ILLNESS INSURANCE

WHAT WE COVER
This document contains a summary of the conditions covered by the product and
benefits under our illness insurance range, as well as the payout percentages you can
claim for. For easy navigation, we’ve broken the sections up into body systems and
colour-coded each of them.
You can use this document to help you decide which benefits to add to your cover, or
to check if you can claim for your condition. Note that this document does not replace
the legal terms and conditions in the product benefit rules.

DO GREAT THINGS EVERY DAY

 SEVERE ILLNESS
SEVERE ILLNESS

MILD ILLNESS
MILD ILLNESS

RETURNING
RETURNING

BENEFIT

BENEFIT

BENEFIT
ILLNESS
TOP-UP
BENEFIT

BENEFIT

BENEFIT
ILLNESS

COVER
TOP-UP
COVER
Angioplasty and/or stenting 30%

CARDIOVASCULAR
Bone marrow failure (incl Aplastic
CANCER

25% 100%
anaemia) Aortic surgery 100%, 50% 100% 50%

Cancer 100%, 50%, 25% 100% 50%, 25% Arrhythmia 75% 100%
Chronic blood disorders 50% 100%
Artery surgery 25% 100% 25%
Early bladder cancer* 15%
Cardiomyopathy 100%, 75%, 50% 100%
Early breast cancer* 15%
Carotid artery surgery 100%, 25% 100% 50%, 25%
Early cervical cancer* 15%
Coronary artery bypass graft 100%, 75%, 50% 100% 50%
Early ovarian cancer* 15%
Heart attack 100%, 75%, 50%, 25% 100% 50%, 25%
Early prostate cancer* 15%
Heart surgery 75% 100% 50%
Early testicular cancer* 15% Minor heart surgery 30%

Early oesophageal cancer* 15% Heart transplant 100% 100%

Gastrointestinal stromal tumour* 15% Heart valve replacement or

100%, 75%, 50% 100% 50%
repair
Hematopoietic stem cell (Bone marrow)
100% 100%
transplant Pathway ablation 30%

Neuroendocrine tumours* 15% Pacemaker insertion 30%

Non-melanoma skin cancer stage lll or IV 100% 100% 50% Pericardiectomy 25% 100% 25%

Partial mastectomy 25% 100% 25% Peripheral arterial disease 100%, 50% 100%

*All early diagnosed cancer payouts are limited to R100 000.

 SEVERE ILLNESS

SEVERE ILLNESS
MILD ILLNESS

MILD ILLNESS
RETURNING

RETURNING
BENEFIT

BENEFIT

BENEFIT
ILLNESS

BENEFIT

BENEFIT

BENEFIT
TOP-UP

ILLNESS
TOP-UP
COVER

COVER
Acquired intellectual/cognitive Acute kidney failure 50% 100%
100% 100%

GASTROINTESTINAL
CENTRAL NERVOUS SYSTEM

impairment
Chronic kidney failure 100%, 50%, 100%
Bacterial meningitis 30%
Chronic liver failure 100%, 75%, 50% 100%
Benign brain tumour 50%, 25% 100%
Chronic pancreatitis 50% 100%
Brain surgery 50% 100% 50%
Crohn’s disease with specified surgery 50%, 25% 100%
Cavernous sinus thrombosis 50% 100%
Kidney transplant 100% 100%
Cerebral aneurysm 30%

Cerebral arteriovenous malformation 30% Liver transplant 100% 100%

Cerebral malaria 50%, 25% 100% Pancreatectomy or pancreas

100% 100%
transplant
Coma 100%, 50% 100%
Permanent ileostomy or colostomy 100% 100%
Dementia (incl Alzheimer’s disease) 100% 100%
Total colectomy 100% 100%
Encephalitis 30% Total cystectomy 100% 100%
Eye stroke 30% Total penectomy 50% 100%
Guillain Barre syndrome with Ulcerative colitis 25% 100%
incomplete recovery 30%

ENDOCRINE
Cushing’s disease 30%
Minor stroke 30%
Nephrectomy 30%
Motor neurone disease 25% 100%
Type 1 diabetes 30%
Multiple sclerosis 50%, 25% 100%

Muscular dystrophy 25% 100%

Myasthenia gravis Class III or higher 100% 100% Accidental HIV for medical, dental or
100% 100%
nurse practitioners
Paralysis 100%, 50% 100%
Accidental HIV via a blood transfusion 100% 100%
HIV/AIDS
Parkinson’s disease 25% 100%
Accidental HIV via a road traffic
Parkinson’s Plus syndrome 25% 100% 100% 100%
accident

Psychiatric disorders 100% 100% Accidental HIV via an organ

100% 100%
transplant
Spinal cord tumour 50% 100%
Accidental HIV via violent crime, rape
Status epilepticus 50% 100% 100% 100%
or indecent assault

Stroke 100%, 75%, 50%, 25% 100% 50%, 25% AIDS 100% 100%
 SEVERE ILLNESS

SEVERE ILLNESS
MILD ILLNESS

MILD ILLNESS
RETURNING

RETURNING
BENEFIT

BENEFIT

BENEFIT

BENEFIT

BENEFIT

BENEFIT
ILLNESS

ILLNESS
TOP-UP

TOP-UP
COVER

COVER
Chronic respiratory failure 100%, 50% 100%
RESPIRATORY

Activities of Daily Living 100%, 75%, 50% 100%

LIFESTYLE
Lobectomy 30% Terminal illness
100% 100%
Lung surgery 100%, 50% 100% 50%

