Classic Comprehensive Plans
The first R375 000 of your approved cancer treatment on the Classic Smart Comprehensive plan
The first R250 000 of your approved cancer treatment on Priority, Saver, Smart and Core plans
Your cancer treatment, if it is a PMB, at a network provider on KeyCare plans (or state facility on KeyCare Start)
All costs related to your approved cancer treatment including Prescribed Minimum Benefit (PMB) treatment during the 12-month period, will add up to the 12-month cycle cover amount. We cover all cancer-related healthcare services up to 100% of the Discovery Health Rate (DHR). We'll pay approved oncology medicine up to a maximum of the Discovery Health Rate (DHR) or Generic Reference Price, whichever is applicable. If your healthcare professional charges more than this rate you will need to pay the difference.
Oncology Innovation Benefit and Extended Oncology Benefit available to members on the Executive and Comprehensive plans
Oncology Innovation Benefit
On the Executive and Comprehensive plans, you have cover for a defined list of cancers and precision medicine, subject to the Scheme's clinical entry criteria. You will need to pay 25% of the costs of these treatments. On the Classic Comprehensive Plan, we will fund up to 50% of the Discovery Health Rate (DHR) for a select list of the innovative medicines and conditions.
Extended Oncology Benefit
On the Executive and Comprehensive plans (not available on the Classic Smart Comprehensive plan), you also have extended cover in full for a defined list of cancers and treatments that meet the Scheme's criteria.
Advanced Illness Benefit
Members in advanced stages of illness have access to a comprehensive palliative care programme. This programme offers unlimited cover for approved care at home