Your cover for cancer treatment

Cancer affects millions of South Africans. Even though many of us know about this condition, it is still a shock when you or a loved one is diagnosed with cancer. It can be emotional and difficult to accept the diagnosis. As a member of LA Health, you have cover for cancer treatment through our Oncology Programme so you can focus on feeling better.

What to do when you’re diagnosed with cancer

Before you (or someone on your membership) start with cancer treatment, you or your doctor have to let us know of the cancer diagnosis. We need details of how your cells behave under the microscope (histology results) that confirm the diagnosis. Please call us on 0860 10 39 33 to register on the Oncology Programme.

How your cover works

Your cover for cancer treatment starts after you register for the Oncology Benefit. If you do not register, we pay for treatment from your available day-to-day benefits.

Please ask your doctor to contact us with your treatment plan so we can let you know how we will pay for treatment before your treatment starts. We pay for approved cancer treatment from the Major Medical Benefit; it will not affect your day-to-day benefits or medical savings.

Prescribed Minimum Benefit treatment

Prescribed Minimum Benefits is a set of conditions for which all medical schemes must provide a basic level of cover. This basic level of cover includes the diagnosis, treatment and costs of the ongoing care of these conditions.

You always have full cover for the treatment the Prescribed Minimum Benefits recommend as long as you use network healthcare professionals and follow the recommended treatment. For cancer, this means that we pay the whole amount for your cancer treatment without using your day-to-day benefits if you meet the criteria.

If you are on the LA KeyPlus Benefit Option, you only have cover for the Prescribed Minimum Benefit cancer care.

LA Comprehensive, LA Core, LA Active and LA Focus

You have cover that goes beyond Prescribed Minimum Benefits. Once you register, we put aside an amount we will use to pay for specific cancer treatment. We pay claims for approved treatment in full from this amount until it’s used up. After that, we pay up to 80% of Scheme Rate for all other cancer treatment and you have to pay the rest yourself.

While most of your benefit limits are worked out for January to December, your Oncology Benefit is worked out from the date you register for 12 months. If, for example, you register on the Oncology Programme on 1 April 2018, the amount we put aside for cancer treatment should last you until 31 March 2019.