If you are admitted to hospital or receive care for approved oncology treatment, your medical scheme may only refund you a portion of what your specialists and surgeons charge for their services. When this happens, we will provide additional cover to pay for these shortfalls.
We cover 3 different categories of shortfalls for oncology. Across all categories, we include cover for modern biological drugs approved by your medical scheme:
- The 20% co-payment applied on all oncology costs
- The 25% co-payment applied on Innovative Cancer Medicines
- Co-payments applied to medicines approved as an ex-gratia benefit by your
(Note: we do not cover oncology shortfalls where a member exceeds a benefit limit applied by their medical scheme or where certain cancer types are excluded by the medical scheme).
If your medical scheme has fixed-value upfront payments on MRI/CT/PET scans,in-hospital endoscopes, in-hospital basic dentistry or defined approved surgical procedures, we will cover these in full.
We also provide you with cover for co-payments applied as a percentage of medical costs and where you voluntarily make use of a non-network provider.
(eg, joint replacements, spinal fusions, pacemakers, etc), we will provide additional cover per procedure. Additional cover is also provided for sub-limits on MRI/CT/PET scans, endoscopes and lens implants.
We cover tariff shortfalls on consultations with a gynaecologist or GP during the 2nd and 3rd trimesters.