The Illness Hospital Benefit Explained

Pays for hospital expenses for illnesses and planned procedures


Hospital Cover for Illnesses

Cover private hospital costs when you are admitted for an illness or planned procedure. Daily amounts are available for up to 21 days in hospital.

Additional cover is available for stated conditions like kidney stones, hernia or appendectomy. Stated conditions are covered up to their stated limits regardless of how many days are spent in hospital.

The benefit is optional. You do not have to include it on your Hospital Plan if you don't want to.

3 Month Waiting Period
3 Benefit Level Choices
Optional Benefit

Choose Your Level of Cover

Flexible levels of cover mean you get to build your plan to suit your needs and budget.

Level 1

Admission Days

  • Up to R6,890 for 1st day
  • Up to R4,770 for 2nd day
  • Up to R4,770 for 3rd day
  • Up to R1,590 per day for the remaining 18 days.

Effectively, up to R45,050 is available per event.

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Level 2

Admission Days

  • Up to R10,600 for 1st day
  • Up to R6,890 for 2nd day
  • Up to R5,300 for 3rd day
  • Up to R1,590 per day for the remaining 18 days.

Effectively, up to R51,410 is available per event.

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Level 3

Includes all Level 2 benefits with additional cover for stated conditions

Stated Conditions

  • Hernia: R21,200
  • Appendectomy: R37,100
  • Gallbladder / Kidney Stones: R37,100
  • Miscarriage: R10,600
  • Hysterectomy: R47,700
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How Does It Work?

Find answers to the most common questions about this benefit. Browse our Help pages and Blog posts for more information.

What is covered?

The Illness Hospitalisation benefit covers you for hospital costs related to an illness.

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.

How do Admission Days work?

There is up to R51,410 available to pay for hospital costs but it is broken up into specific amounts available per day that you spend in hospital (up to a maximum of 21 days).

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

For example, if you spend 72 hours in hospital then, with Level 2/3, you would have available:

  • R10,600 for first 24 hours
  • R6,890 for the second day
  • R5,300 for the 3rd day
  • adding up to R22,790 for the 3 days

How are the Stated Conditions covered?

With Level 3, you get specific cover for specific stated conditions:

  • Hernia: R21,200
  • Appendectomy: R37,100
  • Gallbladder / Kidney Stones: R37,100
  • Miscarriage: R10,600
  • Hysterectomy: R47,700

These amounts are available to pay for treatment regardless of how many days are spent in hospital. These amounts are not in addition to the admission days.

For example, if you are admitted for kidney stone treatment and only spend 24 hours in hospital, then the R37,100 is available for treatment and not just the R10,600 for the 1st day in hospital.

What about Day Procedures?

Day Procedures are hospital procedures that can be done under one day, either in hospital or at a specialised Day Clinic. Examples include tonsillectomy and grommets.

Day procedures are covered under the benefit up to the limit of the 1st admission day on your chosen level.

How is this different to the Accident Hospital Benefit?

The difference is simply whether you are admitted to hospital for an accident event or for some other illness related reason.

If it was an accident that resulted in hospital admission then the Accident Hospitalisation Benefit applies with the larger amounts available to pay for all medical costs related to the accident.

If it was not accident then the Illness Hospitalisation Benefit applies.

What is the waiting period?

There is a 3 month waiting period for any events that fall under admission day cover.

The stated conditions (on level 3) have their own waiting period:

  • 12 month waiting period for stated conditions
  • 24 months waiting period for hysterectomy

Is authorisation required?

Yes. In general, all hospital related claims need to be authorised first.

Authorisation is a simple procedure where the administrator and the hospital determine:

  • if the procedure you need is covered by your policy
  • if you have available amounts left over after previous claims

The authorisation procedure is described on the Claims page. We also have an article that explains how authorisation works with a health insurance.

Is there a hospital network?

No. Our health insurance product works with all major public and private hospitals, as well as day clinics.

This is because health insurance and medical aids work differently. We are not contracted to the hospitals for rates and tariffs, the underwriter guarantees the payment of the stated amounts in your benefit limits.

We have a helpful blog article that explains why the hospital does not need to recognise the health insurance product (unlike a medical aid).

What Health Plan are you going to build?

Get a quote and find out. Talk to us or build your own.


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