LS
Linda S
1 reviews | Active since Jun 2012
18 Nov 2025, 17:45
I DEMAND MY REFUND ASAP!!!
The start of this relationship was rocky in the first place.
1. There is some information that the gentleman who sold the policy to me gave to me only for the policy documents to reflect a different story. The information received mentioned the amount allocated for myself and my beneficiary. Only for that amount to have limitations at GP visits - which is not what was sold to me. Please retrieve that call and listen to all the questions I asked and how they were answered.
2. I visited a GP on 2 October. My card declined when I got there. I was told I need to call to request for funds to be allocated. There were already charges to the card for the failed transaction (swiping). By the time the funds were allocated, the amount to be allocated was short because of the charges. In that phone call, there was no mention of a request for a receipt and an invoice from my GP. Instead, I was told the next time I need funds, I can call and the funds will be made available and I can even access them via Standard Bank as a cash withdrawal.
3. I visited the GP on 2 November. On my call when I requested funds, the consultant detailed that I need to request an invoice from my GP. An invoice and proof of payment was shared via the WhatsApp platform. This included the invoice for pathology which I paid for. The invoice for 2 November reflects an ECG that the doctor requested I get.
4. Do not get me started on the App. When I complained about not being able to log into the App, I was told to remove the App and download again. I did that twice and still experience issues logging in!!
After my follow up on 18 November, via WhatsApp, I am now receiving told the claim cannot be processed without an invoice and PoP from my 2 October GP Visit. How????? No communication came in immediately after that visit. As per No. 1 - the consultant made no mention of such docs that will be required.
I hereby demand that my refund for the pathology be processed immediately.
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Replies (2)
Oneplan Insurance's replyOfficial
18 Nov 2025, 19:07Dear Linda ,
Thank you for taking the time to bring this matter to our attention.
We regret the circumstances under which your correspondence reached us and sincerely apologise for any inconvenience caused. Please be assured that we take all customer feedback seriously, as it enables us to continuously improve our service delivery and processes to better meet our clients’ expectations.
We acknowledge receipt of your complaint and would like to clarify the following; During the sales call, the applicable annual and cover limits for the benefits under your chosen plan were communicated. This information is also reflected in the policy schedule that is emailed to you once your application has been reviewed by our underwriting department. In instances where information is omitted or incorrectly communicated during the sales call, our Quality Assurance team reviews the matter and contacts the client to provide the correct or missing details so that an informed decision can be made regarding continuation of the policy. In your case, our team did reach out to you to communicate the correct information regarding your policy, coverage, and the addition of dependents.
Regarding the card transactions, our system reflects that on 14/09/2025 you attempted to use the card twice without loading funds beforehand. These attempts generated charges that resulted in a negative balance. When funds were later loaded, the outstanding charges were deducted, after which you utilised an amount of R380.00. The claim for this date was reviewed and approved. Our records show no card transactions on 02/10/2025. We also note that on 02/11/2025 two claims were submitted, and an amount of R800.00 was utilised. The invoice received for the GP and Pathology claims was reviewed and approved.
The policy schedule clearly states: “You must submit an actual and valid invoice for each event.” This means that every claim must be supported by a valid, detailed invoice. The policy schedule further states: “If you require a refund, you must provide us with valid proof of payment, and we will refund the cover type within seven (7) days from the date of receipt of the valid proof of payment.” Without proof of payment accompanying the invoice, refund claims cannot be processed.
As communicated via WhatsApp by our Claims team, proof of payment is required for the refund claims dated 02/10/2025. SMS notifications requesting this documentation were also sent to the contact number listed on your policy at the time the claims were processed. Our consultant has indicated that they will contact the service provider directly to obtain the proof of payment.
Certain terms and conditions apply to all policies, and these are communicated upfront and throughout your engagement with us. We remain committed to assisting you within the framework of these terms. Oneplan adheres strictly to Treating Customers Fairly (TCF) principles and takes all reasonable steps to ensure fair and equitable treatment for all clients.
