LifeTime Max 100% Severe Illness Benefit
Provides a base payout of 25% - 100% upon meeting the requirements of one of the defined severe illnesses, depending on severity.
The base payout is then increased by the applicable number of LifeTime Upgrades, which depends on the LifeTime impact score for the illness.
The LifeTime Impact score is dependent on the following factors:
- Expected duration of the severe illness - Invasiveness of surgery
- Impact of any therapy and rehabilitation required and its associated discomfort; and
- Impact of any assisted care and devices.
Each LifeTime Upgrade adds 25% to the base payout percentage, subject to a maximum boosted payout of 100%.
Discovery Life will pay an additional 5% per dependant (up to a maximum of 15%). This boost is not subject to the Max selected.
Professional Health Provider with Catchall Cover and Core 100%
Cover
Tiered severity structure, with payouts ranging from 25% to 100%.
The Core 100% Cover provides a 100% payment for illnesses in the following categories:
- Heart Attack
- Cardiac Surgery and Procedures (excluding Severity D claims)
- Stroke
- Cancer (excluding prophylactic total mastectomy not for cosmetic purposes).
Discovery's LifeTime benefit considers the long-term impact of an illness, as well as the policyholder's family composition at claim stage, to ensure that the claim payout matches the financial impact of the severe illness on a client’s lifestyle.
PPS does not offer a benefit that considers the long-term impact of an illness on a person’s lifestyle.
Payouts for SCIDEP illnesses are guaranteed at 100%.
with the LifeTime Benefit. Boosts will also be applied to non-SCIDEP conditions.
The LifeTime benefit offers an efficient solution for extensive severe illness cover, as the charge for this benefit is only 26.5% more than the Comprehensive option.
The average LifeTime boost was 129% in 2014.
Discovery’s comments
DREAD DISEASE BENEFITS (CONT.)
LifeTime (Plus) Severe Illness Benefit
Provides a base payout of 5% (25% without Plus) to 100%
upon meeting the requirements of one of the defined severe illnesses, depending on severity.
The base payout is then increased by the applicable number of LifeTime Upgrades, which depends on the LifeTime impact score for the illness.
The LifeTime Impact score is dependent on the following factors:
- Expected duration of the severe illness - Invasiveness of surgery
- Impact of any therapy and rehabilitation required and its associated discomfort; and
- Impact of any assisted care and devices.
Each LifeTime Upgrade adds 25% to the base payout percentage, subject to a maximum boosted payout of 100%, 125%, 150% or 200%, as selected.
Discovery Life will pay an additional 5% per dependant (up to a maximum of 15%). This boost is not subject to the Max selected.
Payouts for SCIDEP illnesses are guaranteed at 100%.
Boosts will also be applied to non-SCIDEP conditions.
The LifeTime Upgrades are applicable to Severities A - D.
No equivalent benefit. Discovery's LifeTime benefit considers the long-term
impact of an illness, as well as the policyholder's family composition at claim stage, to ensure that the claim payout matches the financial impact of the severe illness on a client’s lifestyle.
PPS does not offer a benefit that considers the long-term impact of an illness on a person’s lifestyle.
The LifeTime benefits offer the potential to receive up to 215% of the sum assured, whereas PPS will never pay more than the sum assured.
The expected increase for the LifeTime Max of 200%
is 170% of the original sum assured (plus an extra amount up to 15% for financial dependants).
By choosing a LifeTime Max of 125%, 150% or 200%, a client can receive the highest payment in the market for a severe illness claim.
Discovery Life recognises that a payment in excess of the selected sum assured is required in certain circumstances. The LifeTime benefits thus offer a unique, efficient solution that allows the payout to flex such that more than the sum assured can be paid when necessary.
Discovery’s comments
DREAD DISEASE BENEFITS (CONT.)
Multiple claims
Multiple claims are allowed on the Classic and Essential Life Plans as follows.
Classic Life Plan:
Multiple claims are permitted whether the severity of the subsequent related claim is of a higher, lower or same severity as the first claim.
A subsequent claim for the same or related illness is regarded as independent of the first claim (i.e. the full applicable severity level is paid), unless it is a
progressive disease such as cancer.
Maximum payouts:
- Accelerated: no maximum, you can claim provided you have Life Fund available.
- Non-accelerated: No maximum.
Essential Life Plan:
Subsequent related claims will only be paid where the severity level of the subsequent claim is higher than the previous claim.
Maximum payouts:
- Accelerated without Minimum Protected Fund = sum assured.
- Accelerated with Minimum Protected Fund = 2 times sum assured for related claims.
- Non-accelerated = sum assured for related claims.
Multiple Claims
Related claims will only be paid if the subsequent claim is of a higher severity than that of the previous claim.
With the stand-alone benefit, cover reinstates for unrelated conditions.
Maximum payouts:
- Stand-alone benefit: sum assured for related claims.
- Accelerated benefit: sum assured.
The impact of the different definitions is that PPS should be compared to the Essential Life Plan, as Discovery will pay far more for multiple claims on the Classic Life Plan.
On the Classic Life Plan, the non-accelerated benefit reinstates cover for related claims and the full percentage is paid for non-progressive claims.
There is no limit to the amount that you may claim on the Classic Life Plan.
