Oncology Gap Benefit: Up to an aggregate of R165 000 ( 171 000 as of 2021 ) per insured person per annum. The shortfall that arises after your medical aid has processed your account and is due to service providers charging above scheme tariff for medical aid approved oncology treatment plans. (NB: Subject to: the gap cover percentage; and medical aid approved treatment plan being covered up to scheme tariff and within annual scheme oncology limit).
Oncology Co-Payment Benefit: Up to R10 000 per policy per annum
- The co-payment or deductible that your medical aid charges you for certain in-hospital procedures. This co-payment is
NOT related to the scheme tariff and service provider charge shortfall or designated service provider none arrangements, OR
- For claims where the medical aid will only pay a percentage for the approved treatment and the policyholder needs to pay the remaining percentage of the account.
- All costs to be within the annual scheme oncology limit.
- Oncology Extender Benefit: No Benefit
- Breast Reconstruction Surgery: No Benefit
- Global Fee Benefit: No Benefit