Learn about Critical Illness Cover and Temporary Income Protection
Work through each module, try the salary calculator, and test yourself with real client scenarios.
0 of 6 modules complete
1Overview
2Critical Illness
3TIP Cover
4Exclusions
5Scenarios
6Documents
Module 1 of 6 — Overview
What is Simply Flexi Staff Cover?
A group insurance benefit your employer buys for all staff. Think of it as a safety net that sits alongside your salary.
•
How it works
The employer chooses which benefits to include and pays the premiums. Employees are automatically covered — no individual applications. Today we focus on two of the five benefits.
•
Critical Illness
Lump sum payout if you’re diagnosed with a serious illness like cancer or a heart attack
Core: 11 conditions • Comprehensive: 24
•
Temp Income Protection
Monthly income payments if you’re temporarily unable to work due to illness or injury
6, 12 or 24 month payout periods
•
The other 3 benefits in Flexi Staff CoverLife Cover, Occupational Disability Cover, and Funeral Cover — we’re not covering those in detail today, but remember they all work together.
•
Key rule to know from the startCritical Illness, Temporary Income Protection, and Occupational Disability cover can only be selected if the employer has also included Life Cover. Note that other benefits (such as pre-existing condition exclusion rules) are also subject to ongoing changes.
How much does it cost employees?
The employer pays the premiums, but may recover part or all of the cost from employees — this is the employer’s choice. The premium may also be treated as a fringe benefit for tax purposes. Either way, any payout received is completely tax-free.
Module 2 of 6 — Critical Illness Cover
Critical Illness Cover
A one-time, tax-free lump sum paid directly to the employee when they’re diagnosed with a qualifying serious illness.
Imagine you go to the doctor and they tell you — you have cancer. The first shock is the diagnosis. But very quickly the second shock hits: your bond, your groceries, your kids’ school fees… those bills don’t stop.
Critical Illness cover puts a tax-free lump sum in YOUR bank account. Not the hospital’s. Yours. You decide how to spend it — pay off debt, cover living costs, anything.
•
The 28-day rule (very important!)The employee must survive for at least 28 days after the diagnosis. If they die before 28 days, only Life Cover pays. If they survive beyond 28 days, they can claim both CI and Life Cover.
Core vs Comprehensive — what’s the difference?
• Core Option
• Covers the most common 11 conditions
• Pays when illness reaches a severity where it truly begins to impact daily life
• 75% payout for Severity C
• 100% payout for Severity D (most severe)
• 0% for mild/early stage (Severity A or B)
• Covers the most common serious conditions at the severity level where they significantly impact daily life
• Comprehensive Option
• Covers 24 conditions
• Pays for both severe AND early-stage diagnoses
• 25% for Severity A (early stage)
• 50% for Severity B (moderate)
• 75% for Severity C
• 100% for Severity D (most severe)
• Better for clients wanting broader coverage
Understanding severity levels — Cancer example
Payouts are based on severity (A = mildest, D = most severe):
Level
What it means
Core pays
Comprehensive pays
D — Most Severe
Cancer spread widely (Stage 4)
• 100%
• 100%
C — Severe
Significant spread (Stage 3 type)
• 75%
• 75%
B — Moderate
Early invasive cancer (Stage 2 type)
• 0%
• 50%
A — Mild / Early
Very early stage (Stage 1 type)
• 0%
• 25%
•
Key selling point for ComprehensiveEarly-stage cancer detection is becoming more common. With Core, an early cancer diagnosis pays nothing. With Comprehensive, even a Stage 1 cancer pays 25% — on a R500,000 policy that’s R125,000 tax-free. Life-changing money for a lower-income earner.
How much cover can a client get?
Salary-linked max
3× annual salary
Fixed benefit max
4× lowest earner’s salary
Hard cap
R2,500,000
Minimum
R50,000
•
Free Cover — no health questions needed up to these limits5–9 employees: R50k • 10–49: R500k • 50–99: R1m • 100–149: R1.5m • 150+: R2m. Above these limits, employees must answer health questions.
Module 3 of 6 — Temporary Income Protection
Temporary Income Protection
Monthly income payments when an employee is completely unable to work due to illness, injury or surgery.
What happens to your family if you have a big operation and can’t go to work for 3 months? Or 6 months? Your employer stops paying you. But your bond, your groceries, your children’s school fees — they don’t stop.
Temporary Income Protection pays you a monthly amount — similar to your salary — tax-free, for up to 24 months while you recover.
How much will a client receive? — Try the calculator
Enter monthly salary (R)
Estimated monthly TIP benefit (tiered option)
R0
•
Two benefit calculation optionsEmployers choose one of two approaches: (1) the tiered percentage shown below, or (2) a flat 75% of salary — a simpler option that pays the same percentage regardless of income level.
•
Payment terms and deferred period optionsEmployers choose a payment period of 6, 12, or 24 months — this is the maximum duration of benefit payments. They also choose a deferred period of 1, 3, or 6 months — this is the waiting time before payments begin, and it counts within the total payment period.
•
Two benefit options availableEmployers can choose either the tiered percentage option (shown in the calculator below) or a flat 75% of salary option. The tiered option typically results in a higher effective replacement for lower earners.
•
Payment term and deferred period optionsEmployers choose a payment term of 6, 12, or 24 months and a deferred period of 1, 3, or 6 months. The deferred period counts inside the total payment term, so a 3-month deferred period on a 12-month term means only 9 months of actual payments.
•
Two benefit calculation optionsEmployers choose one of two approaches: (1) the tiered percentage shown below, or (2) a flat 75% of salary — a simpler option that pays the same percentage regardless of income level.