Discovery’s Minimum Protected Fund reinstates cover for the same, related and unrelated illnesses, allowing the policyholder to claim more than the sum assured on both the Classic and Essential Life Plan.
PPS’s dread disease benefit does not reinstate for subsequent related claims.
Examples where PPS will not reinstate cover (i.e.
where the policyholder will never be able to claim more than 100% of the sum assured) include the following:
- Subsequent claim for a stroke - Heart attack leading to a stroke - Kidney failure as a result of paraplegia - Blindness as a result of multiple sclerosis
The following table illustrates how important coverage for a recurrence of the same illness or a related illness is:
Illness Incidence of recurrence / related claim
Heart attack 30%1
Stroke 25%2
Paraplegia leading to
kidney complications 20%3 1Post Graduate Medicine
2National Stroke Association 3Neurology Report, Finley et al
The importance of multiple claims can be seen from Discovery’s 2014 claims experience, where we found that a significant number of subsequent claims fell in the same body system. For example, if your first claim was in the heart and artery body system, the chances of you having a subsequent claim in this body system is 75%.
Discovery’s comments DREAD DISEASE BENEFITS (CONT.)
Severe Illness BenefitBooster™
Both the principal and spouse can receive up to 40%
additional severe illness cover at no additional premium if the policy qualifies for BenefitBooster™.
The maximum cover that can be added for each of the principal and spouse is R1.5 million.
The BenefitBooster™ applies to Severity A and B claims.
The boost does not apply to LifeTime and Extender benefits.
For more information see the BenefitBooster™ section.
Simultaneous claims arising from a single cause
The claim event resulting in the highest payment is admitted first. The second claim is admitted if the second condition is still present after six months.
Survival period
There is no general survival period required to get a benefit payment. In certain cases a period is specified to establish severity.
A 14-day survival period applies to the Minimum Protected Fund.
No equivalent benefit.
Simultaneous claims
Only the higher claim will be paid, not both amounts. PPS may at their discretion elect to make both payments.
Survival period
PPS has a survival period of 14 days. In certain cases a longer period is specified to establish severity.
We also found that 48% of subsequent claims in the same body system are of the same or lower severity than the previous claims.
These two statistics illustrate the importance of not having a cap on the maximum amount you can receive for claims in the same body system and in paying multiple claims regardless of their severity.
Discovery's treatment of multiple claims arising from a single event means that a substantially higher payout may be made compared to PPS.
The survival period is especially relevant for PPS's stand-alone benefit. No Severe Illness benefit will be paid if the policyholder dies within 14 days after qualifying for a claim.
Discovery does not apply a general survival period.
There is only a 14 day survival period for the
Minimum Protected Fund to reinstate a client’s cover.
The same 14-day reinstatement period applies to the non-accelerated Severe Illness Benefit.
Discovery’s comments
DREAD DISEASE BENEFITS (CONT.)
Automatic severe illness cover for children
On the Classic Plan, the Severe Illness Benefit selected by the principal and spouse will automatically include severe illness cover for their children.
The amount of automatic cover is equal to 10% of the main Severe Illness Benefit sum assured, limited to a maximum of R135 000 per child per claim event.
The benefit payout varies by severity of illness.
Covers all body systems covered under the main Severe Illness Benefit, as well as a list of conditions affecting children.
A claim against the automatic cover for children will not accelerate the Life Fund or reduce the Severe Illness Benefit of the principal or spouse.
ParentCare
On the Classic Life Plan, the Severe Illness Benefit of the principal and/or spouse will automatically include frail care cover for their parents, objectively defined by self-care Activities of Daily Living criteria.
The benefit amount is 5% of Severe Illness Benefit per parent, subject to a maximum of R100 000 per parent.
Covers all the conditions covered by the Comprehensive Severe Illness Benefit.
A claim against the automatic cover for parents will not accelerate the Life Fund or reduce the Severe Illness Benefit of the principal or spouse.
Global Treatment Benefit
The Global Treatment Benefit is automatically included with the Severe Illness Benefit on the Classic Life Plan.
The benefit offers the policyholder a choice of either:
- Having the treatment performed in South Africa and receiving the normal Severe Illness Benefit amount, depending on the severity of the illness.
- Having the treatment performed in the USA and receiving 80% of what they would have received from the first option, plus the actual cost of treatment at the overseas facility subject to a maximum of the benefit amount that would have been payable under the first option.
No comparable benefit.
No comparable benefit.
No comparable benefit.
Discovery Life was the first insurance company to recognise that the illness of a child has an effect on the parents’ financial situation and lifestyle.
Discovery Life policyholders can insure their children for up to R1.435 million by combining the automatic Severe Illness cover for children and the Child Severe Illness Benefit
Discovery has recognized that the severe illness of a parent can place a significant financial burden on the policyholder.
Discovery policyholders can insure their parents for up to R1 million through the combination of the ParentCare Benefit and the additional Parent Severe Illness Benefit.
Rapid advances in healthcare technology and the emergence of global specialist centres of excellence have prompted Discovery to offer the Global Treatment Benefit.
The benefit ensures that policyholders have access to the best medical treatment for a given illness.
The benefit empowers claiming policyholders to choose whether they want their illness treated locally or in the USA through the Discovery Network.