In South Africa, the rising costs of healthcare and the increasing prevalence of severe health conditions like cancer, heart attacks, and strokes make it essential to have a health insurance plan that includes critical illness cover.
In this guide, we will explore the best medical insurance providers in South Africa that offer comprehensive critical illness cover.
Analysis of Critical Illness insurers includes
☑️ What critical illness medical insurance is.
☑️ Why critical illness cover matters in South Africa.
☑️ The 5 best critical illness medical insurance.
☑️ The most frequently asked questions on critical illness medical insurance.
Let’s get started on understanding your options for critical illness cover in South Africa
Best critical illness medical insurance providers - Summary
Understanding Critical Illness Medical Insurance in South Africa
💙 Critical illness health or medical insurance in South Africa is designed to provide financial protection against severe health conditions that can have a significant impact on an individual's life and finances.
💙 This type of insurance offers a lump-sum payment upon diagnosis of a specified critical illness, helping policyholders cover the high costs associated with treatment, recovery, and other related expenses.
💙 Members who take out this type of cover will have access to the following features:
💙 Critical illness insurance policies typically cover a wide range of serious conditions, including but not limited to cancer, heart attacks, strokes, major organ transplants, and multiple sclerosis. The exact illnesses covered can vary between providers. Lump-Sum Payment
Upon diagnosis of a covered critical illness, the insured receives a lump-sum payout. This payment can be used at the policyholder's discretion, whether for medical treatment, rehabilitation, home modifications, or to cover loss of income during recovery.
Flexibility and Peace of Mind
The financial support provided by critical illness insurance allows individuals to focus on recovery without the added stress of financial burdens. It offers flexibility in terms of how the payout is used, ensuring that the insured can address their specific needs.
Additional Benefits
Some policies may include additional benefits such as counselling services, second medical opinions, and access to wellness programs.
Why critical illness cover matters in South Africa?
In South Africa, the cost of treating critical illnesses can be exorbitant, often exceeding what is covered by standard health insurance or medical aid schemes. Critical illness insurance helps bridge this gap, ensuring that patients can afford the necessary treatments without depleting their savings.
While South Africa has a public healthcare system, it is often overburdened and under-resourced. Private healthcare offers better facilities and quicker access to treatments, but it comes at a high cost. Critical illness insurance makes private healthcare more accessible to those diagnosed with severe illnesses.
Critical care insurance Features
🔍Feature
🏅Old Mutual
🏅Affinity Health
🏅Kaelo Health
📕Core Cover
Yes
Yes
Yes
📅Day Care Procedures
Yes
Yes
Yes
🏥Medical Aid Scheme Fees
Yes
Yes
Yes
➕Prescribed Minimum Benefits (PMBs)
Yes
Yes
Yes
➕➕Additional Benefits
Yes
Optional
Optional
💊Chronic Medication
Yes
Optional
Depends on Plan
🪥Dental Cover
Optional
Optional
Optional
👓Optical Cover
Optional
Optional
Optional
👩⚕️Mental Health Cover
Yes
Yes
Depends on Plan
🤰🏻Maternity Benefits
Yes
Yes
Yes
⚕️Alternative Medicine
Limited
Limited
Varies by Plan
🏊♀️Wellness Programs
Yes
Yes
May be available
🔍Other Features
Yes
Yes
Yes
🛜Network Restrictions
Yes
Yes
Yes
🕳️Gap Cover Options
Yes
Yes
May be available
🛋️Waiting Periods
Yes
Yes
Yes
❌Exclusions
Yes (refer to policy documents)
Yes (refer to policy documents)
Yes (refer to policy documents)
🏅 Premium Options
Varies
Varies
Varies
Finally, a critical illness can lead to a loss of income if the patient is unable to work during treatment and recovery. The lump-sum payout from critical illness insurance can provide financial stability, helping to cover daily living expenses and ensuring that the patient's family is not at greater financial risk.
The 4 best critical illness medical insurance
Below, we reveal the 5 best medical insurance providers in South Africa that provide critical illness cover.
Affinity Health
Unique Features
🔍Feature
🥇Affinity Health
🛎️Combined plan
Integrates the benefits of both the Day-to-Day and Hospital plans
⚖️Premiums
Cost R809 to R1,838 per month depending on the plan selection.
🪑Waiting Period
Normally 3 months.
