Long Covid: How 3 SA insurance companies are handling sickness, disability claims and life cover

A growing number of people globally are reporting living with long Covid – a pervasive condition that persists after the acute stage of Covid-19 has passed.

Research has identified more than 100 million long haulers, and around 200 long Covid symptoms, the most debilitating and commonly reported of which are fatigue, breathing difficulty, and cognitive impairment (which can cause brain fog and memory issues).

While scientists are still trying to understand the exact mechanisms of long Covid, the phenomenon is real, and clinicians and psychologists are trying their best to help these patients navigate their recovery.

In many cases, the condition has caused a delay in long haulers’ return to work or forced them to quit their jobs. Health24 interviewed Linda last year, who was ventilated for 18 days after contracting Covid in December 2020. A couple of months later, the 46-year-old had to resign “from a career [she] thoroughly enjoyed”. 

Many ventilated patients don’t make it out of hospital. But for those who survive, the real challenge begins once they leave the hospital. They are likely to face ongoing health problems – from physical to mental and emotional issues, including post-traumatic stress disorder, breathing issues, depression, problems with daily activities, impending organ damage, and lost jobs.

Health24 spoke to three South African health insurance companies to find out how they are dealing with sickness and disability claims, as well as life insurance cover for long haulers whose lives have been upended by the condition.

Sanlam

Sanlam started receiving long Covid-related claims, which persisted following SA’s first wave of Covid infections, the company’s Chief Medical Officer, Dr Marion Morkel, told Health24.

From an insurance perspective, Sanlam views long Covid the same way as any other disease. Since there are no accepted diagnostic criteria available for the illness yet, existing and new clients may not be able to claim for long Covid specifically, but may still have recourse.

Morkel explained: “There isn’t something on our sickness or temporary income benefit, for example, that says we won’t consider any new diagnosis, or anything that may not be mainstream medicine and has not been put in a diagnostic code.”

What they look for

When applying for insurance for long Covid, Sanlam will need detailed information from your healthcare professional which they will then use to assess the risk based on the product you applied for.

“We will look at the combination of symptoms, clinical signs, and the medical evidence for the level of impairment,” said Morkel, adding: “Based on the product you have with us, this allows us to pay out a sickness or severe illness benefit.”

Would you need evidence of a positive Covid test?

No. According to Morkel, Sanlam will assess the level of impairment the condition has caused the person, irrespective of whether they tested positive for Covid.

“In the event of a claim, we carefully consider the symptoms, clinical findings, and impairment as a result of a claimant’s experience with Covid-19 complications. We then measure and assess these as well as treatment response against our definitions,” she said.

Other considerations

Morkel explained that existing or potential clients cannot receive cover with no restrictions or risk categorisation.

“This is what we do, whether it’s long Covid, diabetes, HIV, etc. We categorise the risk of severity of the illness, what the product is you’re asking for, and then we consider how likely you are to claim under a particular product, and so this will come with an added premium.

However, if a client qualifies for cover and their condition improves or stabilises, they are encouraged to ask Sanlam to review changes to their insurance policy.

Said Morkel: “We recognise that some people may be able to fully recover. So if your health markers have improved, there is no limitation on when you can come back to us and ask us to review the terms we gave you, if you have new evidence that your lung or kidney function, for example, has returned to normal. And people do that frequently, not just for long Covid.”

Does having long Covid affect life cover?

If you already own a life insurance policy, your rate cannot be changed because you’re battling with long Covid, said Morkel.

She added: “For most long Covid sufferers, it doesn’t impact the way we view life cover. Obviously, if you have impaired lung, kidney, or cardiac function, we have to assess that and compare it to the ‘normal’ population, and how much more your risk is compared to them, the same way we do with someone who has had chronic obstructive airways disease and has impacted lung function – their risk is also compared to the normal population.”

Discovery

Discovery Insurance does not discriminate against people who have long-Covid, Sylvia Steyn, Head of Claims at Discovery Life, told Health24.

Said Steyn: “[We are] not changing anything in how we assess applications and underwrite prospective clients. Prospective clients will be underwritten, depending on the complications or conditions which they have developed.”

Underwriting refers to the process insurance companies use to determine the risks involved in insuring people or their assets.

Steyn said that the company applies the same underwriting standards to all its prospective clients, whether the medical condition is the result of long Covid or not.

Applying for cover

The same process as usual is followed for clients to receive insurance cover, i.e. a full medical screening by their underwriting team. 

“Since the advent of the Covid-19 pandemic, we do now also ask prospective clients whether they have had Covid-19 in the past (how long ago; if they made full recovery; and whether there are any symptoms they are battling with),” said Steyn. Existing policies are not impacted by these changes, she added.

Discovery also doesn’t require proof of a positive Covid test. “Their claim will be assessed on the medical complication or condition that they are experiencing, irrespective of what the cause has been,” said Steyn.

Will long haulers pay more for life insurance?

The usual underwriting policy would apply, depending on the client’s medical profile and any conditions which they may have explained Steyn.

“Clients who have presented with common long-Covid symptoms such as brain fog, fatigue and depression, won’t be penalised with increased premiums on their life cover, but they may get exclusions on severe illness, disability and other forms of cover,” she said.

If you are an existing client and already have a life insurance policy with Discovery, they will not differentiate or change their terms based on severe long Covid, added Steyn.

Liberty

Liberty Insurance provides risk cover for various life events. Kedibone Chuene, Chief Specialist: Product Marketing at Liberty told Health24 that the level of cover provided to a client will take into account the extent to which their health has been impacted, based on full health disclosure requirements.

“Whilst we do not have a specific benefit for long Covid, should the client disclose that they have long Covid symptoms, we will assess these symptoms and their current health profile and provide the appropriate level of cover, at a premium that is in line with the risk exposure,” said Chuene.

Applying for cover

If you are a long hauler and want to apply for Liberty’s sickness or disability cover, for example, they will require a full health disclosure and supporting medical reports to assess your health profile before they can issue you with a policy.

Said Chuene: “Our processes are designed to first assess the health profile, and where cover is provided, clients will have the comfort that their cover will pay out at their most vulnerable moments should they need to claim on the policy and provided all other contractual terms and conditions are met.”

No proof of Covid necessary

Like Sanlam and Discovery, Liberty does not require clients to have tested positive for Covid. 

“Long Covid is not yet well understood by the medical research community, and it is not easy to differentiate between people who are suffering from the lingering effects of a severe Covid infection, long Covid and other forms of fatigue syndromes,” said Chuene.

This is why it is even more important that clients fully disclose their health history to allow Liberty to assess their health profile, she said.

Does having long Covid affect life insurance?

“If the client’s health profile at the time of taking out a new policy or additional cover is severe enough to worsen life expectation, or increases the probability of long-term disability, premiums will be adjusted appropriately,” Chuene said.

What about existing clients who have life insurance?

This will not change their cover or premium, provided a full health disclosure was made when Liberty initially accepted the risk on a policy.

“Their existing premium rates will not be changed only because they have long Covid. Liberty’s commitment to existing policyholders is that we will continue to maintain cover,” said Chuene.

As seen first on Health24