Marie du Plessis* has been treated for depression for roughly three years and it costs her more than R5 000 a month to manage the condition. She has a hospital plan, which costs R1 700 a month, but this does not cover any kind of psychological therapy. It only covers up to 20 sessions with a psychiatrist, who she sees four times a year to get a diagnosis and prescriptions.
“Over and above this, it costs me roughly R3 000 a month for psychotherapy with a clinical psychologist, and R580 for medication,” she says.
“Medical aids only cover up to 20 sessions with a psychiatrist – not a clinical psychologist – for major depressive disorders because this is considered ‘in hospital’. The medication is on the list of exempt chronic medications for cover from insurance. There was also an incident where I needed to get 28 stitches from a self-harm injury, but because I was not admitted to hospital overnight, the medical expenses were for my own account. I end up spending roughly R5 500 on medical expenses a month.”
One in four adults in South Africa has been diagnosed with or has experienced periods of mental illness. Many live and work with conditions such as depression, chronic anxiety, adult attention deficit/hyperactivity disorder and bipolar disorder.
The SA Depression and Anxiety Group estimates that depression alone is costing South Africa more than R218 billion in lost productivity. About R28 billion of this is attributable to unscheduled absences from work, while R190 billion can be attributed to people going to work while they are unwell.
Depression, while treatable, is not covered by some medical scheme policies and, depending on whether you suffered from it in the past, it may not even be covered under a life or disability policy.
Discrimination, exclusions and paying more
Depression is not easily understood by the majority of people. It’s a taboo subject and people often tend to distance themselves from you once you tell them your diagnosis.
On top of this, current and former sufferers will find it hard to insure themselves fully, especially when it comes to life and disability insurance.
Premiums are often based on things such as demographics, age, whether you smoke, your qualifications and occupation, and how risky your occupation is. Your income can also make a difference to your premium.
However, when it comes to declaring your depression to an insurance provider, you could pay more or the same for less, meaning you could be covered but will be subject to exclusions.
The good news is that not all depressive episodes are treated the same way by insurers.
Chad Sharrock, financial adviser at Attieh & Associates, says: “It all depends what the customer was depressed about, how severe the depression was and whether it was controlled by medication, for instance.
“For example, postnatal depression or grieving after a spouse passes away are treated as once-off events. I had a customer who suffered from depression after her husband died and the life insurance company gave her the standard rate. But for clients who suffer from anxiety, depression or bipolar, for example, life insurers will put an exclusion of mental illness and, if there’s a related claim, it is rejected.”
Claims for suicide are also not covered.
“When it comes to suicide, there is always an exclusion for two years whether a client suffers from depression or not,” Sharrock says.
“But after that, the life insurance company could still pay out provided there’s no mental illness exclusion.”
Getting the right cover
If you have dependants or are reliant on your work for income to pay your expenses, it’s vital to get life and disability cover in case something happens to you. If you’ve suffered from depression, you may find it harder to get a good deal on your life and disability cover, but that doesn’t mean you shouldn’t try to obtain it.
“A lot of the time, doctors are quick to diagnose depression and there’s nothing much clients can do about it, and it can be on their record. I would say look at and compare at least two options,” advises Sharrock.
“If you’re not happy with the first option and you think you can get a better premium elsewhere, approach another company. If they offer you a similar deal, you may get the same reaction from others too.”
The worst thing you could do, though, is lie about your mental illness when applying for cover.
If after an investigation the insurer finds that you didn’t disclose your mental illness, they may not pay.
“They could evaluate the situation and see if they would pay out based on how they would’ve initially underwritten the policy, and then make an informed decision based on that,” says Sharrock.
“So they could still reject your claim because it would’ve been excluded. They may make a decision based on the fact that it was depression triggered by a specific event – then there may not be a hiccup because they may find that the depression you suffered from previously is unrelated to the reason you are suffering from depression now. However, most of the time, they would not pay if it is chronic depression that you
“The best thing to do is disclose as much as you can at the application stage so that insurers can underwrite you in the best way possible,” says Sharrock.
*Not her real name