We trust this provides clarity on the matter.
Kind regards,
Oneplan.
Thank you for taking the time to bring this matter to our attention.
We regret the circumstances under which your correspondence reached us and sincerely apologise for any inconvenience caused. Please be assured that we take all customer feedback seriously, as it enables us to continuously improve our service delivery and processes to better meet our clients’ expectations.
We acknowledge receipt of your complaint and would like to clarify the following; During the sales call, the applicable annual and cover limits for the benefits under your chosen plan were communicated. This information is also reflected in the policy schedule that is emailed to you once your application has been reviewed by our underwriting department. In instances where information is omitted or incorrectly communicated during the sales call, our Quality Assurance team reviews the matter and contacts the client to provide the correct or missing details so that an informed decision can be made regarding continuation of the policy. In your case, our team did reach out to you to communicate the correct information regarding your policy, coverage, and the addition of dependents.
Regarding the card transactions, our system reflects that on 14/09/2025 you attempted to use the card twice without loading funds beforehand. These attempts generated charges that resulted in a negative balance. When funds were later loaded, the outstanding charges were deducted, after which you utilised an amount of R380.00. The claim for this date was reviewed and approved. Our records show no card transactions on 02/10/2025. We also note that on 02/11/2025 two claims were submitted, and an amount of R800.00 was utilised. The invoice received for the GP and Pathology claims was reviewed and approved.
The policy schedule clearly states: “You must submit an actual and valid invoice for each event.” This means that every claim must be supported by a valid, detailed invoice. The policy schedule further states: “If you require a refund, you must provide us with valid proof of payment, and we will refund the cover type within seven (7) days from the date of receipt of the valid proof of payment.” Without proof of payment accompanying the invoice, refund claims cannot be processed.
As communicated via WhatsApp by our Claims team, proof of payment is required for the refund claims dated 02/10/2025. SMS notifications requesting this documentation were also sent to the contact number listed on your policy at the time the claims were processed. Our consultant has indicated that they will contact the service provider directly to obtain the proof of payment.
Certain terms and conditions apply to all policies, and these are communicated upfront and throughout your engagement with us. We remain committed to assisting you within the framework of these terms. Oneplan adheres strictly to Treating Customers Fairly (TCF) principles and takes all reasonable steps to ensure fair and equitable treatment for all clients.
We trust this provides clarity on the matter.
Kind regards,
Oneplan.
Oneplan Insurance's reply18 Nov 2025, 19:07
Official
Dear Linda ,
Thank you for taking the time to bring this matter to our attention.
We regret the circumstances under which your correspondence reached us and sincerely apologise for any inconvenience caused. Please be assured that we take all customer feedback seriously, as it enables us to continuously improve our service delivery and processes to better meet our clients’ expectations.
We acknowledge receipt of your complaint and would like to clarify the following; During the sales call, the applicable annual and cover limits for the benefits under your chosen plan were communicated. This information is also reflected in the policy schedule that is emailed to you once your application has been reviewed by our underwriting department. In instances where information is omitted or incorrectly communicated during the sales call, our Quality Assurance team reviews the matter and contacts the client to provide the correct or missing details so that an informed decision can be made regarding continuation of the policy. In your case, our team did reach out to you to communicate the correct information regarding your policy, coverage, and the addition of dependents.
Regarding the card transactions, our system reflects that on 14/09/2025 you attempted to use the card twice without loading funds beforehand. These attempts generated charges that resulted in a negative balance. When funds were later loaded, the outstanding charges were deducted, after which you utilised an amount of R380.00. The claim for this date was reviewed and approved. Our records show no card transactions on 02/10/2025. We also note that on 02/11/2025 two claims were submitted, and an amount of R800.00 was utilised. The invoice received for the GP and Pathology claims was reviewed and approved.
The policy schedule clearly states: “You must submit an actual and valid invoice for each event.” This means that every claim must be supported by a valid, detailed invoice. The policy schedule further states: “If you require a refund, you must provide us with valid proof of payment, and we will refund the cover type within seven (7) days from the date of receipt of the valid proof of payment.” Without proof of payment accompanying the invoice, refund claims cannot be processed.
