DB
Diane B
1 reviews | Active since Oct 2010
12 Nov 2024, 13:36
100% do not recommend at all, ever
Avoid this medical aid at all costs. 1) The agent does not give you all the facts upfront when selling you your policy. You need to reallly read that policy document with a fine tooth comb and make sure you fully understand all the things they do not cover. ie If you go to emergency you must be triaged as orange or red to get the emergency benefit, else you pay out of your doctors etc rates which will never even cover half of the fees, so you will be paying the bulk of that bill. You are not covered for a year of claims, just up to the amount on your policy which considering we claim for chronic meds every month, will never be enough - did the agent mention this, no not at all - just assured us that after the one month waiting period we would be covered for our chronic meds scripts. Their app - you can only load one claim at a time, so if you go to a doctor and get a script, you cannot load both claims the same day unless by some miracle you get the invoice uploaded, and it is approved. You take a photo of your invoice and uploaded it and your claim is denied because they cannot read the photo but they do not have upload functionality so you can upload the document, nope you have to then email the document which means more time that your claim is not loaded, whilst you cannot load your claim for your life saving meds, so good luck living whilst they approve your claim. It takes so long to get a claim on that I paid cash and tried to claim the money back as a refund but that was refused because the claim was finally loaded and now they say it was paid via the claim, which it was not, why would I pay cash for a claim I could have claimed on the card? And to top it all their IVR is down, their whatsapp platform is as close as useless so all in all more trouble than it is worth
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Replies (5)
Oneplan Insurance's replyOfficial
12 Nov 2024, 15:39Dear Diane,
Thank you for taking the time to bring this to our attention.
We are sorry to hear about your dissatisfaction and the opinion that you have developed regarding Oneplan Health Insurance as we do take customer feedback seriously to improve our service and process to ensure that we meet our client’s expectations.
Kindly note that insurance or indemnity insurance covers up to a respective cover limit. We inform all our clients that this product is not a Medical Aid product but a Health Insurance product. Our products are marketed and disclosed that we cover up to certain cover limits as the cover is not unlimited. This information is also clearly stated in the policy wording that is sent to all our clients.
Emergency treatment is treatment that cannot wait for a normal consultation with the doctor, clients may go to the nearest hospital casualty unit, where we will cover them should the emergency be confirmed as a triage category Orange or Red. When the hospital contacts us, they will inform us of the triage category that the patient is currently on. “Triage” means assessing emergency patients by medical professionals at the emergency unit into categories of priority based on the urgency of treatment required founded on national/ international scales which includes time frames. The triage category may change based on change in the condition of the insured or the actual diagnosis and treatment received.
It is important to note that authorization is granted based on the information that the hospital provides us with, unfortunately, authorization cannot be granted if the information we receive from the hospital does not fall within the Orange or Red Triage Colour Category. Should the hospital confirm the Triage colour to be Green or Yellow, according to our policy schedule the condition will be covered under the day-to-day benefit being a normal GP consultation, medication, radiology, or pathology up to the respective cover limit. A Green or Yellow Triage is Not covered under the emergency cover.
Kindly note that when the patient is informed of the Triage colour and benefit that the Health Insurance will provide, the choice is entirely up to the client as to whether they will continue with treatment at the hospital.
Chronic medication is covered under the day-to-day benefit and will be assessed through the Scripted medication benefit up to the respective cover limit depending on the number of members that are covered on the policy.
Due to clients having access to load funds upfront, there is a maximum of 2 claims that can be loaded at a time for each dependent. Alternatively, if clients need to utilize more than 2 day-to-day benefits at a time, the client can make payment and request for a refund to be processed. Once the funds have been utilized, we will require a computerized detailed invoice. The reason for this is for auditing purposes on our side and to prevent *****.
Kindly note that should clients experience any issues with regard to contacting us on our Customer Care Line, we have various options that clients can utilize to get assistance, an email can be sent to ***, or a message can be sent via App Chat or via our Whatsapp line *** on as our agents are always on standby ready to assist, alternatively you may also send a call me back request via the Oneplan App and one of our consultants will be in contact with you.
Should a client experience any issues with uploading the invoice via the App, invoices can be sent to us via Whatsapp on *** or an email can be sent to ***.
The standard turnaround time for day-to-day claims to be processed is between 48 - 72 working hours and up to 30 working days for in-hospital claims to be processed as this is dependent on us obtaining all the required information in order to finalize the claim. Certain terms and conditions are always applicable, and these are included in all policy documents before and during your experience with us. The terms and conditions of the policy must be adhered to and app**** fairly for all clients. Please note we are governed by the FAIS Act and must apply the TCF (Treat Customers Fairly) policy to ensure all our clients receive fair service and cover.