A 12-month pre-existing condition waiting period applies. Normally for new members.
💙 Affordable and comprehensive healthcare solutions are offered by Affinity Health, a prominent health insurance company in South Africa.
💙 Daily healthcare, hospitalization, and critical illness coverage are just a few of the medical needs that Affinity Health plans address, all with an eye towards making health insurance accessible to as many people as possible.
Hospital Plan
💙 The Affinity Health Hospital Plan provides extensive cover for serious illnesses and medical emergencies, including critical illness. From R1,348pm
💙 The healthiest amongst us can fall victim to disease and illness. As one of the fastest growing providers of Hospital Plans and Health Cover in South Africa, Affinity Health offers you an affordable Hospital Plan that gives you access to a wide range of features and benefits when you need it most.
💙 The great thing about an Affinity Health Hospital Plan is that you get a much wider choice of hospitals and doctors than if you were a public patient.
💙 This plan ensures that policyholders have access to private hospitals and a wide range of benefits during hospitalization due to severe health conditions.
💙 The critical illness cover within this plan includes major diseases such as cancer, heart attacks, and strokes, ensuring that patients receive the necessary treatment without the financial strain.
Combined Plan
💙 The Combined Plan from Affinity Health integrates the benefits of both the Day-to-Day and Hospital plans, offering a holistic approach to health coverage. This plan includes critical illness cover, ensuring that policyholders are protected against serious health conditions while also receiving routine medical care. From R1,968pm
💙 The Combined Plan provides the financial support needed for treatment and recovery from critical illnesses, covering hospitalization costs and offering additional benefits such as unlimited doctor visits, prescribed acute medication, and access to private hospitals.
💙 By combining day-to-day medical needs with extensive hospital cover, this plan ensures comprehensive healthcare protection for policyholders.
What is the monthly premium for the Affinity Health insurance plans?
Affinity Health plans cost R869 to R2,038 per month, depending on the selection.
What Is the Waiting Period for Affinity Health Insurance Benefits?
The average Affinity Health waiting period for health benefits is three months. A 12-month pre-existing condition waiting period applies. New members may have to wait these periods to claim specific services or conditions.
How to Claim for Affinity Health Insurance Benefits?
☑️ Fill out Affinity Health's online claim form. Include accurate and thorough treatment, service provider, and cost information.
☑️ Your claim and supporting papers can be submitted many ways: Email: Email the completed claim form and scanned copies of all applicable evidence to Affinity Health's designated email address. Fax: Send documents to Affinity Health's fax number. Physical mail: You can mail the documents to Affinity Health's address. Online: Registered users can file some claims immediately through Affinity Health's online site.
☑️ Affinity Health's customer support can be reached by phone or email to trace your claim. They can update you and provide new information.
☑️ Affinity Health verifies and evaluates your claim and plan coverage. Claim processing time depends on complexity and information quality.
☑️ After processing your claim, Affinity Health will notify you. If approved, they will compensate you through your health insurance. If your claim is denied, they should explain why and how to appeal.
Pros and Cons
✅ Pros
❌ Cons
Wide range of cover options to suit different needs and budgets
Monthly costs can vary depending on plan chosen and individual factors
Provides cover for a variety of critical illnesses
May have exclusions or limitations on certain critical illnesses
Established and reputable insurer in South Africa
Important to carefully review the policy wording before purchasing
🟧 Postal Address: Posnet Suite 124, Private Bag x101, Farrarmere, Benoni 1518
Dis-Chem Health
Unique Features
🔍Feature
🥇Dischem Health
🛎️MyHealth Core plan
Entry-level health insurance plan that covers essential day-to-day medical expenses.
Can be enhanced by Medical Emergency Illness Buy-Up option.
📋MyHealth Plus Plan
Comprehensive health insurance offering that includes unlimited access to doctors.
Chronic medication for 27 conditions
⚖️Premiums
Monthly plans cost R270 to R649, depending on the plan.
🪑Waiting Period
Accident Cover: Accident claims are covered immediately.
Day-to-Day Benefits: 1–3-month waiting period.
Hospitalization and Serious Conditions: 6–12 month waiting periods.
💙 Known for their comprehensive coverage options, Dis-Chem Health plans cater to various healthcare needs, including day-to-day medical expenses, accident cover, and critical illness protection.