As communicated via WhatsApp by our Claims team, proof of payment is required for the refund claims dated 02/10/2025. SMS notifications requesting this documentation were also sent to the contact number listed on your policy at the time the claims were processed. Our consultant has indicated that they will contact the service provider directly to obtain the proof of payment.
Certain terms and conditions apply to all policies, and these are communicated upfront and throughout your engagement with us. We remain committed to assisting you within the framework of these terms. Oneplan adheres strictly to Treating Customers Fairly (TCF) principles and takes all reasonable steps to ensure fair and equitable treatment for all clients.
We trust this provides clarity on the matter.
Kind regards,
Oneplan.
Thank you for taking the time to bring this matter to our attention.
We regret the circumstances under which your correspondence reached us and sincerely apologise for any inconvenience caused. Please be assured that we take all customer feedback seriously, as it enables us to continuously improve our service delivery and processes to better meet our clients’ expectations.
We acknowledge receipt of your complaint and would like to clarify the following; During the sales call, the applicable annual and cover limits for the benefits under your chosen plan were communicated. This information is also reflected in the policy schedule that is emailed to you once your application has been reviewed by our underwriting department. In instances where information is omitted or incorrectly communicated during the sales call, our Quality Assurance team reviews the matter and contacts the client to provide the correct or missing details so that an informed decision can be made regarding continuation of the policy. In your case, our team did reach out to you to communicate the correct information regarding your policy, coverage, and the addition of dependents.
Regarding the card transactions, our system reflects that on 14/09/2025 you attempted to use the card twice without loading funds beforehand. These attempts generated charges that resulted in a negative balance. When funds were later loaded, the outstanding charges were deducted, after which you utilised an amount of R380.00. The claim for this date was reviewed and approved. Our records show no card transactions on 02/10/2025. We also note that on 02/11/2025 two claims were submitted, and an amount of R800.00 was utilised. The invoice received for the GP and Pathology claims was reviewed and approved.
The policy schedule clearly states: “You must submit an actual and valid invoice for each event.” This means that every claim must be supported by a valid, detailed invoice. The policy schedule further states: “If you require a refund, you must provide us with valid proof of payment, and we will refund the cover type within seven (7) days from the date of receipt of the valid proof of payment.” Without proof of payment accompanying the invoice, refund claims cannot be processed.
As communicated via WhatsApp by our Claims team, proof of payment is required for the refund claims dated 02/10/2025. SMS notifications requesting this documentation were also sent to the contact number listed on your policy at the time the claims were processed. Our consultant has indicated that they will contact the service provider directly to obtain the proof of payment.
Certain terms and conditions apply to all policies, and these are communicated upfront and throughout your engagement with us. We remain committed to assisting you within the framework of these terms. Oneplan adheres strictly to Treating Customers Fairly (TCF) principles and takes all reasonable steps to ensure fair and equitable treatment for all clients.
We trust this provides clarity on the matter.
Kind regards,
Oneplan.
LS
Linda S's updateReviewer Update
18 Nov 2025, 19:23Please listen to the initial call again. I posed a lot of questions to which responses were not what your response reflects. The calls I received after that call also detail that the policy schedule was not sent to me immediately after the call as promised. The adding of a dependent was also not done as initially requested during the first call which meant a longer waiting period for my dependent.
There was no back and forth calls as you claim to determine the best policy/package for me. I agreed to the policy in the initial call and the documents took DAYS to be shared with me.
When you listen to calls made to me, you will hear the disappointment in your consultant's voice when she learnt that her colleague did not keep to his word. An incomplete policy schedule which excluded my dependent was shared even after I specifically requested for my dependent to be added same time as me.
During the sales call, I asked and asked about the amounts to be allocated and how those work. Your sales person detailed the amount to be allocated and how that applies for all benefits listed under the policy. No mention of additional amounts to be paid by the policy holder were detailed.
