SEVERE ILLNESSNo-one knows what life has in store for them, and the sad fact is that severe illness could strike at any time. Being prepared is the only solution – prepared for the cost of being absent from work during recovery, being cared for at home while ill, potentially modifying your lifestyle and your home, and even perhaps taking early retirement due to ill health. As Severe Illness benefit can vary substantially from one life insurance company to the next, we use Discovery Life, our preferred provider's Severe Illness Benefit to illustrate available benefits, terms and conditions. Discovery provides all the reassurance you need, should you become severely ill, paying out a lump sum and pays multiple claims for related and unrelated events regardless of the severity.
This page has the following sections: 1. How your claim is assessed 2. Benefits available in a Severe Illness Benefit 3. Real life examples of how clients have benefited from Severe Illness Benefit 4. Who should consider a Severe Illness Benefit 5. General terms and conditions of Severe Illness Benefi How your claim is assessedAs a Severe Illness claim can be complex to assess, we first explain how your claim is assessed in the event of severe illness.
· The life changing event must have occurred after the commencement of the benefit. · Symptoms and signs must be compatible with the diagnosis and the relevant special investigations (including blood tests, imaging, histology and other tests) must confirm the diagnosis. · Inability to perform Activities of Daily Living must be due to and compatible with the diagnosis of the life changing event. · Psychiatric illness, chronic fatigue syndrome (and synonyms) and fibromyalgia (and synonyms) and related terms are not covered under the Severe Illness Benefit. · Major organ transplant claims include being on an official South African or international transplant waiting list for the relevant transplant. · Specialist reports are required to assess all claims. A specialist is a medical practitioner registered as a specialist with the Health Professions · Council of South Africa. · The claims definitions in the Discovery Severe Illness Benefit are compliant with the Standardised Critical Illness definitions Project (SCIDEP). When can a claim be refused?
A claim may be declined when:
· Claim arising from any conditions or illnesses that the Claimant has ever suffered from, was ever aware of, or has ever received medical treatment or advice for before commencement of this Benefit, are excluded from commencement or re- in-statement of this Benefit. · The claim arose from participation in a pursuit deemed hazardous by Insurer · The Insurer is unable to get sufficient medical evidence from the claimant or treating medical practitioner to fulfil the criteria to make a Benefit payment. · The Qualifying Member or authorised person fails to provide medical evidence within 90 days. · The Principal Member’s or approved medical scheme plan is in arrears or the Principal Member is not a member of Vitality if they on Discovery Health. · The refusal by the claimant to consent to Insurer obtaining medical information about him or herself. · The severe-illness claim was a result of:
· Insurer shall not be liable for any claim if the Qualifying Member commits any act of dishonesty or fraud relating to any provisions contained in the Benefit · The claimant declines or neglects to undergo reasonable medical treatment when there is a reasonable likelihood that the medical treatment would improve the medical impairment of the claimant. |
Discovery explains how Severe Illness Benefit works in the video below.
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Benefit options
Making Multiple claimsIncrease payoutDiscovery who is our preferred supplier has structured the Severe Illness Benefit to cover all major body systems and to cover
you for multiple claims. On the Classic Life Plan you can receive multiple claim payments, regardless of whether the illnesses are the same, related or not related. It also doesn’t matter if the severity of subsequent illnesses is the same or lower (except for progressive illnesses like cancer). the childbirth benefitCovers multiple births and congenital birth defects.
Waiting periodA waiting period is necessary on this benefit to distinguish severe illness claims from death claims. A 30-day waiting period applies providing the assured individual survives (without the use of life support) to receive the claim proceeds
The Severe Illness Benefit Booster and Spouse Severe Illness Benefit Booster:
Covers you and your spouse by giving you up to an additional 40% of cover at no extra cost, based on how your policy is structured.