•
Payment terms and deferred period optionsEmployers choose a payment period of 6, 12, or 24 months — the maximum duration of benefit payments. They also choose a deferred period of 1, 3, or 6 months — the waiting time before payments begin, which counts within the total payment period.
Tiered percentage breakdown:
First R10,000
80%
Next R20,000 (R10k–R30k)
65%
Next R30,000 (R30k–R60k)
60%
Above R60,000
50%
•
Caps to rememberThe benefit CANNOT exceed the employee’s actual take-home pay. Maximum is R100,000/month. If they have other income replacement policies, the total from all sources is capped at take-home pay.
•
Free Cover limits for TIP (no health questions required up to these amounts)5–9 employees: R10k/month • 10–49: R20k/month • 50–99: R25k/month • 100–149: R30k/month • 150+: R40k/month. Above these limits, employees must answer health questions.
The Deferred Period — what it means
The deferred period is the waiting time before payments start. The employer chooses 1, 3, or 6 months. This waiting time counts INSIDE the total payment period.
Example: 12-month payment period + 3-month deferred period
3 months waiting •
9 months of actual payment •
• A 3-month deferred period on a 12-month term = only 9 months of actual payments.
TIP cover and age
•
TIP benefit does NOT reduce with ageThere is no age-based reduction in the TIP benefit amount. The benefit pays in full for the chosen payment term — however, cover terminates completely when the employee turns 65, even if they are still disabled and mid-claim. For example, an employee with a 24-month payment period who becomes disabled at age 64 will only receive payments until age 65, not the full 24 months.
Module 4 of 6 — Exclusions & Key Rules
Exclusions — What Is NOT Covered
Be completely honest with clients about these upfront. A rejected claim is worse than never selling the product.
•
Your reputation depends on disclosureIf you don’t tell clients about exclusions and a claim gets rejected later, they’ll blame you. Always explain these clearly before signing anyone up.
Critical Illness Exclusions
• Pre-existing Conditions (2 years)
Any illness the client had, showed symptoms of, or was treated for in the 12 months BEFORE cover started. No CI claim for 2 years after cover starts.
• 28-Day Survival Rule
Must survive at least 28 days after diagnosis. If death occurs within 28 days, only Life Cover pays — not Critical Illness.
• Must Have Life Cover
CI cover cannot exist without Life Cover. If Life Cover is cancelled, CI cover also falls away automatically.
• CI Cannot Exceed Life Cover Amount
The Critical Illness benefit can never be set higher than the Life Cover amount selected by the employer.
• All CI cover stops at 65
Even if the employee is still working at 65, all Critical Illness cover terminates on their 65th birthday.
• Specific cancer exclusions (Core & Comprehensive)
Benign or pre-malignant tumours • Carcinoma-in-situ (Tis or Ta) • Non-melanoma skin cancers • Low Gleason score prostate cancer • Liquid biopsy-only diagnoses
Temporary Income Protection Exclusions
• Pre-existing Conditions (1 year)
Any condition the client had or was treated for in the 12 months before cover. No TIP claim for 1 year after cover starts.
• Must be unable to perform their OWN job
The employee must be completely unable to perform the duties of their own specific occupation. Partial inability doesn’t qualify.
• Self-harm at any time
No benefit is EVER paid if the inability to work is caused by attempted suicide or deliberate self-injury.
• Refusal of medical treatment
If a registered doctor recommends treatment and the client refuses without good reason, the claim can be rejected.
• War, riots, terrorism
No benefit if the injury or illness resulted from participation in war, terrorism, civil unrest, or rebellion.
• Stops at age 65
The day an employee turns 65, TIP cover terminates — even if they’re still employed and currently claiming.
•
Free Cover limits for TIP (no health questions required)5–9 employees: R25k/month • 10–49: R25k/month • 50–99: R50k/month • 100–149: R75k/month • 150+: R100k/month. Above these monthly benefit limits, employees must complete health requirements.
Common client questions about exclusions
“What if my employer cancels the policy?” ⌄
For CI and TIP cover, there is no continuation option. If the employer cancels or the employee leaves, CI and TIP cover end immediately.
• Broker tip: This is a reason why employees should value the benefit while employed and encourage their employer to maintain it.
“I work part-time — can I still be covered?” ⌄
Yes — as long as the employee works at least 20 hours per week in South Africa and is on a permanent contract or a temporary contract of at least 6 months.
• Broker tip: Always confirm the employment contract type before assuming eligibility.
“I already have medical aid — why do I need this?” ⌄
Medical aid pays the hospital and doctors. CI and TIP pay YOU — for your living expenses, bond, car, groceries, children’s school fees. They solve completely different problems.
• Broker tip: Use this exact explanation. It makes the difference tangible and memorable.
Module 5 of 6 — Real Client Scenarios
Real Client Scenarios
Read each client situation. Choose the best response or outcome. This is how you’ll handle these conversations in real life.
Module 6 of 6 — Documents
Policy Documents
The full official policy documentation for reference. Use these when a client asks detailed technical questions or when preparing for a claim.
•
Critical Illness Detailed Definitions
Full SCIDEP severity definitions for all 24 conditions — including cancer staging, stroke classifications, heart attack troponin markers, brain tumour WHO grades, leukaemia/lymphoma tiering, and definitions for all Core and Comprehensive conditions.
How to use this documentDon’t try to memorise every page — use it as a reference when a client asks a very specific question (e.g. “exactly which stage of prostate cancer is covered?”). The key facts are covered in the training modules above.
