Being diagnosed with cancer can be overwhelming and leave you feeling unsure and alone. You may have many questions and you may also worry about how your friends and family will react and how to cope with day-to-day tasks, work or finances.
However, many studies have found that cancer patients with a strong support system tend to adjust better to the changes cancer brings to their lives; they have a more positive outlook and often report a better quality of life.
That’s why Bestmed goes the extra mile to ensure our members are supported, through our comprehensive Oncology Care programme.
The Oncology Care programme benefits in a nutshell
We believe that the right treatment and a good support system will help you feel strengthened and motivated. That’s why Bestmed’s Pace, Beat and Pulse healthcare options offer specified benefits that define the cover for cancer. These benefits are called oncology benefits. Bestmed provides oncology benefits, applying evidence-based medicine principles and considering affordability across the different healthcare options.
- Access to benefits and services which form part of the treatment protocol* of the designated services provider (DSP)
- Oncology treatments, including chemotherapy, radiotherapy, certain pathology and consultations
- Approved medicines in the Bestmed oncology formulary
*Should the treatment fall outside of the protocols, clinical motivation can be submitted by the oncologist for consideration
How to gain access to these benefits?
Bestmed members need to register for the Oncology Care programme. You can do this by providing a clinical summary and histology of your cancer as set out by your treating doctor. This report should contain an ICD-10 code, the doctor’s findings, as well as your latest test results confirming the specific type of cancer you have.
This process uses a set of guidelines and protocols that are continually updated as new products are launched and new treatment protocols are established. Please remember that:
- All services must be pre-authorised by us
- Services are rendered by our DSPs
- The services must fall within our funding guidelines
- For more information on our oncology benefits, visit our webpage at https://bestmed.co.za/
Regulating Cancer Treatments
Unfortunately, not all cancers qualify for prescribed minimum benefits (PMB1). In oncology, the treatment process is divided into two sections:
- Cancer that affects non-solid organs and systems
- Cancer of solid organs
Cancer of solid organs qualifies as a PMB1 only if it is treatable. However, there are various cancers of non-solid organs and systems that qualify as PMB conditions e.g. acute leukaemia, lymphomas, multiple myeloma and chronic leukaemia all qualify as PMB.
Treatable cancers that affect solid organs are defined as follows:
- It affects the organ of origin and has not spread to other organs
- The cancer has not caused incurable damage to the organ in which it originated or another life-supporting organ
- Or, if none of the above apply, there is evidence that more than 10% of people with a similar cancer survive after treatment for at least five years
If a solid-organ cancer does not meet the above-mentioned criteria, it’s considered a non-treatable cancer and is therefore not viewed as a PMB in terms of the current legislation.
Find out more about Bestmed’s oncology programme and benefits. Call us on 012 472 6254 or send an email to email@example.com.
1 What is a Prescribed Minimum benefit (PMB)? As set out by the Council of Medical Scheme’s, a PMB is a set of defined benefits to ensure that all medical scheme members have access to certain minimum health services, regardless of the benefit option they have selected. The aim is to provide people with continuous care to improve their health and well-being and to make healthcare more affordable.