Lung transplant 100% 100%

Prolonged mechanical ventilation 100% 100%

Pulmonary arterial hypertension 100%, 50% 100%

Pulmonary artery surgery 75% 100% 50%

AUTOIMMUNE
Pulmonary embolism 30% Advanced rheumatoid arthritis 50%, 25% 100%

Recurrent pulmonary emboli 50% 100% Connective tissue disease 100%, 75%, 50% 100%

Polymyositis 100% 100%

Enucleation of the eye 50% 100%

SENSES

Loss of hearing 100%, 50% 100%

Moderate loss of hearing 30%

Loss of sight 100%, 50% 100%

Loss of speech 100% 100%

Retinitis pigmentosa 25% 100%

Accidental brain injury 100%, 75%, 50%, 25% 100%

TRAUMA

Amputation of limb 50% 100%

Less extensive burns 30%

Major burns 100%, 75%, 50%, 100%

Trauma 30%
 Child Illness Benefit Achondroplasia

CONGENITAL BIRTH DEFECTS

Anal atresia
This benefit pays up to 10% of the cover amount (maximum R500 000) on the Severe Illness Cover if Autosomal recessive polycystic kidney disease
the insured person’s child suffers a severe illness or is born with a congenital birth defect and if the Biliary atresia
survival period is met. It covers 80 child illnesses and 26 congenital birth defects. Brain and skull disorders
Cerebral palsy
Choanal atresia
Endocrine: Cleft lip and complete cleft palate
Activities of Daily Living:
Type 1 diabetes Clubbed feet (talipes)
Child-specific catch-all
Congenital blindness
Terminal Illness
Gastrointestinal: Congenital deafness
Autoimmune: Acute kidney failure Congenital heart disease
Advanced rheumatoid arthritis Chronic kidney failure Congenital hip dislocation
Connective tissue disease Chronic liver failure Cystic fibrosis
Juvenile idiopathic arthritis Chronic pancreatitis Down syndrome
Polymyositis Crohn’s disease with specified surgery Duchenne syndrome or congenital myotonic dystrophy
Kidney transplant Haemophilia
Cancer: Liver transplant Hirschsprung’s disease
Pancreatectomy / pancreas transplant
Bone marrow failure (including severe aplastic anaemia) Hydrocephalus
Cancer Permanent ileostomy/colostomy
Hypospadias
Chronic blood disorders Total colectomy
Inborn metabolic disorders
Hematopoietic stem cell (bone marrow) Total cystectomy
Total penectomy Klinefelter’s syndrome
transplant
Ulcerative colitis Myelomeningocele
Non-melanoma skin cancer stage III or IV
Necrotising enterocolitis
Partial mastectomy
HIV/AIDS: Neuro-developmental disorders
Cardiovascular: Accidental HIV via a blood transfusion Tracheo-oesophageal fistula or oesophageal atresia
Aortic surgery Accidental HIV via a road traffic accident
Arrhythmia Accidental HIV via an organ transplant
Artery surgery Accidental HIV via violent crime, rape or
Cardiomyopathy indecent assault
Carotid artery surgery AIDS For Women Benefit
Coronary artery bypass graft
Heart attack Respiratory: The For Women Benefit pays a single amount if the insured person suffers a female-specific
Heart surgery Chronic respiratory failure illness event. These events will provide a payout that varies by the severity of the condition.
Heart transplant Lung surgery
The For Women Benefit covers three types of events: Cancer, Complications during
Heart valve replacement/repair Lung transplant
pregnancy and Fertility-related events.
Pericardiectomy Prolonged mechanical ventilation
Peripheral arterial disease Pulmonary arterial hypertension
Pulmonary artery surgery Cancer:

FOR WOMEN BENEFIT EVENTS

Central Nervous System: Recurrent pulmonary emboli Prophylactic bilateral mastectomy 25 %
Acquired intellectual / cognitive impairment
Benign brain tumour Senses: Complications During Pregnancy:
Brain surgery Enucleation of the eye Amniotic fluid embolism 50 %
Cavernous sinus thrombosis Loss of hearing Antepartum haemorrhage 25 %
Cerebral malaria Loss of sight Disseminated intravascular coagulopathy 50 %
Coma Loss of speech Eclampsia 25 %, 50%
Dementia (incl Alzheimer’s) Retinitis pigmentosa Ectopic pregnancy 25 %
Motor neurone disease Miscarriage due to diagnostic procedures 25 %
Note published 27 May 2020

Multiple sclerosis Trauma: Postpartum haemorrhage 50 %

Muscular dystrophy Accidental asphyxiation Severe vaginal tearing 50 %
Myasthenia gravis Class III or higher Accidental brain injury Stillbirth 25 %
Paralysis Accidental near drowning Uterine rupture 50 %
Parkinson’s disease Amputation of limb
Parkinson’s Plus syndrome Dog bites Fertility-Related:
Psychiatric disorders Major burns Endometriosis stage III or IV 15 %
Status epilepticus Multi-fibroid uterus 15 %
Stroke Premature ovarian failure 15 %
Spinal cord tumour Prophylactic bilateral oophorectomy 15 %

Old Mutual Life Assurance Company (SA) Limited is a licensed FSP and Life Insurer.