Critical Illness Cover

Earn an income even if you are too sick to work

Critical illness insurance relieves the financial strains of serious disease by providing a lump-sum payment if you are diagnosed with and survive a life-changing sickness.

These illnesses can include, for example, cancer, heart attack, stroke, multiple sclerosis, or Parkinson's disease.

What is the purpose of the cover?

Critical illness cover provides financial assistance upon diagnosis of a covered condition in the form of a lump-sum payment that is completely tax-free and can be used on anything you feel appropriate, from medications and hospital costs to the paying off of debt and more.

If you become seriously ill you may no longer be able to work due to your condition. The money that you receive from your insurance could be used to pay off large debts so as to bring down the monthly expenses of your household to make it more manageable, going forward, for your family.

Who needs cover?

If your income is dependent on you and you don't have enough savings to tide you over if you become seriously ill or disabled, then cover is important. If you are the breadwinner in your family and your household will not be able to survive without your income then it is vital to consider this form of insurance. Or if you do not have an employee benefits package to cover a longer time off work due to sickness.

Insurance cover pays out a lump-sum amount after the diagnosis of a condition covered has taken place.

What does Severe illness cover?

These illnesses are mostly seen as long-term and very serious conditions such as a heart attack or stroke, loss of arms or legs, or diseases like cancer, multiple sclerosis or Parkinson's disease.

These are all illnesses that can be severely debilitating and prevent you from being able to function in a work environment. This is why you will need to be insured against an event like this. If you are unable to work then you will be unable to earn an income to support your family.

Cover generally does not cover chronic conditions such as diabetes, asthma, or multiple sclerosis and they also do not cover pre-existing conditions.

What are the benefits of cover?

Insurance cover provides cover for serious medical situations and because these emergencies or illnesses often incur above-average medical costs, this cover will pay out cash to help cover those costs where traditional health insurance may not.

What could be defined as a Critical illness?

Severe illness can be defined as anyone suffering from an illness or disease such as Cancer, Kidney failure, Heart Attack (Myocardial Infarction), Coronary Artery (Bypass) SurgeryHeart Valve Surgery, Major Organ Transplantation, Multiple Sclerosis, Aorta graft surgery, and Primary Pulmonary Arterial Hypertension to name a few.

Insurance cover will attend to the expenses that you may incur due to a serious illness and help you pay your expenses while ill. Disability cover replaces the income you lose due to an illness or injury. Important to note is that critical illness and disability policies can also differ on the duration of benefits and the way the money is paid out to you. You may receive a lump sum amount or a monthly payment depending on your policy.

How much does cover cost?

Your premium is determined by age and risk profile when you take out insurance.

Insurance cover provides for severe illness, dread disease, and a variety of illnesses, impairments, and injuries, that can have a serious impact on your family’s health and functionality.

Conditions covered:

• A cardiac and arterial system such as a heart attack.
• Connective tissue diseases such as rheumatoid arthritis.
• Ear, nose, and throat system such as loss of speech.
• Endocrine and metabolic diseases such as diagnosis of type 1 diabetes.
• A digestive system such as Crohn's disease or ulcerative colitis requires recurring surgery.
• HIV and Aids.
• Major burns.
• Muscles, bones, and joints such as a hip joint replacement.
• Brain and nerves such as motor neuron disease.
• Lungs and breathing such as respiratory failure.
• Severe aplastic anemia.
• Terminal illnesses such as chronic lung problems.
• Trauma such as coma.
• Kidney and urinary tract such as kidney failure.
• A visual system such as the total and permanent loss of sight in one or both eyes.

Who is eligible for cover?

The minimum entry age is 18, while the maximum entry age is 59 and the maximum coverage is 65.

When submitting a claim, you generally need to provide the following documentation, which may differ according to the insurance provider of choice:

• Original claim forms from the insured.
• Employer and medical attendant.
• Medical reports.
• Clinical evidence.
• A certified copy of the ID of the insured member.
• A copy of the insured member’s payslip.
• Proof of banking details.

An insurance claim will be paid as soon as the relevant medical proof that the event falls under one of the defined illness claim events, has been received.

Can I get covered without Life insurance?

You can take out severe illness cover without life insurance, but that may not be the most cost-effective option.

Is cover mandatory in South Africa?

No, cover is not mandatory in South Africa, but highly encouraged in the event that you do not have enough savings to cover your expenses and can longer work due to becoming seriously ill or disabled.

Do I need to take out insurance if I have Medical aid?

Medical aid plans provide cover while you are in the hospital, but the problem starts with your out-of-hospital expenses and chronic medication, which medical aids generally do not cover when it comes to experimental treatments.

Heart diseases, stroke, and cancer may leave you with a huge financial burden, even if you are on a generally good medical aid plan

How much cover do I need?

There is no specific way to determine the amount of severe illness cover that you need, and it comes down to the amount of cover that you can afford.

Cover will not pay out when you or your family members insured do not meet the requirements of one of the defined critical illness claim events. The cover amount will be paid out to you as the policyholder.