I am happy to schedule a session where we can review that call!!!
The claim shows no records of 2 October yet your SMS comms details the claim for 2 October was not processed?? How??
Valid proof was shared accordingly.
As mentioned, no further comms was sent after the September visit.
The only number listed under my policy is my number.
How is the SMS comms dating 2 October when the GP visit was 2 November??
How is one treated fairly as per your principles when your comms is contradictory??
I need to know what the ETA is after the agent contacts my GP and gathers all the information so you can process my claim????
There was no back and forth calls as you claim to determine the best policy/package for me. I agreed to the policy in the initial call and the documents took DAYS to be shared with me.
When you listen to calls made to me, you will hear the disappointment in your consultant's voice when she learnt that her colleague did not keep to his word. An incomplete policy schedule which excluded my dependent was shared even after I specifically requested for my dependent to be added same time as me.
During the sales call, I asked and asked about the amounts to be allocated and how those work. Your sales person detailed the amount to be allocated and how that applies for all benefits listed under the policy. No mention of additional amounts to be paid by the policy holder were detailed.
I am happy to schedule a session where we can review that call!!!
The claim shows no records of 2 October yet your SMS comms details the claim for 2 October was not processed?? How??
Valid proof was shared accordingly.
As mentioned, no further comms was sent after the September visit.
The only number listed under my policy is my number.
How is the SMS comms dating 2 October when the GP visit was 2 November??
How is one treated fairly as per your principles when your comms is contradictory??
I need to know what the ETA is after the agent contacts my GP and gathers all the information so you can process my claim????
LS
Linda S's update18 Nov 2025, 19:23
Reviewer Update
Please listen to the initial call again. I posed a lot of questions to which responses were not what your response reflects. The calls I received after that call also detail that the policy schedule was not sent to me immediately after the call as promised. The adding of a dependent was also not done as initially requested during the first call which meant a longer waiting period for my dependent.
There was no back and forth calls as you claim to determine the best policy/package for me. I agreed to the policy in the initial call and the documents took DAYS to be shared with me.
When you listen to calls made to me, you will hear the disappointment in your consultant's voice when she learnt that her colleague did not keep to his word. An incomplete policy schedule which excluded my dependent was shared even after I specifically requested for my dependent to be added same time as me.
During the sales call, I asked and asked about the amounts to be allocated and how those work. Your sales person detailed the amount to be allocated and how that applies for all benefits listed under the policy. No mention of additional amounts to be paid by the policy holder were detailed.
I am happy to schedule a session where we can review that call!!!
The claim shows no records of 2 October yet your SMS comms details the claim for 2 October was not processed?? How??
Valid proof was shared accordingly.
As mentioned, no further comms was sent after the September visit.
The only number listed under my policy is my number.
How is the SMS comms dating 2 October when the GP visit was 2 November??
How is one treated fairly as per your principles when your comms is contradictory??
I need to know what the ETA is after the agent contacts my GP and gathers all the information so you can process my claim????
There was no back and forth calls as you claim to determine the best policy/package for me. I agreed to the policy in the initial call and the documents took DAYS to be shared with me.
When you listen to calls made to me, you will hear the disappointment in your consultant's voice when she learnt that her colleague did not keep to his word. An incomplete policy schedule which excluded my dependent was shared even after I specifically requested for my dependent to be added same time as me.
During the sales call, I asked and asked about the amounts to be allocated and how those work. Your sales person detailed the amount to be allocated and how that applies for all benefits listed under the policy. No mention of additional amounts to be paid by the policy holder were detailed.
I am happy to schedule a session where we can review that call!!!
The claim shows no records of 2 October yet your SMS comms details the claim for 2 October was not processed?? How??
Valid proof was shared accordingly.
As mentioned, no further comms was sent after the September visit.
The only number listed under my policy is my number.
How is the SMS comms dating 2 October when the GP visit was 2 November??
How is one treated fairly as per your principles when your comms is contradictory??
I need to know what the ETA is after the agent contacts my GP and gathers all the information so you can process my claim????