We encourage all our clients and potential clients to ensure that they do understand all products available in the market and perhaps approach their Financial Advisor for a factual comparison of products as hearsay may cause a consumer to make a decision based on inaccurate information. Once again, we apologize for any inconvenience caused and hope the above brings clarity to the matter.
Kind Regards, Oneplan
Thank you for taking the time to bring this to our attention.
We are sorry to hear about your dissatisfaction and the opinion that you have developed regarding Oneplan Health Insurance as we do take customer feedback seriously to improve our service and process to ensure that we meet our client’s expectations.
Kindly note that insurance or indemnity insurance covers up to a respective cover limit. We inform all our clients that this product is not a Medical Aid product but a Health Insurance product. Our products are marketed and disclosed that we cover up to certain cover limits as the cover is not unlimited. This information is also clearly stated in the policy wording that is sent to all our clients.
Emergency treatment is treatment that cannot wait for a normal consultation with the doctor, clients may go to the nearest hospital casualty unit, where we will cover them should the emergency be confirmed as a triage category Orange or Red. When the hospital contacts us, they will inform us of the triage category that the patient is currently on. “Triage” means assessing emergency patients by medical professionals at the emergency unit into categories of priority based on the urgency of treatment required founded on national/ international scales which includes time frames. The triage category may change based on change in the condition of the insured or the actual diagnosis and treatment received.
It is important to note that authorization is granted based on the information that the hospital provides us with, unfortunately, authorization cannot be granted if the information we receive from the hospital does not fall within the Orange or Red Triage Colour Category. Should the hospital confirm the Triage colour to be Green or Yellow, according to our policy schedule the condition will be covered under the day-to-day benefit being a normal GP consultation, medication, radiology, or pathology up to the respective cover limit. A Green or Yellow Triage is Not covered under the emergency cover.
Kindly note that when the patient is informed of the Triage colour and benefit that the Health Insurance will provide, the choice is entirely up to the client as to whether they will continue with treatment at the hospital.
Chronic medication is covered under the day-to-day benefit and will be assessed through the Scripted medication benefit up to the respective cover limit depending on the number of members that are covered on the policy.
Due to clients having access to load funds upfront, there is a maximum of 2 claims that can be loaded at a time for each dependent. Alternatively, if clients need to utilize more than 2 day-to-day benefits at a time, the client can make payment and request for a refund to be processed. Once the funds have been utilized, we will require a computerized detailed invoice. The reason for this is for auditing purposes on our side and to prevent *****.
Kindly note that should clients experience any issues with regard to contacting us on our Customer Care Line, we have various options that clients can utilize to get assistance, an email can be sent to ***, or a message can be sent via App Chat or via our Whatsapp line *** on as our agents are always on standby ready to assist, alternatively you may also send a call me back request via the Oneplan App and one of our consultants will be in contact with you.
Should a client experience any issues with uploading the invoice via the App, invoices can be sent to us via Whatsapp on *** or an email can be sent to ***.
The standard turnaround time for day-to-day claims to be processed is between 48 - 72 working hours and up to 30 working days for in-hospital claims to be processed as this is dependent on us obtaining all the required information in order to finalize the claim. Certain terms and conditions are always applicable, and these are included in all policy documents before and during your experience with us. The terms and conditions of the policy must be adhered to and app**** fairly for all clients. Please note we are governed by the FAIS Act and must apply the TCF (Treat Customers Fairly) policy to ensure all our clients receive fair service and cover.
We encourage all our clients and potential clients to ensure that they do understand all products available in the market and perhaps approach their Financial Advisor for a factual comparison of products as hearsay may cause a consumer to make a decision based on inaccurate information. Once again, we apologize for any inconvenience caused and hope the above brings clarity to the matter.
Kind Regards, Oneplan
Oneplan Insurance's reply12 Nov 2024, 15:39
Official
Dear Diane,
Thank you for taking the time to bring this to our attention.
We are sorry to hear about your dissatisfaction and the opinion that you have developed regarding Oneplan Health Insurance as we do take customer feedback seriously to improve our service and process to ensure that we meet our client’s expectations.
Kindly note that insurance or indemnity insurance covers up to a respective cover limit. We inform all our clients that this product is not a Medical Aid product but a Health Insurance product. Our products are marketed and disclosed that we cover up to certain cover limits as the cover is not unlimited. This information is also clearly stated in the policy wording that is sent to all our clients.
Emergency treatment is treatment that cannot wait for a normal consultation with the doctor, clients may go to the nearest hospital casualty unit, where we will cover them should the emergency be confirmed as a triage category Orange or Red. When the hospital contacts us, they will inform us of the triage category that the patient is currently on. “Triage” means assessing emergency patients by medical professionals at the emergency unit into categories of priority based on the urgency of treatment required founded on national/ international scales which includes time frames. The triage category may change based on change in the condition of the insured or the actual diagnosis and treatment received.
