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Oncology Buddies is an educational platform for cancer care intended for cancer patients and their loved ones. The main areas of focus are awareness, education and support.
Cancer treatment is expensive, and it will be very important to understand what benefits you have available if you are part of a medical aid scheme.
Here are a few terms that you need to understand before talking to your medical aid:
Prescribed Minimum Benefits (PMB)
In terms of the Medical Schemes Act of 1998 (Act No. 131 of 1998) and its Regulations, all medical schemes have to cover the costs related to the diagnosis, treatment and care of a set of conditions and emergencies. These costs include the cost of medicine as well as certain tests and consultations and other care each year. 13
A PMB-condition
PMB conditions, which is required to be covered by your medical aid’s PMB funds, includes any emergency medical condition, a defined list of 271 other diagnoses and a defined list of 27 chronic conditions. Prostate cancer which is regarded treatable, are listed as a PMB condition. You will still have to register the condition with your medical aid in order for them approve the prescribed treatment and to set aside the funds to cover all aspects of your treatment. 13
Treatment motivation
If your medical aid does not cover a condition or a specific medication from their chronic benefits, they may ask for additional personal information regarding your medical history, your current medical condition and the impact it has on your life. 13
Your doctor can provide this information to the scheme either directly, or with the help of a third party organisation that aims at improving care for people suffering from specific conditions. You will be required to provide consent to share your personal information with any other persons first in order for these organisations to assist you and your doctor to apply for reimbursement of your treatment.
Speak to your doctor or pharmacist about getting the most out of your medical aid scheme benefits, they may direct you to specialist support groups or programmes that can assist in getting the right information to your scheme.