Increase cover without underwritingIncrease your cover without underwriting every three years by 20%, subject to a negative HIV test, with the Guaranteed
Insurability Benefit. This is particularly valuable if you expect your income to grow faster than inflation. |
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How clients have benefited from an Income Continuation Benefit
Mrs Mitchell found a lump in her breast and consulted a medical specialist. A biopsy was done and confirmed that she had stage I breast cancer, which qualifies for a Severity D payout under Discovery’s Severe Illness Benefit. However, Discovery’s Life Time Severe Illness Benefit took the expected future lifestyle impact of her claim into account and upgraded the payout from 25% to 100% of the insured amount. On top of this, her Severe Illness Extender Benefit paid out an additional 25%, giving her an |
Further information on Income Protection policy
Tax consideration |
Your income protection premiums are not tax deductible. In the event of a claim, the money you receive is tax free.
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Regulatory protection |
Life insurance companies in South Africa are regulated by the Financial Services Board. South Africa enjoys excellent financial services regulations and supervision, giving you the confidence that a life insurance company will pay according to the insurance contract you have signed up.
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Medical underwriting |
Underwriting is the process used by a life insurance company to assess your risk factors. When you apply for an Income Protection benefit, the life insurance company will do medical tests on you. If you are not healthy, the life insurance company may increase the premium it will charge you, decline certain benefits, or decline your application.
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General exclusions |
Life insurance companies may not pay out the Severe Illness claim on most of the following reasons:
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WhY should consider investing in a SEVERE ILLNESS BENEFIT?
The providers of severe illness policies all agree that medical scheme cover, disability or income protection cover and severe illness cover serve different needs. A medical scheme can cover you for the medical expenses associated with your illness, subject to certain rules and limitations, but your scheme may not meet all your medical needs. Severe illness cover can make up the shortfall.
Problems arise with long-term expenses, he says. For example, on basic plans, cover for chronic medication is often limited to a list of conditions – and even the more comprehensive medical scheme options do not cover everything. The costs associated with a critical illness can be significant. The lifetime costs of a severe stroke, for example, can amount to between R500 000 and R1 million, taking into account initial rehabilitation and chronic medication.
Source: Personal Finance,Laura du Preez
Problems arise with long-term expenses, he says. For example, on basic plans, cover for chronic medication is often limited to a list of conditions – and even the more comprehensive medical scheme options do not cover everything. The costs associated with a critical illness can be significant. The lifetime costs of a severe stroke, for example, can amount to between R500 000 and R1 million, taking into account initial rehabilitation and chronic medication.
Source: Personal Finance,Laura du Preez
What is the minimum premium?
The minimum premium is about R150 per month. So a Severe Illness benefit is affordable.
What if I don't pay my premium?
If you miss a premium payment, the life insurance company will try to debit your account again later in the month, or debit this month and next month's premiums next month. If you miss the premium payment again next month, the life insurance company will debit 3 months' premiums the following month. If the debit order is again unsuccessful, the life insurance company will have no choice but to terminate your policy.
After your policy is terminated, for a limited period of time, the life insurance company will allow you to reinstate your policy if you manually pay all the outstanding premiums into the insurance company's bank account, provide the proof of payment and complete a satisfactory declaration of health form.
After your policy is terminated, for a limited period of time, the life insurance company will allow you to reinstate your policy if you manually pay all the outstanding premiums into the insurance company's bank account, provide the proof of payment and complete a satisfactory declaration of health form.
Our product providers
As an independent financial planning practice, we have contracts with the following product providers in order to offer you a product that suits your needs:
Discovery, Hollard, Momentum, Old Mutual
Discovery, Hollard, Momentum, Old Mutual
Our preferred providers
We have done the necessary due diligence in selecting the following preferred provider:
Discovery
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We select Discovery Life as our preferred provider for the following reasons:
1. Reputable financial services group 2. Financially sound 3. Innovative product features 4. Immediate upgrade to 100% of your pre-disability income if you become permanently disabled 5. Uses 5 Underpins to assess claim, to find ways to pay the client in need 6. Meet upfront expenses with lump-sum disability payment 7. Extends cover on family members through Family Protector 8. Contribution waiver through Contribution Protector 9. Clever use of technology to provide excellent client service 10. Class leading travelling nurse service 11. Fast, fair claims More info: Discovery Life Overview Brochure |