It is important to note that authorization is granted based on the information that the hospital provides us with, unfortunately, authorization cannot be granted if the information we receive from the hospital does not fall within the Orange or Red Triage Colour Category. Should the hospital confirm the Triage colour to be Green or Yellow, according to our policy schedule the condition will be covered under the day-to-day benefit being a normal GP consultation, medication, radiology, or pathology up to the respective cover limit. A Green or Yellow Triage is Not covered under the emergency cover.
Kindly note that when the patient is informed of the Triage colour and benefit that the Health Insurance will provide, the choice is entirely up to the client as to whether they will continue with treatment at the hospital.
Chronic medication is covered under the day-to-day benefit and will be assessed through the Scripted medication benefit up to the respective cover limit depending on the number of members that are covered on the policy.
Due to clients having access to load funds upfront, there is a maximum of 2 claims that can be loaded at a time for each dependent. Alternatively, if clients need to utilize more than 2 day-to-day benefits at a time, the client can make payment and request for a refund to be processed. Once the funds have been utilized, we will require a computerized detailed invoice. The reason for this is for auditing purposes on our side and to prevent *****.
Kindly note that should clients experience any issues with regard to contacting us on our Customer Care Line, we have various options that clients can utilize to get assistance, an email can be sent to ***, or a message can be sent via App Chat or via our Whatsapp line *** on as our agents are always on standby ready to assist, alternatively you may also send a call me back request via the Oneplan App and one of our consultants will be in contact with you.
Should a client experience any issues with uploading the invoice via the App, invoices can be sent to us via Whatsapp on *** or an email can be sent to ***.
The standard turnaround time for day-to-day claims to be processed is between 48 - 72 working hours and up to 30 working days for in-hospital claims to be processed as this is dependent on us obtaining all the required information in order to finalize the claim. Certain terms and conditions are always applicable, and these are included in all policy documents before and during your experience with us. The terms and conditions of the policy must be adhered to and app**** fairly for all clients. Please note we are governed by the FAIS Act and must apply the TCF (Treat Customers Fairly) policy to ensure all our clients receive fair service and cover.
We encourage all our clients and potential clients to ensure that they do understand all products available in the market and perhaps approach their Financial Advisor for a factual comparison of products as hearsay may cause a consumer to make a decision based on inaccurate information. Once again, we apologize for any inconvenience caused and hope the above brings clarity to the matter.
Kind Regards, Oneplan
Thank you for taking the time to bring this to our attention.
We are sorry to hear about your dissatisfaction and the opinion that you have developed regarding Oneplan Health Insurance as we do take customer feedback seriously to improve our service and process to ensure that we meet our client’s expectations.
Kindly note that insurance or indemnity insurance covers up to a respective cover limit. We inform all our clients that this product is not a Medical Aid product but a Health Insurance product. Our products are marketed and disclosed that we cover up to certain cover limits as the cover is not unlimited. This information is also clearly stated in the policy wording that is sent to all our clients.
Emergency treatment is treatment that cannot wait for a normal consultation with the doctor, clients may go to the nearest hospital casualty unit, where we will cover them should the emergency be confirmed as a triage category Orange or Red. When the hospital contacts us, they will inform us of the triage category that the patient is currently on. “Triage” means assessing emergency patients by medical professionals at the emergency unit into categories of priority based on the urgency of treatment required founded on national/ international scales which includes time frames. The triage category may change based on change in the condition of the insured or the actual diagnosis and treatment received.
It is important to note that authorization is granted based on the information that the hospital provides us with, unfortunately, authorization cannot be granted if the information we receive from the hospital does not fall within the Orange or Red Triage Colour Category. Should the hospital confirm the Triage colour to be Green or Yellow, according to our policy schedule the condition will be covered under the day-to-day benefit being a normal GP consultation, medication, radiology, or pathology up to the respective cover limit. A Green or Yellow Triage is Not covered under the emergency cover.
Kindly note that when the patient is informed of the Triage colour and benefit that the Health Insurance will provide, the choice is entirely up to the client as to whether they will continue with treatment at the hospital.
Chronic medication is covered under the day-to-day benefit and will be assessed through the Scripted medication benefit up to the respective cover limit depending on the number of members that are covered on the policy.
Due to clients having access to load funds upfront, there is a maximum of 2 claims that can be loaded at a time for each dependent. Alternatively, if clients need to utilize more than 2 day-to-day benefits at a time, the client can make payment and request for a refund to be processed. Once the funds have been utilized, we will require a computerized detailed invoice. The reason for this is for auditing purposes on our side and to prevent *****.
Kindly note that should clients experience any issues with regard to contacting us on our Customer Care Line, we have various options that clients can utilize to get assistance, an email can be sent to ***, or a message can be sent via App Chat or via our Whatsapp line *** on as our agents are always on standby ready to assist, alternatively you may also send a call me back request via the Oneplan App and one of our consultants will be in contact with you.