💙 Their plans are designed to ensure that policyholders have access to quality healthcare services while also enjoying additional benefits like discounts on health products through the Dis-Chem rewards program.
💙 Dis-Chem Health leverages the extensive network of Prime Cure, providing access to a wide range of healthcare providers across the country.
MyHealth Core Plan
💙 The MyHealth Core Plan is an entry-level health insurance plan that covers essential day-to-day medical expenses. This plan can be enhanced with the Medical Emergency Illness Buy-Up option, providing additional coverage for medical emergencies due to critical illnesses such as heart attacks, strokes, and acute asthma attacks.
💙 By combining this buy-up option with the MyHealth Core Plan, policyholders can enjoy comprehensive protection against major health events.
MyHealth Plus Plan
💙 The MyHealth Plus Plan is a more comprehensive health insurance offering that includes unlimited access to doctors and specialist visits, chronic medication for 27 conditions, and various other healthcare benefits.
💙 This plan can also be paired with the Medical Emergency Illness Buy-Up option, further enhancing the coverage to include critical illnesses.
What is the monthly premium for the Dis-Chem Health insurance plans
Monthly plans cost R120 to R723, depending on the plan.
What Is the Waiting Period for Dis-Chem Health Insurance Benefits?
☑️ Accident Cover: Accident claims are covered immediately.
☑️ Day-to-Day Benefits: GP appointments, medicines, and basic dental treatment normally have a 1–3-month waiting time.
☑️ Hospitalisation and Serious Conditions: Hospitalisation and critical condition or surgery coverage may require 6–12 month waiting periods.
How to Claim for Dis-Chem Health Insurance Benefits
☑️ Complete the Dis-Chem Health claim form. This form is available at Dis-Chem Health locations or online. Verify all details to avoid delays.
☑️ Complete and submit your claim form with supporting papers. Claims can be submitted via email, mail, or branch, depending on Dis-Chem Health's recommendation.
☑️ After receiving your claim, Dis-Chem Health will manage it according your insurance. To ensure accuracy, verify the claim details and accompanying papers.
☑️ Dis-Chem Health will notify you of the claim. They will reimburse the healthcare provider promptly or refund your out-of-pocket expenses after examining your claim.
Pros and Cons
✅ Pros
❌ Cons
Affordable plans with varying levels of cover
May have limited coverage for certain critical illnesses compared to other insurers
Convenient access to Dis-Chem pharmacies
Specific policy details and exclusions should be carefully reviewed
Offers additional benefits like discounts on medication
May not be suitable for individuals with high-risk lifestyles or specific health conditions
Dis-Chem Health Insurance Contact Details
✅ Call:
Sales: 0861 029 892
Customer Support and General Enquiries: 0861 029 892
Family, Legal or Financial Counselling: 0861 635 766
❌ WhatsApp: None ❌ Fax: None ✅ Mobile App: Available on Apple Store, Google Play and AppGallery ✅ Website enquiry: https://dischemhealth.co.za/contact/
OnePlan
Unique Features
🔍Feature
🥇OnePlan
🛎️OnePlan Blue Plan
Extensive coverage for both day-to-day medical needs and hospitalization.
Critical illness cover, providing up to R315,000 per defined disease per year.
📋OnePlan Professional Plan
"Most comprehensive offering.
Extensive coverage for a wide range of healthcare needs.
Offering up to R390,000 per defined disease per year."
⚖️Premiums
From R480 for entry-level coverage to R1765 per month for full coverage
🪑Waiting Period
3-month waiting period
Pre-existing conditions require a 12-month waiting period.
Accidental injuries can be claimed immediately after your policy begins.
OnePlan offers critical illness cover as part of its health insurance plans. Specifically, OnePlan provides coverage for dread diseases, which is another term for critical illnesses. This coverage includes up to R315,000 per defined disease per year, with a waiting period of six months for claims related to these illnesses.
OnePlan's health insurance plans are designed to offer comprehensive protection, including hospital cover, day-to-day medical benefits, and additional services like trauma and assault counselling, and accidental HIV protection. This makes OnePlan a great option for individuals seeking financial protection against severe health conditions in South Africa.
OnePlan Blue Plan
The OnePlan Blue Plan is designed to offer extensive coverage for both day-to-day medical needs and hospitalisation. This plan includes critical illness cover, providing cover per defined disease per year.
