This programme manages benefits to members and dependants with cancer, once the patient is registered with the Cancer/Oncology Management Programme.
If the patient is not registered, Libcare may reject the claims or pay them from the day to-day cover (which could deplete those benefits very quickly). Once you are registered on the programme for the benefit year, Libcare provides cover up to the limits shown on the Benefit below:
All approved oncology treatment accumulates to an annual oncology limit of R768 000 per beneficiary
PET CT Scans are limited to one per family member and restricted to staging and malignant tumors, subject to the annual oncology limit
Note: Once the annual oncology limit is reached, only Prescribed Minimum Benefit ( PMB) treatment is covered.
Specialised Medicine for Oncology is limited to R527 500 per beneficiary accumulating to the annual oncology limit of R768 000.
Associated diagnostics R77 400 per beneficiary (included in above limit of R768 000 and further limited to 12 months post-active treatment)
Bone Marrow Transplants
For Bone Marrow Transplants, the harvesting, transplantation and anti-rejection medication will fall under the Major Medical Benefit. Treatment prior to transplantation, such as Chemotherapy and Radiotherapy, are categorised under the Oncology Benefit. Prior approval from Libcare is required before commencing any work-up for the Bone Marrow Transplant. The treating doctor has to send a treatment plan and any supporting documentation to the Oncology Management Department. Once approved, a letter of authorisation will be sent to you and to the doctor. You will then need to contact Libcare Approvals on email@example.com to obtain authorisation for admission to hospital. Donor-search cover is limited to the Republic of South Africa.
Please note: No benefits will be granted without pre-authorisation having been obtained for hospitalisation and treatment for Bone Marrow Transplants. Should you have any queries with regard to the above, please contact the Oncology Management Department.
Cancer/Oncology - How to register
Upon diagnosis, the doctor sends a treatment plan to Libcare
Tel: 0800 12 CARE (2273). Operating hours: 08:00 - 17:00 Monday to Friday
The treatment plan is reviewed by the Oncology Management Department. After the team has assessed and approved your treatment plan, they will send authorisation letters to you and your doctor indicating:
- the treatment authorised
- the approved quantities, and
- the period for which the authorisation is valid.
Your doctor must advise Libcare of any change in your treatment, as the doctor will need to re-assess and update your authorisation. Failure to do this may result in Libcare rejecting your claims or paying them from an incorrect benefit (e.g. your Medical Savings Facility or other day-to-day benefit), as there will not be a matching oncology authorisation.
In addition to the authorisation from the Libcare Cancer/Oncology Management team, you will also need to get separate pre-authorisation from Libcare Approvals for any hospitalisation, or private nursing/hospice services which you may need during the course of your oncology treatment. (Email: firstname.lastname@example.org)