Specialised Medicine Cover & Benefits
If you’ve been prescribed a medication with a name you can’t pronounce and a price tag that’s eye-watering, chances are it’s classified as specialised medicine. These advanced treatments – often for cancer, autoimmune conditions, and rare diseases – aren’t always covered under basic plans. Here’s what to know.
Comparative Overview of Medical Aid Providers
This table outlines which providers offer specialised medicine cover, what the annual limits are, and whether co-payments or pre-approvals apply.
Provider | Plan Name | Monthly Premium (± 2024) | Specialised Medicine Coverage & Rules |
Discovery | Comprehensive Series | ±R6,800 | Covered under oncology/rare disease benefit – subject to authorisation |
Momentum | Summit Option | ±R5,900 | Covers biologics via extended benefit – co-pay may apply |
Bonitas | BonComprehensive | ±R6,300 | Includes cancer & specialised drug fund – R200k+ limit |
Best Plans for Different Profiles
Patients on Biologic Drugs
Recommended Plan:
Momentum Summit Option
Why? Access to high-cost autoimmune therapies and immunologics with managed authorisation.
Oncology & Advanced Treatments
Recommended Plan:
Discovery Comprehensive Series
Why? Robust oncology programme that includes medication, radiation, and specialist consults
Key Considerations Before Choosing a Plan
- Is the medication included under a specialised or oncology benefit?
- Does it require pre-authorisation from the scheme?
- Are there annual or lifetime limits on expensive treatments?
- Will you need to pay a co-payment if using a non-preferred brand or provider?
FAQs
Yes, but only on select plans with extended medication benefits. Authorisation is usually required.
Submit a treatment plan from your specialist, along with diagnosis details and medication motivation.
Usually not – unless approved under a managed care programme.