Pandemic Shield FAQs

Certainty in a time of anxiety

What does it cover?

The Pandemic Shield insurance policy provides cover for the current coronavirus pandemic – and for future pandemics. Any sudden outbreak of disease declared to be a pandemic by the World Health Organisation (WHO), and recognised as such by the national government, will be covered under your Pandemic Shield policy.

To qualify for a fixed sum pay-out under your Pandemic Shield policy, you will need to have been hospitalised for at least 48 hours, and to have tested positive for COVID-19.

On the Diamond Plan, you will receive a once-off payment of R50 000, plus R500 per day for the duration of your hospital stay (up to a maximum of 14 days, whichever is the shorter). On the Gold Plan, you will receive R25 000 as a once-off payment.

Why do I need Pandemic Shield insurance cover?

If you are hospitalised due to COVID-19, you will be unable to work – possibly for several weeks. Even with the best medical care, it may take you some time to fully recover. Even if you are not earning, you will still have bills to pay – and additional expenses related to your treatment.

Pandemic Shield insurance provides a fixed sum pay-out that can make a real difference. You can put it towards:

The cost of your hospital healthcare
Other expenses such as transport for family members who visit you
Childcare services for your children while you can’t take care of them
Meeting payment obligations when you’re unable to earn due to hospitalisation

Is this a medical scheme?

No, Pandemic Shield insurance is not a medical scheme. Rather, it pays out a fixed amount if you are hospitalised as a result of COVID-19.

Who is eligible for Pandemic Shield insurance?

Any person younger than 60 years at the time they apply may take out this insurance. Only one policy is allowed per insured person.

What are the waiting periods?

A 21-day general waiting period applies to all Pandemic Shield policies under this policy. No claims can be made during the waiting period. Events that occur during the waiting period cannot be claimed for, even if the claim is submitted after the expiration of the waiting period.

Will I need to undergo a medical?

No, this is not necessary. You can still be accepted for Pandemic Shield cover if you have a pre-existing condition.

What if I am hospitalised again for COVID-19?

You can make a subsequent claim under your Pandemic Shield policy but only once a 21-day period has elapsed since your previous discharge from hospital following treatment for COVID-19.

Will I be able to claim if I am hospitalised for quarantine purposes?

No, you must have been admitted to a registered hospital for the ongoing treatment of a pandemic illness (This includes COVID-19) to qualify for a claim under the Pandemic Shield policy.

Please note: These FAQs are merely for information purposes and do not purport to be or act as advice.

Is pandemic cover available for families?

No, at present the policy only covers one individual. This is currently being reviewed.

Can minor children younger than 18 years who cannot legally enter into the contract take out cover?

A parent can take out cover on behalf of a minor and sign the application on their behalf. The parent will be the premium payer.

Can a client pay annually in advance?

Yes, this would be possible. Please discuss this option with your broker.

Isn’t there a risk of people taking out the policy, and then cancelling in a few months’ time when life goes back to “normal”? Is there a fixed term before cancelling the policy because members might cancel after Covid-19?

Please remember that this policy covers any sudden and global outbreak of a disease classified by the World Health Organisation (WHO) as a pandemic after 1 January 2020, and subsequently recognised by the country it is contracted in and acknowledged as a pandemic. This pandemic insurance is therefore not only applicable to Covid-19, but also covers any future WHO declared pandemics. If a member cancels, giving the mandatory 30-days’ notice, a 6-month waiting period will be imposed before they can join again.

What documentation is needed to submit a claim?

A fully completed and signed claim form for each event.
Proof from the hospital (on their letterhead) or a hospital statement, stating the date of admission and date of discharge.
A pathologist report confirming the positive diagnosis for the declared pandemic.
The Underwriter reserves the right to call for additional information of a clinical nature.

How long will it take to pay my claim?

Sirago Underwriting Managers have weekly claims payment runs, which take place every Friday.

Can I only claim after being discharged from hospital?

Yes, with all the required supporting documentation and evidence.

Will Pandemic Shield or the Insurer issue guarantee of payment to the hospital?.

Unfortunately not. Once assessed and approved, applicable benefits will be paid directly into the policyholder’s account.

Will I be covered in a private or public hospital?

You will be covered in any registered hospital where you have been admitted for a minimum admission period of 48 hours for medical treatment directly related to the pandemic.

Can this product be sold outside SA?

Unfortunately, not.

Does the cover only relate to incidences in SA or also overseas cases?

South Africa only. If you are admitted to a registered hospital in South Africa for treatment after a positive diagnosis for Covid-19 After the 21-day waiting period, and are hospitalized in SA, for longer than 48 hours, the location of contraction is irrelevant.

Is there a Rand limit on this policy?

The Overall Annual Limit (OAL) for claims is aggregated to a maximum of R164 000 per annum per policy.

What is the minimum and maximum entry age?

Any person younger than sixty (60) years can take out this insurance policy. Only one policy is allowed for one Insured Person. This policy has a cover cease age of sixty (60) years.

Will I be able to claim against the policy if I have minor symptoms, test positive, and are in self-isolation at home without requiring hospitalization? If not, is there any additional option to take to cover for such a scenario?

Unfortunately not, as this will result in significantly higher premiums. In addition to this, if you contract the disease whilst in hospital as a result of a different admission, this policy will not pay out.

Will I be able to claim against the policy if I am quarantined, but not hospitalised? If not, is there any additional option to take to cover for such a scenario?

This policy only caters for an admission to hospital, for ongoing treatment, as a result of a positive diagnosis for a registered pandemic.

Does the waiting period of 21 days refer to calendar days? In other words, if a policy is incepted on 1 August, would the waiting period be until 22 August?

Yes.

The policy wording refers to a “beneficiary” (section 16). Does this mean that should the client die, the funds would be paid to beneficiary versus the member – would it not always pay to member anyway?

In the event of death of the policyholder, benefits will be paid to the member’s estate unless a beneficiary is nominated, in which case payment will be made to the beneficiary.

Will a claimant have to declare his/her pay-out to SARS?

Yes.

If a member on the Diamond option tested positive for the pandemic, was hospitalized for 3 days then sent home as the hospital needed the bed for more severe cases, then after a few days at home got worse and was re-hospitalized, would the member be able to claim the additional days in hospital for the “per day” cash benefit?

The daily cash allowance is only claimable for registered days in hospital. If you are discharged because of capacity and re-admitted within a few days for the initial diagnosis, then the days will accumulate again from the readmission date. Only upon a new positive pathology test after the additional 21 day waiting period has elapsed between admissions, will a secondary claim be able to be submitted.

What if I contract Covid-19 during the 21-day waiting period – am I allowed to immediately stop paying premiums if unable to benefit from the cover?

Before you make any decisions around purchasing or cancelling an insurance policy, always consult with your or an accredited advisor. This is the only way to ensure that you are not compromising or prejudicing any party. However, as per the policy rules, there is a standard 30-days cancellation notice period required. However, the Insurance Act and the Policy allows for a cooling off period of 14-days, which only leaves an additional 7 day waiting period.

As an example, we believe that it would be unwise to cancel the policy due to the following reasons:

Even if you contract Covid-19 during the waiting period, say on day 14, statistics indicate that a person may only require hospitalisation at a later stage — therefore making the waiting period complete. If you cancelled the policy when you tested positive, you would have no cover. It is important to remember that the waiting period is not related to when you are infected or diagnosed, BUT when you are hospitalisation;
You may be re-infected and only require hospitalisation the second time. If you cancel the policy prematurely you will not have cover. (People that previously tested positive for Covid-19 are not prevented from taking out the policy); and
This policy also provides cover for future pandemics.