The PPS Critical Illness Cover is an insurance product that covers serious illnesses, such as cancer and kidney failure, for amounts ranging from R300,000 to R11 million. Depending on the severity of the critical illness, the benefit pays out a lump sum ranging from 5% to 100% of the cover amount.

The payout from PPS critical illness cover can be used however the policyholder sees fit. PPS policyholders typically use the cover amount to cover out-of-pocket medical expenses, seek alternative treatments, and/or pay for rehabilitation costs.

Critical illnesses covered by PPS come with different benefits, and each benefit affects the claim that the policyholder makes. Benefits that are available are based on the severity of an illness. Below we go through the benefits that the plan provides.

PPS Critical Illness Cover Benefits

The PPS critical illness cover comes with three benefit options to choose from. These options are discussed in detail below.

Main Benefit

The main critical illness benefit comes with a cover amount of up to R11 million. The main cover provides cover for:

• Cardiovascular diseases
• Hematological diseases
• Neurological diseases
• Trauma counseling
• Kidney and Urological diseases
• Transplants
• Musculoskeletal
• Gastrointestinal
• Connective Tissue
• ICU benefit
• Cancer benefit
• Respiratory diseases
• Sensory benefits
• Endocrine
• The main cover includes three plans with payouts ranging from 5% to 100% of the cover amount. Children are covered under the main plan from birth, with no limit on the number of children or claims.

Children’s critical illness cover provides up to R250,000.00 of the main policyholder’s cover amount. For critical illnesses in children, 10% of the cover amount can be advanced; however, the benefit is capped at R250,000.00.

Policyholders can select one of three main benefits. The following are the options available to policyholders:

Basic Benefit

When a policyholder is diagnosed with a critical illness, the basic benefit pays a percentage of the sum insured. The benefit is proportional to the severity of the disease. Cancer, heart attack, and stroke are just a few of the conditions covered by the plan.

The benefit payout ranges from -5% to 100% of the cover amount. The plan pays out fixed percentages of the cover amount of 5%, 10%, 25%, 50%, 75%, or 100%. The basic benefit coverage begins at R200,000.00.

Core 100%

If the policyholder is diagnosed with a critical illness, the core 100% benefit pays out 100% of the cover amount. The benefit covers four of the most common conditions: cancer, heart attack, stroke, and coronary artery bypass graft.

When a policyholder is diagnosed with one of the four most common conditions, Core 100% pays out 100% of the cover amount. The plan also covers other conditions, but payouts are tiered based on the severity of the condition.

CI 100%

The CI 100% plan provides a premium benefit that covers most of the listed benefits. The plan makes a payout regardless of the severity of a diagnosis. The payout on the plan ranges between R200,000.00 to R11 million, depending on the cover amount that the policyholder has chosen.

Exact Rider Benefit

The Exact Rider benefit provides coverage of R1 million to R3 million. The plan supplements primary critical illness coverage at a fraction of the primary critical illness benefit premiums.

The Exact Rider benefit covers cancer-related diagnoses and pays a lump sum. The plan is for cancer treatment that necessitates or allows for the use of targeted therapy.

To receive the Exact Rider Benefit, the policyholder must be diagnosed with cancer and must obtain confirmation that targeted therapy can be used. Only if the treatment is for targeted therapy will the policy pay.

Expander Rider Benefit

The Expander Rider benefit is a critical illness insurance policy that pays out if the policyholder is diagnosed with a critical illness. However, the benefit only covers critical illness diagnoses at an early stage. The policy has a maximum cover amount of R250,000.00.

In addition to the critical illness coverage, the policy has an additional premium. The plan provides a maximum payment of 25% up to R250,000.00 for diagnoses of critical illnesses. The plan covers critical illnesses such as schizophrenia, cerebral malaria, bacterial meningitis, and hip replacement.

Catchall Benefit

The Catchall benefit provides coverage of all conditions that are not listed but which also meet the defined WPI (whole person impairment) claims criteria. The cover under the benefit ranges between R200,000.00 to R11 million. This benefit comes at an additional premium to the policyholder.

Advantages of PPS Critical Illness Cover

• The cover comes with additional benefits that the primary cover doesn’t offer and can enhance the cover.
• There are different add-ons for policyholders to choose from.
• The policyholder can make multiple claims under the plan.
• The ICU benefit is included on the plan, which covers ICU admission as a result of a disease or injury.
• Children are automatically covered on the plan for a maximum of R250,000.00.
• The cover provides coverage for a number of critical illnesses.
• The payout amount can be used by the policyholder in any way they see fit.
• Monthly premiums on the cover are affordable as premiums are flexible.
• The Catchall benefit is available, which provides cover for all severe illnesses that are not listed in any of the benefit categories on the plan.
• The maximum cover amount of over R11 million is very high.

Disadvantages of PPS Critical Illness Cover

• The cover doesn’t have a premium back benefit for being claim-free over a certain period of time.
• There is no paid-up benefit, which is available for some similar insurance products in South Africa for those who are over the age of 65.

Conclusion

The PPS Critical Illness Cover offers excellent value for money to policyholders because it covers not only the policyholder but also their children. Children are insured at no extra cost up to a maximum of R250,000.00. The policy also includes add-ons that can be used to improve the insurance product.

When the policyholder is claim-free, there is no cashback or premium refund benefit. This is the plan’s main disadvantage. However, overall, the coverage provides great value, even though there are no free added benefits other than the child benefit.