💙 In addition to critical illness cover, the plan offers up to R60,000 per insured event for in-hospital illness, and up to R230,000 per insured event for accident cover. The plan also includes benefits for casualty illness and accident, maternity pre-birth, and optometry, making it a well-rounded choice for comprehensive healthcare protection.
OnePlan Professional Plan
The OnePlan Professional Plan is the most comprehensive offering from OnePlan, providing extensive coverage for a wide range of healthcare needs. This plan includes critical illness cover offering per defined disease per year.
The plan also covers day-to-day medical expenses with higher annual limits and includes additional services such as accident disability cover and trauma, assault, and accidental HIV protection.
What is the monthly premium for the OnePlan Health insurance plans?
You can pick from R500 for entry-level coverage to R1975 per month for full coverage with OnePlan.
What Is the Waiting Period for OnePlan Health Insurance Benefits?
☑️ Most medical services under day-to-day benefits have a 3-month waiting period. Most daily benefits will not be available during the first three months of your policy.
☑️ Pre-existing conditions require a 12-month waiting period. Maternity Benefits: Maternity claims cannot be lodged until after a waiting period, usually 10 months.
☑️ Accidental injuries can be claimed immediately after your policy begins.
How to Claim for OnePlan Health Insurance Benefits
☑️ Install the OnePlan app on your smartphone. The app is essential for policy management and claims.
☑️ Enter your credentials on the app to view your policy and claims choices.
☑️ Prepare all documentation before submitting your claim. These may contain medical invoices, receipts, and reports.
☑️ Submit your claim via app. You must submit claim details and upload documents through the app. The process is simple, with prompts for each step.
☑️ OneCard is a unique OnePlan feature. Your card gets preloaded with monies if a claim is authorised. To avoid out-of-pocket medical costs, use the OneCard to pay directly.
☑️ The software lets you follow your claim after submission. OnePlan processes claims swiftly and communicates progress via the app.
☑️ OnePlan's app-based customer assistance can help with claim concerns. They can help with any issues.
Pros and Cons
✅ Pros
❌ Cons
Offers a range of plans to suit different budgets and needs
Costs can be higher compared to some other providers for comprehensive coverage
Provides cover for a wide range of critical illnesses
Specific policy details and exclusions should be carefully reviewed
Established insurer with a good reputation
May have waiting periods for certain conditions
OnePlan Health Insurance Contact Details
🟧 Phone:
General Inquiries: 010 0010 141
Monday to Friday: 8:00 AM – 5:00 PM
Saturday: 8:00 AM – 12:00 PM
Pet & Health Hospital Authorisation, Admission & Emergency: 24/7 (same number: 010 0010 141)
💙 Selection of health insurance products at Ubuntu Med Health Insurance in South Africa are carefully tailored to suit the unique requirements of individuals and families. Their range of products includes day-to-day benefits, hospital cover, and combined plans, all focused on providing flexibility and affordability.
💙 Ubuntu Med's health insurance plans are designed to provide clients with the flexibility to customize their coverage to meet their specific needs. Clients can personalize their plans by adjusting the number of people insured, selecting the benefits they want, and setting their coverage limits.
💙 Ubuntu Med Health hospital plan has established strong partnerships with key service providers and networks throughout South Africa, which has greatly improved their service delivery and expanded their coverage reach.
Hospital Benefits Plan
For a fixed amount, this plan offers a monthly premium of R186 that takes care of hospitalization costs resulting from accidents or illnesses.
What is the monthly premium for the Ubuntu Med Hospital plan insurance plans?
Ubuntu provides a wide range of plans to cater to different needs, with prices starting from R195 for hospital coverage and going up to R435 for daily benefits.
What Is the Waiting Period for Ubuntu Med Hospital plan Insurance Benefits?
Ubuntu has implemented distinct waiting periods for various benefits, rather than enforcing a single universal waiting period. This approach allows for greater flexibility and tailored coverage for their members. Here is the waiting period structure:
☑️ Accidents are promptly covered by your insurance, allowing you to receive immediate coverage for any injuries you may sustain from day one.
☑️ Typically, there may be a waiting period of one to three months for commonly utilized benefits such as prescription drugs and doctor’s visits.
☑️ Due to the nature of high-risk benefits, such as critical illness coverage, there might be a waiting period of 6 to 12 months. This waiting period is in place to manage the potential risks associated with these benefits.
