Not honoring policy
I have been with one plan for 8 Years, I have recently gotten pregnant. I should be covered for pregnancy, but with oneplan you are NOT covered for pregnancy until 4 months, and they are also NOT covering my scans at all. My wording for radiology claims ALL scans and ultrasounds and "much more" is covered, there is NO exclusions for pregnancy! It's in my policy wording, but they refuse to honor the policy! I feel **********.
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Replies (6)
Oneplan Insurance's replyOfficial
15 Feb 2023, 19:11Dear Jennifer,
Thank you for taking the time to bring this to our attention.
We sincerely apologize for the circumstances under which your Hellopeter posting has reached us, and we apologize for any inconvenience caused. We do take customer feedback seriously to improve our service and process to ensure that we meet our client’s expectations.
Kindly note that the Maternity Pre-Birth Cover is separate from the Radiology Cover, and each benefit has its cover limit.
Should you wish to have any ultrasounds or scans done, this will be covered under the Radiology benefit up to the respective cover limit.
You may claim from month 4 or week 16 of a confirmed pregnancy for the Maternity Pre-Birth Cover. We will require a confirmation of pregnancy letter as the letter will serve as a confirmation of how far along you are with your pregnancy, this will ensure that the claim is processed correctly.
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. Oneplan subscribes to its TCF principles and will take all reasonable steps to ensure fair and equal treatment of all our clients. We do have your best interests at heart, and we will assist with all we can in line with our terms and conditions.
We have acknowledged your complaint 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 in the hopes to provide clarity on the above matter. Congratulations on the pregnancy and we wish you and your new bundle of joy the best of health.
Kind Regards,
Oneplan
Thank you for taking the time to bring this to our attention.
We sincerely apologize for the circumstances under which your Hellopeter posting has reached us, and we apologize for any inconvenience caused. We do take customer feedback seriously to improve our service and process to ensure that we meet our client’s expectations.
Kindly note that the Maternity Pre-Birth Cover is separate from the Radiology Cover, and each benefit has its cover limit.
Should you wish to have any ultrasounds or scans done, this will be covered under the Radiology benefit up to the respective cover limit.
You may claim from month 4 or week 16 of a confirmed pregnancy for the Maternity Pre-Birth Cover. We will require a confirmation of pregnancy letter as the letter will serve as a confirmation of how far along you are with your pregnancy, this will ensure that the claim is processed correctly.
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. Oneplan subscribes to its TCF principles and will take all reasonable steps to ensure fair and equal treatment of all our clients. We do have your best interests at heart, and we will assist with all we can in line with our terms and conditions.
We have acknowledged your complaint 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 in the hopes to provide clarity on the above matter. Congratulations on the pregnancy and we wish you and your new bundle of joy the best of health.
Kind Regards,
Oneplan
Oneplan Insurance's reply15 Feb 2023, 19:11
Official
Dear Jennifer,
Thank you for taking the time to bring this to our attention.
We sincerely apologize for the circumstances under which your Hellopeter posting has reached us, and we apologize for any inconvenience caused. We do take customer feedback seriously to improve our service and process to ensure that we meet our client’s expectations.
Kindly note that the Maternity Pre-Birth Cover is separate from the Radiology Cover, and each benefit has its cover limit.
Should you wish to have any ultrasounds or scans done, this will be covered under the Radiology benefit up to the respective cover limit.
You may claim from month 4 or week 16 of a confirmed pregnancy for the Maternity Pre-Birth Cover. We will require a confirmation of pregnancy letter as the letter will serve as a confirmation of how far along you are with your pregnancy, this will ensure that the claim is processed correctly.
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. Oneplan subscribes to its TCF principles and will take all reasonable steps to ensure fair and equal treatment of all our clients. We do have your best interests at heart, and we will assist with all we can in line with our terms and conditions.
We have acknowledged your complaint 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 in the hopes to provide clarity on the above matter. Congratulations on the pregnancy and we wish you and your new bundle of joy the best of health.
Kind Regards,
Oneplan
Thank you for taking the time to bring this to our attention.
We sincerely apologize for the circumstances under which your Hellopeter posting has reached us, and we apologize for any inconvenience caused. We do take customer feedback seriously to improve our service and process to ensure that we meet our client’s expectations.
Kindly note that the Maternity Pre-Birth Cover is separate from the Radiology Cover, and each benefit has its cover limit.
Should you wish to have any ultrasounds or scans done, this will be covered under the Radiology benefit up to the respective cover limit.
You may claim from month 4 or week 16 of a confirmed pregnancy for the Maternity Pre-Birth Cover. We will require a confirmation of pregnancy letter as the letter will serve as a confirmation of how far along you are with your pregnancy, this will ensure that the claim is processed correctly.
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. Oneplan subscribes to its TCF principles and will take all reasonable steps to ensure fair and equal treatment of all our clients. We do have your best interests at heart, and we will assist with all we can in line with our terms and conditions.
We have acknowledged your complaint 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 in the hopes to provide clarity on the above matter. Congratulations on the pregnancy and we wish you and your new bundle of joy the best of health.
