What is Accident Cover Benefit?
This article refers to an insurance product, which is different from a medical aid.
Hospitalisation is usually required because you have had an unexpected accident (fallen off a ladder, attacked by a dog, involved in a car collision), or because something has gone wrong “healthwise” and you have an illness (kidney stones, stroke, cysts). Medical aid automatically covers you for both type of events, but with hospital insurance you need a separate cover for accident and/or illness. Here we deal with Accident Cover, but you should also see our article on hospital insurance Illness Benefit.
(Tip: Plans that only cover treatment needed as a result of an accident are usually much cheaper than those that cover benefit for illness. )
If you have an Accident Benefit, you will have cover for various types of hospitalisation. Different plans pay out differently, and offer more (or less) additional benefits. Read the small print carefully, and always speak to a broker before choosing a policy. To help you, we have included the most common benefits below. You might not need (or get) all of them, and it’s up to you to decide which benefits are essential.
Note: not all these benefits are available on all the plans.
Casualty Benefit
Two types of cover for casualty as a result of an accident:
- Requires admission to hospital
- Does not require admission
If there is no admission required, then you will be using a simple “ER accident” benefit. These usually have a per event and per year limits and will apply to “per person” or “per family”.
If your injury does require admission to hospital, then things get more tricky. In order to be covered for this portion, you need some sort of hospital benefit.
Be careful. Some ER benefits only apply to “after hour” visits.
Hospitalisation
There are three main types of hospital cover for accidents:
- has a flat limit, per event or per year. (Example: Flexicare has R1 million limit, Affinity Health has R275,000 per event limit)
- and/or has a cash payout per day spent in hospital (Example: Stratum pays additional R2,000/day). Cash payouts are paid to you directly, and can be used at your discretion.
- pays for stabilisation only
If you have a stabilisation only benefit, once you are stabilised you will need to provide alternative cover to continue to stay in a private hospital.
Netcare has no limit if you are treated in one of their hospitals for less than 90 days
Heart Attack and Stroke
Some plans are including heart attacks and strokes under their “accident-only” plans, and are providing an explicit sublimit to treat these. Normally, this would be an “Illness benefit”. (Example: Dischem Health)
MRI and CT Scans
With this benefit, you will be covered for specialised radiology if you are admitted to hospital due to accident. Without this explicit benefit, all such costs will likely need to be paid out of your cash payout or other sublimit, unless otherwise stated.
There will be a limit to this benefit, and hospital admission is a requirement.
(Example: Elixi, Stratum)
Disability Payout
This is a lump sum cashout should you be disabled as a result of an accident. (Example: OnePlan)
In a similar vein, some plans have a benefit to pay for out of hospital rehabilitation and physiotherapy, if you were hospitalised due to an accident. (Example: Stratum)
Funeral and Death Cover
On a more sombre note, should you die as a result of your accident, this benefit would pay out a lump sum to your family, either to help with funeral expenses or to alleviate other financial pressures. (Example: OnePlan and Elixi)
