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Wednesday, October 30, 2013 - 10:23
Not all costs covered

Near the end May was evidently “World Multiple Sclerosis Day”, intended to create global awareness of a disease that continues to baffle doctors. Along with other severe illnesses that affect the lives of sufferers and their families, this disease has a financial impact that is seldom ever planned for.
“People are often under the impression that Medical Aid cover is enough for all additional costs associated with Multiple Sclerosis and other similar severe illnesses,” says Jaco Gouws, Risk Product Marketing Manager at Old Mutual. “MS, like Muscular Dystrophy, Alzheimer’s and Rheumatoid Arthritis is a degenerative illness where a patient’s health deteriorates over a period of time. This affects the quality of life and is taxing on the patient’s mental and physical wellbeing.
“The loss of income when one is no longer able to work; funds needed to adapt the home or transport; alternative medical care; rehabilitation; or the need for caregivers for example, also needs to be considered. These costs are not covered, in most part, by Medical Aids.”
Gouws adds that the average age of diagnosis of MS is 30 years, with the average life expectancy of another 30 years from the date of diagnosis. Many insurance companies offer a benefit called “severe illness cover”. These solutions are designed to pay out a benefit when a life assured is diagnosed with one of the severe illnesses listed in the contract. The pay-out will assist in any lifestyle adjustments required as a result of the diagnosis and its associated complications.
In the case of degenerative illnesses, claims should be submitted when a certain level of disability or impairment is reached. For example, if you need help with bathing, but are able to perform all other activities of daily living, your level of disability is not severe enough for a benefit payment. However, if you need help with bathing and cannot eat or dress yourself at all, or fail any two activities of daily living, a claim qualifies for a payment from a medical point of view.
“Earning ability cover offers additional benefits, which could provide you with the financial support you need from as early as initial diagnosis,” says Gouws. “These should include benefits specifically linked to both occupational disability and functional impairment.”
An occupational disability benefit will pay out when the disease has reached a stage where you are no longer able to work. For example, a common occurrence in MS sufferers is a condition called Optic Neuritis, which is an inflammation of the nerve to the eye, affecting your ability to see. You can most probably still bath and dress yourself, meaning that your life quality score does not qualify for the severe illness benefit payment. However, your occupational disability benefit will, in all likelihood, pay out, ensuring you an income when you are no longer able to work.”
The same applies to the functional impairment benefit when, for example, your left arm is paralysed. You may still be able to work, which means that you cannot claim an occupational disability benefit, and you may not qualify for payment either under a severe illness benefit. However, you will most probably qualify under the functional impairment benefit.
“The most comprehensive solution will ensure that your quality of life is maintained at various stages of your illness,” says Gouws.

Copyright © Insurance Times and Investments® Vol:26.6 1st June, 2013
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