Should you get chronic illness cover?

When you are young and seemingly healthy, probably the last thing on your mind is getting chronic illness cover. What is the point if there is nothing wrong with you? Moneybags journalist Jessica Wood investigates what chronic illness cover is, and what is covered.

Having medical aid cover, or some other form of health cover, makes sense as this will help cover the costs of doctor’s visits during the pesky cold and flu season, as well as any unforeseen occurrences, such as a broken bone or appendicitis.

But what if something more serious happens to your health, and you can’t work, or carry on with your daily routines? In this case, chronic illness cover would come in handy, but is it for everyone?

What is a chronic illness?

A chronic illness is a health condition or disease that is long-lasting, or that develops over time. The Center for Managing Chronic Disease explains: “Chronic Disease is a long-lasting condition that can be controlled but not cured.” goes on to say that a chronic disease is one that lasts three months or longer, and “generally cannot be prevented by vaccines or cured by medication, nor do they just disappear.”

However, it is important to differentiate between chronic and acute diseases, as a chronic disease may have relapses, with periods of remission in between each bout of the disease.

For example, arthritis is a chronic condition. The arthritis can go into periods of remission where the patient does not suffer from joint pain and inflammation, but this remission may be of long or short duration, with the arthritis recurring ever so often.

It is also important to note that not all chronic illnesses, despite what some people may believe, only occur in older people. For example, chronic diseases such as diabetes and Systemic Lupus Erythematosus (SLE) can start to show symptoms in teenagers and young adults.

Chronic illness cover

If you are a member of a medical aid scheme or have a hospital plan, as part of the Prescribed Minimum Benefits (PMB) you will be covered for chronic illnesses.

However, you may have to complete additional application forms for this cover to be activated, as the medical aid or hospital plan provider will need to know the details of the condition and have information from your doctor regarding your disease.

The chronic condition you have, as well as the severity of it will also be a determining factor in the type of treatment or medication that is approved by your medical scheme provider.

Medical scheme Discovery, for example, states: “For a condition to be covered from the Chronic Illness Benefit, there are certain criteria the member needs to meet. This ensures that our members receive sustainable funding for cost- effective treatment.

“You need to apply for each chronic condition to be covered from the Chronic Illness Benefit. We will only pay for the medicine and treatment from the Chronic Illness Benefit if your condition and medicine is approved.”

For any chronic conditions that are not listed on the Chronic Disease List, you will have to contact your medical scheme provider to find out under what conditions, if any, they will provide cover for.


The good news is that medical schemes do cover you for chronic illnesses because they have to by law. The Council for Medical Schemes website highlights that there is a list of 25 chronic conditions with specified medication and treatment listed on the Chronic Disease List, which falls under the PMB that a medical aid must provide. To view the Chronic Disease List, click here.

It states: “If you have one of the 25 listed chronic diseases, your medical scheme not only has to cover medication, but also doctors’ consultations and tests related to your condition. The scheme may make use of protocols, formularies (lists of specified medicines) and Designated Service Providers (DSPs) to manage this benefit.”

While your medical scheme covers the cost of your chronic illness treatment it won’t cover costs for other things, such as your loss of income. This is why experts recommend chronic illness cover in addition to the cover provided by your medical scheme. It’s to cover the costs that your income would’ve covered had you been able to work as well as other unforeseen expenses.

According to Ryan Chegwidden, head of product and technical at Hollard Life, things such as disability or critical illness cover are something that people only worry about when they get older. However, he revealed: “The reality is, the sooner you consider risk cover, the better. It’s a fact that the cost of insurance products increase as you get older.”

While you are young and fit you may not need such cover. But should an event happen it could be more costly when you do finally subscribe for such insurance.  He added: “If you’re unlucky and suffer poor health or a debilitating accident before applying for cover, the cost will be significantly higher. In certain scenarios, cover may exclude pre-existing conditions entirely. This means that you won’t get cover for any claims that are directly related to the excluded conditions.”

Hospital plans

It is not only comprehensive medical aid schemes that offer chronic condition cover. A cheaper alternative to taking out a comprehensive medical scheme, would be to have a hospital plan. Hospital plans will also cover the 25 PMB chronic conditions on the Chronic Disease List.

Selfmed’s MEDXXI Hospital Plan covers such illnesses but the provider points out: “[We] are also very aware that hospital plans may not be the best solution for every single medical scheme member. Young couples starting a family, for example, would do well to get a more comprehensive medical plan to cover their children against potential ailments. Similarly, elderly persons with identified illnesses or the risk for hereditary health problems would do well to take out more comprehensive cover, with bigger allowances for specialist consultations or chronic medication.”

For more information on the difference between a medical aid and hospital insurance (hospital plan), click here.

Youth and critical illness insurance cover

One thing to consider when looking at critical illness cover is that, even though you are young and fit, there is no guarantee that you will remain that way. People are being diagnosed with chronic conditions, cancer and other disease far more frequently, and at much younger ages than they were in the past.

“The reality is that you need cover when you are younger.  This is the most productive time of your life when you are most reliant on your income to meet financial obligations, take care of your growing family and secure a comfortable future retirement.  Buy early in your career as it is not only the time when you need it most, but also the time when insurance premiums are cheaper,” highlighted Chegwidden.