Below are some industry terms that you should know about hospital and healthcare insurance.
An accident is a sudden, uncertain and unexpected event which is caused solely and directly by violent, external, physical and visible means and independently of any other cause.
An acute illness is a condition with a rapid onset, a short course, or both. Acute may be used to distinguish an illness from a chronic form.
This is a % deduction from the sum assured (see below) which covers the claims administration costs.
A chronic illness is a condition which has to be treated on an ongoing basis for a prolonged period of time, usually more than three months.
A credit rating agency either based in South Africa or internationally rates the insurance provider’s ability to pay claims or a hospital’s ability to pay for services you claim for.
The deductable is a set rand amount that must be paid upfront by the member for a defined list of procedures. This is the monthly premium that you contribute towards your hospital plan.
Some medical conditions and procedures may be excluded from being claimed for under your hospital plan. These will be defined in your policy contract.
The policy may or may not cover you in the following instances:
Confinement to rest or convalescent homes, hospices, frail care- or similar establishments
Pre-existing injuries and illnesses for the first 24 months of the policy
Abortion, miscarriage, or complications arising from childbirth
Maternity benefits during the first 12 months
All Illness claims during the 1st 90 days of the policy
AIDS or HIV infection, including all phases and consequences thereof
Depression and Mental Disorders
Hospital Cash Plan
A Hospital Plan is an insurance policy that pays a specified amount to you in the event that you go to hospital. This is usually to compensate for lost income and payment of hospital services. Hospital cover pays you a daily lump sum and you can chose what you want to do with that money. It’s up to you.
The life insured is you and other persons whose names appear in the Policy Schedule, and who is/are resident in South Africa.
Long-Term Insurance Act
Medical Insurance is governed by The Financial Services Act and the Long-Term Insurance Act and insures individuals against the risk of incurring medical expenses.