Cover for cancer
As a Remedi 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 PMB, is always covered, when you use our DSP and providers we have payment arrangements with.
All PMB treatment costs add up to your cover amount per your chosen benefit option benefits. If your treatment costs more than the cover amount, we will continue to cover cancer treatment that is confirmed as PMB level of care in full.
Your cover amount depends on your chosen benefit option's available benefits.
We will cover:
The first R490 000 of your approved cancer treatment on the Comprehensive Option is covered at 100% of the Remedi Medicine Rates. Thereafter, a remaining amount of R705 000 is covered at 80% of the Remedi Medicine Rates.
The first R410 000 of your approved cancer treatment on the Classic Option is covered at 100% of the Remedi Medicine Rates. Thereafter, a remaining amount of R265 000 is covered at 80% of the Remedi Medicine Rates.
On the Standard Option, your cancer treatment is covered in line with the requirements for PMBs and only PMB level of care will be covered.
All costs related to your approved cancer treatment including PMB treatment during the 12-month period, will add up to the 12-month cycle cover amount. We'll pay approved oncology medicine up to a maximum of the applicable Remedi Medicine Rate 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 available to members registered on the Comprehensive benefit option
Oncology Innovation Benefit
If you are registered on the Comprehensive benefit option, 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. We will fund up to 75% of the Remedi Medicine Rate for a select list of the innovative medicines and conditions.
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