The ICU Benefit Explained

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Extra Hospital Cover for Intensive Care Units

3 month waiting period
2 Benefit Levels
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Optional Benefit
Nationwide Network

The Illness Hospitalisation benefit can be increased to add up to R100,000 additional cover for up to 5 days in an ICU.

The ICU benefit is purely optional with 2 levels of cover to choose from.

The Hospital Plan has flexible cover for all of this and more.

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Choose Your Level of Cover

Flexible levels of cover mean you get to choose your benefit limits to suit your needs and budget.

Level 1

  • R12,500 per day
  • Up to R62,500 available per event

Level 2

  • R20,000 per day
  • Up to R100,000 available per event

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What is Covered?

The ICU benefit adds extra cover in addition to the Illness Hospitalisation benefit. It covers up to 5 consecutive days in an Intensive Care Unit.

ICU costs are claimed from the ICU benefit first and additional costs may then apply to the Illness Hospitalisation benefit.

There needs to be a diagnosis for procedures to be covered and they must be medically necessary. Elective surgery and admission for diagnostic purposes is not covered under this benefit

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How do Admission Days work?

There is up to R100,000 available to pay for ICU costs with specific amounts available per admission day. What this means is that there are limits available per day spent in an ICU up to a maximum of 5 days.

Each admission day is calculated as 24 consecutive hours spent in an ICU and each admission day follows on from the previous day.

For example, if you are admitted into an ICU ward and spend 72 hours there then, under Level 2, you would be eligible for:

  • R20,000 for the 1st day
  • R20,000 for the second day
  • R20,000 for the 3rd day
  • totalling R60,000 for the 3 days spent in ICU

The admission day cover for the Illness benefit would not add to this, claims will come out of the ICU benefit first if you have it selected on your plan.

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Is Pre-Authorisation Required?

All Hospital claims for planned procedures need to be pre-authorised 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.

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How can I increase my cover?

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:

  • ICU benefit for additional cover for stays in an intensive care unit
  • Dread Disease cover which offers larger amounts to help cover treatment of specific critical illnesses
  • Maternity cover which has a stated amount to cover the birth of your child in hospital.
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How does this relate to the Accident Hospitalisation benefit?

The Accident Hospitalisation benefit is designed to offer generous cover for the treatment of all medical costs related to an accident event. Visits to ICU will be covered under the Accident Hospitalisation benefit.

The Illness Hospitalisation benefit is designed to offer cover for hospital costs that are not related to an accident.

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Simple & Efficient Claims

Find out how the claims process works for rapid and pain-free claims handling.

No upfront payments
Claims paid directly to providers
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Answers to Your Questions

Is there a waiting period for the ICU benefit?

The ICU benefit has a 3 month waiting period.

Where I can find the network hospitals?

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.

How are claims paid?

Claims are paid directly to the medical providers. You can find all the details on our claims page.

Do I have to take the ICU benefit?

No. This is a purely optional benefit. You may choose to include it or not according to your needs and budget.

What are the age limits?

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.

How many people can be on a policy?

Episodic health insurance policies can include:

  • you
  • your spouse/partner
  • up to 6 children