How oncology cover works on SA medical aid
Cancer is a Prescribed Minimum Benefit. The regulations to the Medical Schemes Act 131 of 1998 list specific cancer conditions and treatment algorithms that every registered medical scheme option must fund, regardless of price point — a hospital plan and a top comprehensive option both carry that obligation. Schemes may require you to use their designated service providers and to follow registered treatment protocols for PMB funding to apply.
Above the PMB floor, schemes differ. Some publish a separate annual oncology amount for non-PMB treatment; some fund treatment in full up to a threshold and then apply a member co-payment; some state plainly that cancer cover is PMB-level only. Those rules live in each scheme's oncology benefit documents and registered rules, so the practical step is always to confirm the current oncology programme rules with the scheme before treatment starts.
Sources: Council for Medical Schemes · Medical Schemes Act 131 of 1998
Published 2026 oncology limits, by scheme
This is the number that decides what a cancer diagnosis costs you: the rand amount your option funds in full, and what you pay above it. These figures are not in the plan summaries our comparison tables use, so we source them from each scheme's own 2026 benefit documents and cite every row. Where we could not find a primary source, we say so rather than estimate.
| Scheme | Plan / group | Oncology amount | Counted | What the document says | Source |
|---|---|---|---|---|---|
| Discovery Health | Executive and Classic Comprehensive | R500 000 | per beneficiary | The first R500 000 of approved cancer treatment over a 12-month cycle that starts at diagnosis. | Source |
| Discovery Health | Classic Smart Comprehensive | R375 000 | per beneficiary | The first R375 000 of approved cancer treatment over a 12-month cycle. | Source |
| Discovery Health | Priority, Saver, Smart and Core (Active Smart excluded) | R250 000 | per beneficiary | The first R250 000 of approved cancer treatment over a 12-month cycle. | Source |
| Discovery Health | KeyCare plans | No rand cap | — | Cancer treatment classified as a Prescribed Minimum Benefit, at a network provider — or at a state facility on KeyCare Start. No separate rand-capped oncology amount is published. | Source |
| Bonitas | BonComprehensive | No rand cap | — | No rand oncology cap published. PMB oncology is unlimited, and non-PMB oncology above the benefit limit is unlimited at a network provider with a 20% co-payment. | Source |
| Bonitas | BonClassic | R448 200 | per family | R448 200 per family for oncology. All costs for approved cancer treatment, including PMB treatment, accumulate to this limit. | Source |
| Bonitas | BonComplete | R336 100 | per family | R336 100 per family for oncology, excluding specialised drugs above the limit. All approved cancer treatment costs accumulate to this limit. | Source |
| Medshield | PremiumPlus | R500 000 | per beneficiary | For 2026 the oncology limit moved from R437 000 per family to R500 000 per beneficiary — a change in both the amount and the basis it is counted on. | Source |
| Medshield | MediPlus | R326 000 | per family | Oncology limit R326 000 per family for 2026, with separate sub-limits of R152 000 per family for specialised oncology drugs and R105 000 per family for breast reconstruction. | Source |
Sourced and last checked 2026-08-07. Per beneficiary and per family are not interchangeable — a R500 000 per-beneficiary limit and a R500 000 per-family limit are very different on a plan covering four people.
What you pay once the limit is reached
On the schemes above, cover generally does not stop at the threshold — it steps down. Discovery Health pays further approved treatment at up to 80% of the Discovery Health Rate, so a member using a provider it has a payment arrangement with pays no more than 20% of the cost. Bonitas continues to fund non-PMB oncology without a ceiling at a network provider, also on a 20% co-payment, and applies a 30% co-payment if you voluntarily use a non-network oncology provider under Regulation 8(3). On both, PMB cancer treatment keeps being paid in full.
That residual 20–30% share on a long course of treatment is the shortfall gap cover exists to fund, and it is the single most common reason members with cover still face a large cancer bill.
- Fedhealth: The 2026 flexiFED summaries in our data set describe oncology cover qualitatively ('comprehensive oncology cover') without publishing a rand threshold, and we have not sourced one from a primary Fedhealth 2026 document.
- Medihelp: No rand oncology threshold appears in the 2026 Medihelp benefit summaries we hold, and we have not sourced one from a primary Medihelp 2026 document.
- Momentum Health: Broker comparison sites publish per-option oncology thresholds with a 20% co-payment above them, but we have not verified those figures against a primary Momentum 2026 benefit document, so we do not repeat them here.
- Treatment prices: we do not publish a rand cost for chemotherapy or radiation. The South African cost studies that exist are several years old and reported per cycle in euros, and the ranges circulated online are not traceable to a verifiable source.
What the 2026 brochure data shows
These are counts and quotes taken straight from the plan data — not rankings, and not a recommendation of any option.
- Bonitas: BonPrime
- Discovery Health: Active Smart
options publish unlimited overall hospital cover, and 43 allow any private hospital. Most cancer treatment is delivered in hospital or by specialists, so the hospital limit and network rule on an option affect where treatment can be given.
Options with oncology detail in the 2026 brochure summary
Quoted as published, with the source document for each. Every other option in the data set still carries the PMB cancer obligation; its brochure summary simply does not break oncology out separately.
Bonitas: BonPrime
- “Unlimited for PMBs for cancer treatment.”
- “R224 100 per family for non-PMB cancer treatment.”
Discovery Health: Active Smart
- “Cancer cover limited to Prescribed Minimum Benefits”
Fedhealth: flexiFED 3 Hospital
- “Generous oncology and mental health benefits”
Fedhealth: flexiFED 4 Hospital
- “Comprehensive oncology, mental health & prosthetics”
Fedhealth: flexiFED 4 Savings
- “Comprehensive oncology, mental health & prosthetics”
Fedhealth: flexiFED 4Elect Hospital
- “Comprehensive oncology, mental health and prosthesis cover”
Fedhealth: flexiFED 4GRID Hospital
- “Comprehensive in-hospital, oncology & prosthetics cover”
What we could not populate from the plan data
Our 2026 plan data set is extracted from official scheme brochures, which do not carry structured oncology fields. We therefore hold no verified values for: the oncology annual limit per option, oncology self-payment gap and co-payment-percentage thresholds, and designated oncology provider or network names (including ICON). Rather than estimate them, we have left them out. We are sourcing the schemes' 2026 oncology benefit documents to add these fields.
Cancer cover on medical aid: common questions
Does every medical aid in South Africa cover cancer?
Yes, at a minimum. Cancer is included in the Prescribed Minimum Benefits (PMBs) set out in the regulations to the Medical Schemes Act 131 of 1998, so every registered medical scheme option must pay for the diagnosis, treatment and care of the PMB cancer conditions, subject to the scheme's designated service providers and treatment protocols. What differs between plans is the cover offered above that legal minimum.
How much cancer cover does a medical aid give you in 2026?
It depends entirely on the option. Across the 2026 scheme documents we have sourced, published oncology thresholds run from R250 000 to R500 000 — Discovery Health funds the first R500 000 of approved treatment on Executive and Classic Comprehensive, R375 000 on Classic Smart Comprehensive and R250 000 on Priority, Saver, Smart and Core; Bonitas publishes R448 200 per family on BonClassic and R336 100 per family on BonComplete; Medshield publishes R500 000 per beneficiary on PremiumPlus and R326 000 per family on MediPlus. Note whether a limit is counted per beneficiary or per family — on a family plan that difference matters more than the headline number.
What happens when cancer treatment costs more than my oncology limit?
On most of the schemes we sourced, cover does not simply stop. Discovery Health pays further approved treatment at up to 80% of the Discovery Health Rate, so a member using a provider it has a payment arrangement with pays no more than 20%. Bonitas keeps funding non-PMB oncology without a ceiling at a network provider, also subject to a 20% co-payment, and applies a 30% co-payment if you voluntarily use a non-network oncology provider. In both cases PMB cancer treatment continues to be paid in full. That residual co-payment is the shortfall gap cover is designed to address.
What does cancer treatment actually cost in South Africa?
We deliberately do not publish a rand price for chemotherapy or radiation. Credible South African cost studies are sector-specific, several years old and reported per treatment cycle in euros, and the ranges circulated online are not traceable to a verifiable source. The number that actually decides what you pay is your scheme's oncology threshold and the co-payment above it, which is what this page publishes instead.
What does 'PMB-level cancer cover' mean on a hospital plan?
It means the option pays cancer treatment according to the PMB rules and treatment algorithms only, and does not add a separate non-PMB oncology benefit on top. Treatment that falls outside the PMB definitions or protocols may then not be funded by that option.
What is an oncology self-payment gap or co-payment threshold?
Several schemes fund approved cancer treatment in full up to a stated rand amount, after which the member pays a percentage of further non-PMB treatment costs. The threshold and the percentage differ per scheme and per option: the 2026 documents we sourced show a 20% member share above the threshold at Discovery Health and Bonitas, rising to 30% at Bonitas if you voluntarily use a non-network oncology provider. These rules sit in each scheme's oncology benefit documents rather than in the summary brochures our plan table is built from, so we source them separately and cite each one.
Do I need to use a specific oncology network?
Often, yes. Bonitas appoints an Oncology Network as the designated service provider and applies a 30% co-payment for voluntary use of a non-network oncology provider. Discovery Health funds PMB cancer treatment in full when you use its designated service providers, and recommends its DSP oncology network on Essential Smart and Essential Dynamic Smart to avoid penalties. The 2026 plan summaries in our own data set do not name an oncology network per option, so confirm the designated provider arrangement directly with the scheme before treatment starts.
Is this page financial advice?
No. It is a factual comparison of what the 2026 scheme brochures in our data set publish. It is not advice and not a recommendation. Speak to an accredited financial adviser or the scheme itself before joining or switching.
Compare on your own numbers
All figures on this page are taken from official 2026 scheme brochures and are linked to their source document. This is general information, not financial advice, and not a recommendation of any scheme or option. Benefits, limits and contributions change — always confirm current oncology benefit rules directly with the scheme before joining, switching or starting treatment.