Critical Illness Cover and Professional Health Preserver
Download the forms required to submit a Critical Illness Cover and Professional Health Preserver claim. Find the correct contact details and browse answers to common questions.
Download Claim Forms
Download and complete the relevant forms below. PPS may request additional supporting medical documentation depending on your claim.
Submit your completed claim
Email your completed claim forms to the PPS Claims team. Ifyou're unsure which forms are required, contact the team for assistance.
Find the answers you are looking for
We’ve answered some of the most common questions to help you better understand this solution and make informed decisions with confidence.
The PPS Critical Illness Product is a standalone benefit. The PPS Critical Illness Cover benefit is an accelerated benefit linked to your Life Cover, which means any Critical Illness benefit paid will reduce your Life Cover sum assured.
Your benefit is paid as a percentage of your assured sum, based on the severity of your condition as defined in the PPS Provider™ Policy. The available severity levels are:
- 100%
- 75%
- 50%
- 25%
- 10%
- 5%
A full list of covered critical illnesses, trauma conditions and physical impairments can be found in Appendix A of your PPS Provider™ Policy or in your most recent PPS Provider™ Policy Certificate.
Each Critical Illness Cover claim event has specific medical definitions and thresholds.
PPS compares your diagnosis and clinical evidence to these predefined criteria. Your claim is assessed against the exact wording and requirements in the PPS Provider™ Policy. If you do not qualify for a 100% severity level benefit at first, but your condition deteriorates, you can submit a subsequent claim.
PPS will assess your claim and if it meets the predefined criteria for a higher severity level benefit, you may receive an additional benefit less what was already paid
The survival period is the minimum time an individual must remain alive after the occurrence of a specified event or the diagnosis of a condition. For critical illness claims, a standard survival period of 14 days is required. Claims will not be considered if the claimant passes away within this period.
The CatchAll benefit is an optional rider available with Accelerated or Standalone Critical Illness Cover. It provides cover for certain permanent impairments that are not specifically listed in Appendix A of the PPS Provider™ Policy, provided they result in at least 11% whole person impairment, as measured using the latest American Medical Association Guides. Severity levels are detailed in Appendix C of the PPS Provider™ Policy.
These optional rider benefits increase the claim payout to 100% of your sum assured for qualifying conditions.
- The Core 100% Rider applies to selected core conditions, such as heart attack, certain cardiac procedures, stroke and most cancers.
- The CI 100% Rider extends this enhanced benefit to both the core conditions and a wider range of additional claim categories listed in Appendix A of the PPS Provider™ Policy.
The Expander Rider is an optional benefit that provides cover for less severe conditions, paying up to 25% of your Critical Illness Cover sum assured, subject to a maximum of R250,000 per benefit category. The covered conditions are listed in Appendix G of the PPS Provider™ Policy.
The Exact Rider is an optional benefit that provides an additional payout for targeted cancer therapy, provided your cancer meets the Critical Illness claim definitions in the PPS Provider™ Policy. Your treating specialist must confirm, supported by laboratory and clinical evidence, that targeted therapy is medically necessary and appropriate in accordance with internationally recognised clinical guidelines.