Our Oncology Disease Management Programme supports members with cancer. The team consists of highly skilled healthcare professionals who work in conjunction with your doctor to ensure that the treatment you receive is both clinically appropriate and cost-effective. Our team is also supported by a number of oncologists and haematologists from the private, public and academic sectors.

 

What does the programme include?

Our Oncology Disease Management Programme gives you the following benefits:

• Access to the Independent Clinical Oncology Network (ICON): We’ve contracted with ICON, an organisation that includes 75% of all practicing oncologists in South Africa in order to provide your oncology treatment. For more details of the ICON Network, visit www.cancernet.co.za or call your Oncology Case Manager on 0860 100 572.
• Coverage for chemotherapy, radiotherapy and associated medicine: We’ll pay for chemotherapy and medicine directly associated with the treatment of cancer, provided a valid authorisation has been obtained. Treatment for conditions not directly related to the treatment of the cancer (e.g. depression) as well as treatment for the long-term conditions that may develop as the result of chemotherapy or radiotherapy will be funded from an alternative benefit (e.g. the Chronic Disease Benefit or your day-to-day benefit).
• Consultations and visits: These will be covered while you have either an active chemotherapy or radiotherapy authorisation. Prior to starting treatment and once treatment has been concluded, consultations are paid from the day-to-day benefit.
• Pathology: We’ll cover oncology-related pathology claims while you’re receiving either chemotherapy or radiotherapy and for 12 months post treatment.
• Radiology: We’ll cover general oncology-related radiology claims while you’re receiving either chemotherapy or radiotherapy treatment, and for 12 months post treatment.
• Specialised radiology (e.g. CT scans, MRIs, angiography, radio-isotopes): These procedures require a separate pre-authorisation, and will be paid from Risk.
• PET scans: You can have up to two PET scans per family per year, restricted to staging of malignant tumours.
• Surgery and hospitalisation: These claims will be paid from Risk, subject to you obtaining a valid authorisation from the Hospital Authorisation Centre.
• Stoma therapy: This will be paid from OHEB first (if your option has an OHEB) and once depleted, from Risk. Pre-authorisation is not required.
• Terminal care and private nursing: As part of our oncology benefit, the Terminal Care Benefit will cover accommodation in a hospice or terminal care facility for the care of patients in terminal stages of life (subject to a limit). You’ll need to get pre-authorisation from the Hospital Authorisation Centre. Private nursing will be paid from the Alternatives to Hospitalisation benefit, where this is available.

 

How to access this benefit
If you’re a Fedhealth member and want to access the oncology benefit, you’ll need to get pre-authorisation. This process uses a set of cancer guidelines and protocols that are continually updated as new products are launched and new treatment protocols are established.

Need more information?
Read more about Fedhealth’s oncology benefit here.