Medical cover with evacuation
South Africa's private medical care is excellent — and expensive, cash-up-front for visitors. A minor accident can become a five-figure bill; a serious one, with a private ambulance and a medevac home, six. A policy covering treatment and emergency evacuation home is non-negotiable. Check the evacuation limit is high (US$100,000+), not a token figure.
The two systems
Public hospitals are stretched; private hospitals are world-class and where you want to be. Travel insurance that pays for private care is the whole point. If you're uninsured and end up in a public facility, you'll understand why this matters fast.
Malaria
Only the lowveld — Kruger, the KZN reserves below the escarpment, and the far northeast — carry risk, and mostly in the summer wet season. The Western Cape, Garden Route, Drakensberg, Johannesburg, and the Eastern Cape reserves are malaria-free. Prophylactics are a personal choice; the baseline is covering up at dawn and dusk and using repellent, year-round, anywhere north of the escarpment.
What to declare
Pre-existing conditions, adventure activities (a hike above 2,000m, scuba diving, a walking safari), and any motorcycling — these are routinely excluded unless declared. Read the activity list before you assume you're covered on the Otter Trail or a shark-cage dive.