Oncology

It is important that prior to commencing active treatment for cancer, you are registered on the Oncology Disease Management Programme (See Benefit Summary for applicable benefits and limits per your chosen option).

What benefits does the Scheme provide in respect of cancer treatment?

• The fees charged by your doctor for administering medication, regardless of whether it is done intramuscularly, sub-cutaneously or intravenously, are paid at 100% of the TopMed Tariff, irrespective of whether or not treatment forms part of hospitalisation.
  Note: Medicine to counteract the side effects of chemotherapy and radiotherapy will be paid according to the TopMed’s Oncology Disease Management Program’s guidelines.
• Cancer medicine, chemotherapy and radiotherapy is subject to Disease Management under the care of a medical professional. Please note that benefits may be forfeited if members do not comply with the treatment plan.
• Cancer medicine received on discharge from hospital will be limited to 7 days’ supply and is subject to available day-to-day benefits.
• Pathology, X-rays, doctor visits during active treatment, materials and items claimed as materials will also be paid from the members’ major medical benefits.
• Consultations, pathology and radiology related to cancer will continue to be paid one year after active treatment has been completed.
• Long-term chronic conditions that develop as a result of chemotherapy and radiotherapy are not covered under this benefit.
  How to register on the Oncology Disease Management Programme
  Please follow these steps:
• Either you or your treating doctors can us on 0860 00 21 58 or Fax through your treatment plan to (031) 580 0492
• After the treatment plan has been assessed and authorised, an authorisation number is sent to the treating oncologist or physician, within 48 hours.
• In the event of a change in your treatment please ensure that either your or your treating doctor advised your case manager, to ensure that your authorisation is updated accordingly.