Just two weeks before Thanya de Carvalho was diagnosed with a critical illness, multiple sclerosis, her husband had urged her to speak to her insurer so she can get 10 times more benefits than she was getting at the time.
She said she’d do it, but, in her mind, she wondered why she would need to do it urgently because she was young.
But two weeks later, her life changed drastically as she was diagnosed with a “chronic autoimmune disease, where the immune system attacks the myelin sheath that protects nerves in the central nervous system”, and now she’s uninsurable.
“[At the time when my husband said I should do it, I thought, ‘what’s going to happen tomorrow?’ Two weeks later, I was diagnosed. [Now,] I cannot increase my benefit 10 times more. I will benefit [from my husband], but my husband won’t benefit from me,” De Carvalho told attendees at the Momentum Science of Success Festival held recently.
“That’s an unfortunate situation because I cannot get any cover. The message I want to leave is, when you get your first paycheck, ensure that you have all your financial affairs in order. Have your medical aid. Have what you need. Have your critical illness and your life insurance policies. Put those things in place before it’s too late.
“An important message I want to get across is that I am uninsurable. I cannot get any cover. I cannot get disability cover, cannot get credit, nor can I get life cover.”
In the days before De Carvalho was diagnosed, she she was constantly making spelling mistakes and would correct them, only to make them again.
She thought she was tired, but it was far more serious.
Joretha Bothma, Momentum Life Insurance head of product development, underwriting, and claims, says there are products designed for different kinds of critical illnesses.
“Disability cover looks at what your potential [is] to be able to perform the duties of your employment or your workplace, and what happens in the event of a disease or illness and your income needs to be replaced.
“What I want to touch on is particularly your personal profile, your personal risk profile, and what that looks like. When you’re diagnosed with a critical illness that’s defined, and for which the medical criteria that you stipulate is met, it [the cover] will pay out the lump sum. So that lump sum is what gives you the financial flexibility and security to be able to make lifetime decisions at a point in time that’s very difficult.”
De Carvalho says she now has a lot of expenses. Among others, she and her husband had to build a house with no stairs because she can’t judge them. There are also enablements around their home so that she can hold onto them. There are also various specialists that she has to see, and that’s an additional expense, as are the continuous blood tests and medication.
Now, pause and think hard about what your needs are and what you’re covered for.
Would you be able to take care of yourself or your family if you were ever diagnosed with a critical illness? Would your savings or insurance be enough to cover home renovations?
Since it’s medical aid renewal season, it’s an opportunity for you to look at your health plan. JustMoney head of customer experience Sarah Nicholson says only 16% of respondents to their survey, Money & Me, are “able to cover a R10,000 emergency, and only 27% are insured for medical costs, on average”.
“It’s crucial to ensure that your healthcare package balances sufficient protection with affordability. Start gathering information now so you can make an informed, confident decision about whether your current medical aid plan meets your needs and budget,” she says.
It’s crucial to ensure that your healthcare package balances sufficient protection with affordability.
— Thanya de Carvalho
“Don’t leave this decision until the last minute. The larger medical schemes have announced premium increases of up to 10% for 2026. Households that are already under pressure from rising food, electricity, and fuel prices will find this premium jump to be a strain on their monthly budgets.
“A different network plan or a slightly cheaper option could meet your essential healthcare needs without compromising financial stability, but this requires thorough research.”
She says most medical schemes adjust contributions, savings allocations, and hospital benefits each year. “Some introduce new plans and amend rules for chronic medicines. They communicate these changes to their members via member portals, emails, and benefit guides.
“Plan upgrades are generally only allowed during an annual window, typically from November to mid-December. Downgrading may be possible during the year, subject to specific timing and scheme rules.
Nicholson says healthcare is one of the “most crucial pillars” of financial well-being. “By taking a few hours to review your medical cover and understanding what’s changing in 2026 and exploring alternatives, you can ensure that you and your family are protected while getting the best value for your hard-earned money.”
JustMoney gives tips to check for shortfalls or overspending in healthcare protection:
Note what’s changing in your current plan: Read your benefit update correspondence carefully and compare the 2025 and 2026 documents. Even small changes can affect day-to-day expenses.
Assess your current needs: Consider your typical medical expenses over the past 12 months and whether your requirements have changed. Perhaps you’re planning a pregnancy, you’ve developed a chronic condition or you need specialist visits.
Weigh up plans within your scheme: You may be paying for benefits you no longer need. Assess whether a different plan within your current scheme could better suit your budget.
Compare medical aid schemes: Use comparison tools such as MedAidQuote and Hippo or consult a professional healthcare broker to evaluate packages from multiple providers.
Watch out for hidden costs and co-payments: Some plans have strict rules about hospital networks and/or require pre-authorisation for routine procedures. Co-payments for scopes, specialist consultations, certain medicines and out-of-network providers can also add up. A plan that appears cheaper upfront may cost more overall, once co-payments and exclusions are factored in.
Consider taking out gap cover: Many doctors charge above medical scheme rates, leaving a shortfall that you must cover. Gap cover is a low-cost add-on that can protect you from unexpected costs.
Get advice before making changes: Switching plans is a big decision. Some plans have waiting periods, late-joiner penalties or restrictions for pre-existing conditions. Financial advisers or accredited medical scheme consultants can help you compare options accurately and understand the long-term implications of changing plans.
Sowetan
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