Medical Aids and Breast Cancer

Cancer is probably the most dreaded word coming from the doctor’s lips, when he gives a diagnosis. The mere mention of the word gives rise to thoughts to medical aids and breast cancer. How do medical schemes cope with this scourge?

To many women, this is all too familiar. One in every 33 women are going to become victims of breast cancer. This is the most common cancer among the female population. A lot of women feel that breast cancer with its diagnosis and treatments, robs them of their femininity and identity. After all, the breasts symbolize fertility..

Medical Aids and Breast Cancer – Early Detection


This is of vital importance as the disease can spread aggressively. In cancer of the breast, with Stage 1, there is an 80% chance of survival if caught early. With this in mind, most medical schemes have programmes or special sections, pertaining to Preventative or Wellness Benefits.


  • Mammograms – most medical aids will cover the costs of a mammogram each year as part of their Wellness or Preventative screening programme.
  • Brac Gene Test – some medical aids will pay for this if there is a strong family history of breast cancer. Brac 1 and Brac 2 genes are susceptible to breast cancer, so women who inherit one of these mutations are at a greater risk.
  • Clinical Breast Examination – every young girl and woman should know how to self-examine their own breasts. Alternatively, a doctor or gynaecologist could do this at least once a year. The Preventative Care aspect of medical aids covers this.


 breast cancer

 Medical Aids and Breast Cancer РDiscussing the Cover

  • All medical schemes will provide cover for Treatable Breast Cancer. This will include in-hospital care, specialist fees, chemotherapy, radiation, and medication. The amount they pay, and the type of treatment will depend on the medical aid and the option you have chosen.
  • If the cancer has spread, you will have a maximum limit on your Oncology Benefit of between R200 000 and R500 000. After this a 20% co-payment usually applies.
  • Notify your medical aid immediately of the diagnosis.
  • Get pre-authorization for treatment.
  • It is possible that your medical aid will expect you to enroll in their oncology programme.
  • Use a designated service provider, so that you do not need to pay in the difference if your specialist is contracted out of the medical aid rates.
  • You and your doctor will have to submit a treatment plan to your medical aid. This will then be evaluated for treatment and medication.
  • Schemes usually pay for the cancer medication used by the state to treat cancer. If you choose to use something more expensive, you will have to pay in the difference from your own pocket. Expensive drugs such as Herceptin will have to have very specific clinical guidelines if the medical aid is to pay for it.
  • Some procedures and treatments are excluded in the amount your medical aid is prepared to pay.
  • Some medical schemes will pay the cost of a wig, breast prosthesis, and re-constructive surgery after a mastectomy.
  • Each Medical aid has their own particular rules for services for which they will pay.



Treatment is most effective before you become aware of more pronounced symptoms. Early detection is important. Be aware of breast changes through your various stages of life, and if anything feels or looks different, act immediately and consult your doctor.


All info was correct at time of publishing