☑️ Individuals with pre-existing medical conditions may experience extended waiting periods, usually ranging from twelve to twenty-four months.
How to Claim for Health Insurance Benefits
☑️ Prior authorization is required for several treatments, especially hospitalization, by Ubuntu Med. To prevent coverage issues and delays in claims processing, it is crucial to obtain pre-approval for your treatment and its associated costs.
☑️ Remember to ask your medical professional for any necessary documents after your treatment. I have gathered a collection of bills and medical records that confirm the payment and acknowledgment of medical services.
☑️ If you want to submit a claim with Ubuntu Med, you have the option to obtain the necessary documentation from their website or by contacting customer care. For optimal efficiency, it is crucial to ensure that all fields are completed with utmost accuracy and thoroughness.
☑️ Please submit the completed claim form to Ubuntu Med along with any necessary supporting documentation. There are various options available for submitting these papers promptly, such as sending them via email, traditional mail, or an online portal, depending on the specific circumstances.
☑️ Ubuntu Med will process your claim in accordance with the terms of your policy. It is important to ensure the claim is valid, double-check the information, and assess the costs in relation to your coverage limits.
☑️ After processing your claim, Ubuntu Med will inform you of the outcome. Payment for healthcare services can be made directly to the provider or reimbursed to you, depending on the approval and the terms of your plan.
Pros and Cons
✅ Pros
❌ Cons
Affordable Premiums
Limited Comprehensive Coverage
Offers low-cost plans under R300, making healthcare more accessible.
Limited Chronic Condition Management
Designed to cover specific health events or conditions, such as minor injuries or short-term illnesses.
Chronic conditions and long-term care are often not covered, requiring separate plans or out-of-pocket expenses.
Quick Access to Basic Care
Restricted Network of Providers
Ideal for Young and Healthy Individuals
No Specialist Care
Suitable for those who generally have good health but want coverage for unexpected health episodes.
Specialist consultations and treatments may not be included, requiring additional costs.
Simple and Transparent Plans
No Hospitalization Coverage
Plans are easy to understand and designed for specific health needs.
Hospitalization or extensive treatment is typically not covered under these low-premium plans.
Preventive Care Options
Higher Out-of-Pocket Costs for Major Treatments
Some plans may include preventive care, such as vaccinations or health check-ups.
You may face significant out-of-pocket expenses for major health issues not covered by the plan.
Easy Enrollment Process
Limited Benefits for Ongoing Health Needs
Simplified sign-up process, often with minimal paperwork.
Plans may not cover ongoing or long-term health needs, focusing more on immediate care.
Ubuntu Health Contact Details
🟧 Address: Innovation Park 1400 Angela Blvd, South Bend, IN.
What does critical illness cover and why is it important?
Critical illness cover is a type of health insurance that provides a lump-sum payment upon the diagnosis of a specified critical illness. This financial support can be used for medical treatment, recovery expenses, or any other needs the policyholder may have. The importance of critical illness cover lies in its ability to alleviate the financial burden associated with severe health conditions, allowing policyholders to focus on recovery without the added stress of medical bills and loss of income.
Which critical illnesses are typically covered by health insurance providers in South Africa?
The specific critical illnesses covered can vary between providers, but commonly included conditions are cancer, heart attack, stroke, major organ transplants, kidney failure, chronic coronary heart disease, paraplegia, and total blindness due to illness. Some providers may offer additional coverage for other serious conditions.
Are there any waiting periods before I can claim critical illness benefits?
Yes, most health insurance providers enforce a waiting period before critical illness benefits can be claimed. This waiting period can range from a few months to a year, depending on the policy. For instance, Episodic Health has a 12-month waiting period for their Dread Disease benefit, while other providers might have different timelines.
How does the payout work for critical illness cover?
Upon diagnosis of a covered critical illness, the insured person receives a lump-sum payout. This amount is predetermined based on the policy and can be used at the policyholder's discretion. The payout is meant to cover medical expenses, lifestyle adjustments, and any other financial needs during the treatment and recovery period.
Can I add critical illness cover to my existing health insurance plan?
Many health insurance providers offer critical illness cover as an add-on to their existing plans. For example, Dis-Chem Health offers the Medical Emergency Illness Buy-Up option, which can be added to their Accident Cover plans. This flexibility allows policyholders to enhance their coverage based on their individual needs and budget.
