Misleading Oneplan Insurance policy wording, they make it up as they go along!

I am a fairly healthy individual and only needed a in-case-of emergency type of hospital cover and something that would cover child birth at a later stage. Oneplan looked like good insurance as they specifically had illness in Hospital cover and a separate cover specifically for Natural Birth/C-section single event of R50 000. The policy wording is very clear and even provided a definition of what "Child birth is" No mention of pregnancy at all.

I got pregnant and at 30 weeks had a pregnancy complication and spent 2 days in hospital for observation. At 37 weeks, two weeks before my scheduled c-section I got my letter from Oneplan to cover the birth from the Natural birth cover as per their policy. I paid my gynae upfront R18K with the understanding that I could claim it back after the birth as per Oneplans instruction. I was admitted to a private hospital without any issue, and had a scheduled c-section birth.

Then 1 month later, to my shock, my claims started being returned from the suppliers. They said that Oneplan informed them that my Natural Birth Cover has been exhausted. Turns out, Oneplan paid for my 30 week emergency hospitalization from the Natural birth cover and says it is all related to pregnancy. So there was nearly a R25k shortfall I had to cover for the birthing event.

To make things worse, I fell very ill after giving birth and developed a breast abscess that I had to have emergency plastic surgery for, 5 weeks post giving birth. Once again I was admitted to a private hospital without any questions, only 30 days later I found out all the medical providers claims had been rejected again.

According to OnePlan the "Natrual birth and Emergency C-section cover" is not only for the single event of giving birth but to cover any and all pregnancy related claims emergency or not.

So I feel that their policy wording is false advertising and misleading. If the cover is meant for all pregnancy related items then it should state this. They make it up as they go along.

I have escalated to the ombudman but they do nothing.

I would suggest to never use ONEPLAN as you dont know what you are covered for according to their simple policy wording. They pay what they want.