Medical insurance is a new, amazing type of health cover for South Africans. Understand that this kind of insurance is totally different and separate from medical aid. In fact, medical insurance does not have anything to do with your health providers at all.
How is medical insurance different?
Whereas a medical aid is closely in touch with hospitals, doctors, dentists and specialists, your health insurance company could not care less what your bills are. Instead they offer a set maximum amount for several products, procecdures, consultations and hospital stays. With the cash amount they pay out it is up to you to settle your bills.
So, for instance, on the OnePlan Core Plan (which costs R365 per month for an individual) you get the following:
What cover does the OnePlan Core Plan offer?
- General Practitioner (Doctor) – Up to R 320 per visit
- Scripted Medication – Up to R145 per script. Paid through Mediscor electronic claim system. No over counter medication.
- Pathology – Up to R405 per event.
- Radiology – Up to R405 per event.
- Dentistry – Up to R550 per visit. Max of 3 visits a year.
- Specialist Cover – Not covered on this plan.
- Maternity Pre Birth – Up to R555 per visit. 3 Visits per Pregnancy. Annual limit of R 1670.
- Optometry – Up to R950 – Limited to claim this every 24 months per dependant.
- Casualty Illness – Up to R4900 for life threatening emergency illness in casualty units. Excess:4 months plus – R200
- Casualty Accident – Up to R4900 for accident events in casualty units that does not result in admission. Excess:0-3 Months – 15 % | 4 months plus -R200
- Accident Cover – Up to R140 000 per insured event. Up to R280 000 per family per event. Excess: R600 | Contact sport -15% of claim amount (12 months waiting period).
- Illness In Hospital – Not covered on this plan
- Dread Disease – Not covered on this plan
- Natural Birth and Emergency Caesareans – Not covered on this plan
- Accident Disability – Up to R180 000 for the duration of the policy. only principal insured is covered.
- Family Death Cover – Principal Insured: R7 500 | Spouse/Partner:R7 500 | Children 14-21 yrs:R7 500 Children 6-13 yrs R3 750 | Children 1-5 yrs R1 850 Children unborn(28 weeks) to 0 yrs: R1 100
- Trauma, Assault and Accidental HIV – Trauma and assault counselling, Accidental HIV protection services. Accidental HIV infection treatment.
- Repatriation – Up to R12 200 per insured person. Repatriation of mortal remains to funeral home.
- Ambulance and Emergency Services – 24 hr Medical assistance with an emergency dedicated line. In the event of a justifiable,life-threatening medical emergency, the insured will be transported by ambulance to the nearest appropriate medical facility.
Can I get extra cover from OnePlan?
The above Core Plan is just the start of what OnePlan provides. Yes, you can also look at the Blue, Professional and Executive plans.
Start the process of signing up for health insurance. Complete and submit the form on this page to get a health insurance quote right away.