Kind Regards,
Oneplan
's updateReviewer Update
15 Feb 2023, 20:44Thank you for your response.
I take note of your 16 week policy, and look forward to confirming pregnancy with you, however since we have not confirmed pregnancy with one plan, this is under radiology and should be covered. I look forward to notifying you at 16 weeks or 4 months, as per your required policy.
I take note of your 16 week policy, and look forward to confirming pregnancy with you, however since we have not confirmed pregnancy with one plan, this is under radiology and should be covered. I look forward to notifying you at 16 weeks or 4 months, as per your required policy.
's update15 Feb 2023, 20:44
Reviewer Update
Thank you for your response.
I take note of your 16 week policy, and look forward to confirming pregnancy with you, however since we have not confirmed pregnancy with one plan, this is under radiology and should be covered. I look forward to notifying you at 16 weeks or 4 months, as per your required policy.
I take note of your 16 week policy, and look forward to confirming pregnancy with you, however since we have not confirmed pregnancy with one plan, this is under radiology and should be covered. I look forward to notifying you at 16 weeks or 4 months, as per your required policy.
's updateReviewer Update
16 Feb 2023, 15:23This issue stands and has been confirmed, my scans are NOT covered with oneplan for pregnancy until 16 weeks / 4 months.
's update16 Feb 2023, 15:23
Reviewer Update
This issue stands and has been confirmed, my scans are NOT covered with oneplan for pregnancy until 16 weeks / 4 months.
's updateReviewer Update
16 Feb 2023, 15:26This issue stands and has been confirmed, my scans are NOT covered with oneplan for pregnancy until 16 weeks / 4 months.
's update16 Feb 2023, 15:26
Reviewer Update
This issue stands and has been confirmed, my scans are NOT covered with oneplan for pregnancy until 16 weeks / 4 months.
Oneplan Insurance's replyOfficial
16 Feb 2023, 16:13Good day Jennifer,
Thank you for taking our call earlier and for allowing us the opportunity to further explain.
As per our telephonic conversation, kindly note that the scans for the baby will only be covered after 16 weeks (4 months) of the pregnancy under the Maternity Pre-Birth benefit. Maternity-related visits/claims are not covered under the Specialist cover. The claim was reviewed and covered under the GP benefit up to the respective cover limit.
We have since escalated your query to the relevant department. One of our consultants from our in-hospital department will be in contact with you to further explain the Natural Birth and Emergency Caesarean Benefit.
Kind Regards,
Oneplan
Thank you for taking our call earlier and for allowing us the opportunity to further explain.
As per our telephonic conversation, kindly note that the scans for the baby will only be covered after 16 weeks (4 months) of the pregnancy under the Maternity Pre-Birth benefit. Maternity-related visits/claims are not covered under the Specialist cover. The claim was reviewed and covered under the GP benefit up to the respective cover limit.
We have since escalated your query to the relevant department. One of our consultants from our in-hospital department will be in contact with you to further explain the Natural Birth and Emergency Caesarean Benefit.
Kind Regards,
Oneplan
Oneplan Insurance's reply16 Feb 2023, 16:13
Official
Good day Jennifer,
Thank you for taking our call earlier and for allowing us the opportunity to further explain.
As per our telephonic conversation, kindly note that the scans for the baby will only be covered after 16 weeks (4 months) of the pregnancy under the Maternity Pre-Birth benefit. Maternity-related visits/claims are not covered under the Specialist cover. The claim was reviewed and covered under the GP benefit up to the respective cover limit.
We have since escalated your query to the relevant department. One of our consultants from our in-hospital department will be in contact with you to further explain the Natural Birth and Emergency Caesarean Benefit.
Kind Regards,
Oneplan
Thank you for taking our call earlier and for allowing us the opportunity to further explain.
As per our telephonic conversation, kindly note that the scans for the baby will only be covered after 16 weeks (4 months) of the pregnancy under the Maternity Pre-Birth benefit. Maternity-related visits/claims are not covered under the Specialist cover. The claim was reviewed and covered under the GP benefit up to the respective cover limit.
We have since escalated your query to the relevant department. One of our consultants from our in-hospital department will be in contact with you to further explain the Natural Birth and Emergency Caesarean Benefit.
Kind Regards,
Oneplan
's updateReviewer Update
17 Feb 2023, 09:03Yes, Thank you.
Please note that NO scans are covered until 16 weeks / 4 months. Then from 4 months to 9 months, only 4 scans/ doctor visits will be covered, any further complications or required scans or doctors visits will come out of the client pocket.
Please note that NO scans are covered until 16 weeks / 4 months. Then from 4 months to 9 months, only 4 scans/ doctor visits will be covered, any further complications or required scans or doctors visits will come out of the client pocket.
's update17 Feb 2023, 09:03
Reviewer Update
Yes, Thank you.
Please note that NO scans are covered until 16 weeks / 4 months. Then from 4 months to 9 months, only 4 scans/ doctor visits will be covered, any further complications or required scans or doctors visits will come out of the client pocket.
Please note that NO scans are covered until 16 weeks / 4 months. Then from 4 months to 9 months, only 4 scans/ doctor visits will be covered, any further complications or required scans or doctors visits will come out of the client pocket.