Should a client experience any issues with uploading the invoice via the App, invoices can be sent to us via Whatsapp on *** or an email can be sent to ***.
The standard turnaround time for day-to-day claims to be processed is between 48 - 72 working hours and up to 30 working days for in-hospital claims to be processed as this is dependent on us obtaining all the required information in order to finalize the claim. Certain terms and conditions are always applicable, and these are included in all policy documents before and during your experience with us. The terms and conditions of the policy must be adhered to and app**** fairly for all clients. Please note we are governed by the FAIS Act and must apply the TCF (Treat Customers Fairly) policy to ensure all our clients receive fair service and cover.
We encourage all our clients and potential clients to ensure that they do understand all products available in the market and perhaps approach their Financial Advisor for a factual comparison of products as hearsay may cause a consumer to make a decision based on inaccurate information. Once again, we apologize for any inconvenience caused and hope the above brings clarity to the matter.
Kind Regards, Oneplan
DB
Diane B's updateReviewer Update
13 Nov 2024, 14:07Seriously - I request a refund to my bank account because I had to pay out of my bank account for my appointment on the 28th, now apparently that refund was paid to my OnePlan card, that is not what I requested and I still cannot see where that refund reflects on the card? Why give people the option to have a claim paid to their bank account and then do what you want anyways? I am so over this medical insurance - what a crock of dog poo
DB
Diane B's update13 Nov 2024, 14:07
Reviewer Update
Seriously - I request a refund to my bank account because I had to pay out of my bank account for my appointment on the 28th, now apparently that refund was paid to my OnePlan card, that is not what I requested and I still cannot see where that refund reflects on the card? Why give people the option to have a claim paid to their bank account and then do what you want anyways? I am so over this medical insurance - what a crock of dog poo
DB
Diane B's updateReviewer Update
13 Nov 2024, 14:11Oh and the above is not hearsay, this is the feedback i got this morning regarding my refund that I requested into my bank account, this is fact. Your pathetic app - fact. I asked via whatsapp that one of your agents call me, did they NO, I got questioned as to why I wanted a call, your IVR was down so I could not call in. Despite following the whatsapp promps and putting in Medical the agent was asking me about vets, then said they would put me through to the claims - well nothing absolutely nothing. No response from the claims department there, I had to phone in again later when the IVR had been fixed. Unprofessional, slow and argumentative. The only satisfactory call to OnePlan was saturday night where the agent took the time to explain what our options were regarding emergencies.
DB
Diane B's update13 Nov 2024, 14:11
Reviewer Update
Oh and the above is not hearsay, this is the feedback i got this morning regarding my refund that I requested into my bank account, this is fact. Your pathetic app - fact. I asked via whatsapp that one of your agents call me, did they NO, I got questioned as to why I wanted a call, your IVR was down so I could not call in. Despite following the whatsapp promps and putting in Medical the agent was asking me about vets, then said they would put me through to the claims - well nothing absolutely nothing. No response from the claims department there, I had to phone in again later when the IVR had been fixed. Unprofessional, slow and argumentative. The only satisfactory call to OnePlan was saturday night where the agent took the time to explain what our options were regarding emergencies.
DB
Diane B's updateReviewer Update
13 Nov 2024, 14:13I will not recommend OnePlan, not even to my worst enemy. I will continue to tell my friend and family about the horrible experiences we have had todate. I will continue to post on social media. When your agents sell policies to people they need to be honest and upfront, lying by omission is still lying and it is *********
DB
Diane B's update13 Nov 2024, 14:13
Reviewer Update
I will not recommend OnePlan, not even to my worst enemy. I will continue to tell my friend and family about the horrible experiences we have had todate. I will continue to post on social media. When your agents sell policies to people they need to be honest and upfront, lying by omission is still lying and it is *********
Oneplan Insurance's replyOfficial
13 Nov 2024, 16:39Dear Diane,
Thank you for reaching out to us.
We have acknowledged your query and we have escalated the matter to the relevant department. One of our consultants will be in contact with you to further discuss the matter at hand. Kind Regards,
Oneplan
Thank you for reaching out to us.
We have acknowledged your query and we have escalated the matter to the relevant department. One of our consultants will be in contact with you to further discuss the matter at hand. Kind Regards,
Oneplan
Oneplan Insurance's reply13 Nov 2024, 16:39
Official
Dear Diane,
Thank you for reaching out to us.
We have acknowledged your query and we have escalated the matter to the relevant department. One of our consultants will be in contact with you to further discuss the matter at hand. Kind Regards,
Oneplan
Thank you for reaching out to us.
We have acknowledged your query and we have escalated the matter to the relevant department. One of our consultants will be in contact with you to further discuss the matter at hand. Kind Regards,
Oneplan