If you contract a major dread disease, you'll have major medical cover with the Dread Disease benefit.
Available as an add-on to the Illness Hospitalisation benefit, your cover can be increased up to R350,000 for 8 defined critical illnesses.
Dread Disease benefit is purely optional with flexible levels of cover to choose from.
The Hospital Plan has flexible cover for all of this and more.
Flexible levels of cover mean you get to choose your benefit limits to suit your needs and budget.
The Dread Disease benefit is designed to offer extra cover for major critical illnesses that can't adequately be covered by the Illness Hospital benefit alone.
The benefit offers stated amounts to cover medical expenses for specific critical illnesses once per member per policy lifetime. This means that the chosen limits are available once per member and do not reinstate.
Standardised Critical Illness Definitions (SCIDEP) staging will apply and is explained below.
For example, if a member is diagnosed with Stage 4 cancer then the full amount is available for claims against that instance of cancer. Once it is depleted, then it can't be reinstated for that member again but is available for other policy members.
The Dread Disease benefit can not be claimed in addition to the Illness Hospitalisation or ICU benefits. Claims are settled against the Dread Disease benefit first, you can't claims from multiple benefits at the same time for the same event.
The Dread Disease benefit includes cover for 8 specified critical illnesses:
All Hospital claims for planned procedures need to be pre-authorised at least 48 hours before hospital admission. This is a simple procedure where we determine whether the procedure you need is covered under your benefits and whether you still have available amounts left over after previous claims.
You can find more detail about the process on the Claims page.
SCIDEP staging applies to certain critical illnesses and defines the severity of the illness. The benefit then covers treatment according to that stage:
For example, if a member is diagnosed with Stage 2 cancer, then 50% of the available benefit can be used for treatment leaving the remaining 50% to cover future events for that member.
The Hospital Plan includes additional benefits that can be added when you choose to take out the Illness Hospitalisation benefit. These optional benefits can increase your cover for more specific events. Take a look at:
Access private healthcare when you need to see a doctor, visit a dentist, get medication or go to hospital.
Find out how the claims process works for rapid and pain-free claims handling.
The benefit has a 12 month waiting period.
Yes. The benefit limit is available regardless of the delivery method.
The benefit doesn't have a specific hospital network and is designed to work with all major hospital groups. The Network page has all the information needed.
Claims are paid directly to the medical providers. You can find all the details on our claims page.
All new members joining a policy must be younger than 65 years on date of application.
Child dependants must be younger than 21 years before they will need to start their own policy.
However, if your child is still a registered full-time student and unmarried, then they may stay on the policy as a child dependant until they turn 26.
Episodic health insurance policies can include:
