So how would you like to get paid for seeing the doctor before seeing him or her?
That’s one of the benefits offered by OnePlan. But let’s take a look at their Blue Plan in more detail, shall we?
Let’s get the cost out of the way first
OnePlan offers six different options:
- The top of the range Elite plan
- The Executive plan
- The Professional plan
- The Blue plan
- The Core plan, and
- The Health plan
The OnePlan Blue plan sits right smack bang in the middle meaning it should be the most popular plan of the bunch.
Costing of the Blue plan is as follows for 2017:
|Monthly Cost||Monthly Cost|
|Single||R 570||Couple||R1, 095|
|Single with one child||R 895||Couple with one child||R1, 450|
|Single with two children||R1, 230||Couple with two children||R1, 680|
|Single with three children||R1, 560||Couple with three children||R1, 915|
|Single with four children||R1, 895||Couple with four children||R2, 150|
They also offer you the option of adding on an excess buster.
This clocks in at R35 a month and takes care of the excesses which apply for hospitalisation.
To decide on whether or not you need it, ask yourself: “Can I come up with the excess in an emergency or not?” If no, then you ask yourself whether you can afford not to spend the extra R35 a month? We’ll discuss excesses below, so hang in there, will you?
So what are you getting for your hard earned money?
This is one of their comprehensive plans meaning that it offers:
- day-to-day benefits known as health benefits, and
- hospital risk cover.
Let’s look at the health benefits first:
|Waiting Period||Amount Paid|
|Doctor||30 days||Up to R290 per visit|
|Prescription||30 days||Up to R135 per script|
|Blood tests||30 days||Up to R365 per event|
|X-Rays||30 days||Up to R365 per event|
|Dentist||90 days||Up to R490 per visit|
|Pre-birth maternity||7 months for new policies||Up to R490 per visit|
|Optometry||12 months||Up to R865|
But be careful of the T’s and C’s…
- Prescription medicine does not include over-the-counter medicines. These are medicines which can be bought without a prescription. So if your doctor prescribes any of these, then OnePlan won’t pay. Prescription medicines are paid through an electronic claim system but you need to pay the pharmacy any shortfall. Chronic conditions might also be excluded at application stage, so be aware of this.
- Dentistry is only allowed three times a year for everyone on your plan
- Specialist visits are not paid at all on the Blue Plan
- Pre-birth maternity, while it has a 7 month waiting period for brand new policies; it also has a 4 month waiting period from date of conception for existing policies and 3 visits per pregnancy.
- Optometry is limited to one claim per dependant every 24 months.
And also of the overall annual limits:
You see, even though OnePlan will pay up to R290 per visit, this doesn’t mean you can visit the doctor a hundred times a year, racking up bills of thousands of Rands.
They have capped the benefits as follows:
|2 to 3 persons||R10, 800|
|4 or more persons||R14, 340|
So take a single person for example.
- This person will pay R570 a month for 12 months – that’s R6, 840 a year.
- Compare that to the annual limit of R6, 425 which is more than fair considering we haven’t even gotten to the hospital risk cover.
Let’s get onto the hospital risk cover now.
There are 11 benefits on offer.
Of these, 5 have a compulsory excess which must is payable by you. Let’s deal with them first.
Hospital Risk Cover with excesses:
- Up to R4, 800 is paid for life threatening emergency illnesses treated in casualty units
- During the first 3 months there is no excess payable which sounds great but you’re in the 90 waiting period so you can’t claim anyway.
- From month 4 onwards, a R200 excess is payable
- Up to R4, 800 is paid for accident events treated in casualty units where you aren’t admitted into hospital
- No waiting periods at all
- During the first 3 months, a 15% excess is payable. That means a maximum possible excess of R720 per event
- From month 4 onwards, a R200 excess applies
- Up to R165, 000 per insured event with a maximum of R330, 000 per family per event
- No waiting periods
- If not related to a contact sport, then a R600 excess applies
- If injury was caused by a contact sport, then a 12 month waiting period applies. After that a 15% excess applies. R165, 000 x 15% means R24, 750 as an excess. This is a situation where the excess buster makes a lot of sense!
Illness in Hospital
- Up to R37, 000 per event per person
- Up to R98, 000 per insured per year
- A 90 day waiting period applies. Pre-existing conditions, whether known or unknown, are excluded for 12 months.
- Tonsillectomies, grommets, ear surgery, adenoidectomies, sinuses, hernias, complications with pregnancy, gynaecological conditions, kidney and gall stones, bladder surgery, ulcers, all scopes, spinal procedures and joint surgery are some of the conditions excluded for 12 months. Check the policy wording for your specific condition.
- From month 4 to 6, a 15% excess applies. R37, 000 x 15% means an excess of R5, 550. Once again, excess buster makes sense here.
- From month 7 onwards, the excess drops to 5% which means R1, 850 as a potential excess based on the R37, 000.
- Up to R37, 000 per insured event per person
- This includes natural childbirth and caesarean section
- It forms part of the annual ‘illness in hospital’ maximum benefit which is R98, 000
- A 12 month waiting period applies
- A 10% excess applies. R3, 700 is the maximum amount payable as an excess
Now for those hospital benefits with no excesses:
- Up to R227, 000 per defined disease per year. Thereafter you can only claim again for the same dread disease – or another dread disease – after a 6 month recovery period has passed.
- This is for medical expenses at an approved hospital.
- Only the following are considered to be dread diseases – heart attack, coronary artery disease needing surgery, heart valve replacement, aorta surgery, stroke, cancer, acute kidney failure, brain tumours, and major organ transplants.
- A 6 month waiting period applies except in the case where it was pre-existing or diagnosed within the first 6 months, in which case the waiting period becomes 12 months.
- Up to R159, 000 once off, and only for the principal insured
- No waiting period
Family Death Cover
|Main Member and Spouse or partner||R6, 120 each|
|Children 14 – 21 years of age||R6, 120 each|
|Children 6 – 13 years of age||R3, 060 each|
|Children 1 – 5 years of age||R1, 530 each|
|Stillborn from 28 weeks onwards||R920|
- For natural death a 90 day waiting period applies
Trauma, Assault, and Accidental HIV
- Counselling and HIV treatment is covered
- No waiting periods
- Up to R12, 200 per person
- Body is sent to the funeral home
- No waiting periods
Ambulance and Emergency Services
- 24 hour emergency medical assistance hotline. Think 911!
- In a genuine life threatening medical emergency, they will pay for transport to the nearest appropriate medical facility.
Oh, and before I forget…you need to be between the ages of 18 and 65 in order to join.
What do you think?
I want to stress that OnePlan is not a medical aid. It was never designed to do what a medical aid does, and in fact, by law isn’t allowed to compete. OnePlan is not encouraging anyone to cancel their medical aid and replace it. See OnePlan as something which supplements your existing medical aid.
And before anyone complains that they might have to first pay the doctor and then claim back from OnePlan. Download the OnePlan-claim-process brochure to see how easy it is to claim.
If I were to compare it strictly in terms of cost to health benefits then here is how it looks:
|Monthly Cost||Annual Cost||Annual Limit|
|Single||R570||R6, 840||R6, 425|
|Single with one child||R895||R10, 740||R10, 800|
|Single with two children||R1, 230||R14, 760||R10, 800|
|Single with three children||R1, 560||R18, 720||R14, 340|
|Single with four children||R1, 895||R22, 740||R14, 340|
|Couple||R1, 095||R13, 140||R10, 800|
|Couple with one child||R1, 450||R17, 400||R10, 800|
|Couple with two children||R1, 680||R20, 160||R14, 340|
|Couple with three children||R1, 915||R22, 980||R14, 340|
|Couple with four children||R2, 150||R25, 800||R14, 340|
I’d definitely suggest it for those of you who are either single or a single parent with one child.
But that’s, as I said, only looking at the health benefits. If you take into consideration the hospital risk cover, then it makes sense to a much broader market.
Come on, pop your details in below and we’ll have someone from OnePlan call you back.
Until next time.
The InsuranceFundi Team