1 reviews | Active since Jul 2023
One Plan, should be called No Plan
One Plan, ya right, should be called No Plan
If you think you have piece of mind because you have a One Plan Hospital Plan, you are wrong.
Honestly, you are better off putting your premium into a monthly Investment account and get some interest on your money. Firstly, and this is a fact, look it up, Medi Clinics are no longer going to be taking One Plan Medical insurance. They are that difficult to deal with. This came from the Medi clinic’s admin department when trying to deal with No Plan when trying to admit my wife after an accident.
One Plan is dishonest and leave you with no recourse to challenge their decision on a claim.
There Hospital Plan contract isn’t worth the paper its written on.
“ACCESS TO PRIVATE HOSPITALS Get access to private hospitals at an affordable premium to help you get the help you need, quicker.”
This is not true.
We got no answer when phoning OnePlan, nothing on the day of the accident or the day after she admitted herself into Medi Clinic. There phone simply rang unanswered. We couldn’t get help at all, never mind quicker. She was in hospital for 2 days before we got any response from One Plan which when joining No Plan, were told we were covered for R175 000 Accident cover (Admission). They would not cover pain management, the CT or MRI scans. They paid exactly Zero of the R175 000 Cover.
She had to discharge herself, two days later, still in pain because we could not get answers from One Plan and were running up a hospital bill we were worried we wouldn’t be able to cover ourselves financially despite our supposed R175 000 Accident cover.
We had a bill of over R30 000 for the 2 days of which No Plan paid eventually paid R5600 which is the Casualty Accident cover, IE cutting your finger and needing stitches which was not why my wife was in hospital. Despite this being outlined as an accident by the Medi clinic to No Plan, needing a spine specialist and physio, X-rays, MRI Scan amongst others which One Plan ignored and simply paid the minimum amount possible despite the accident falling under the higher cover requirements.
One Plan did not accept Medi Clinics outline as that of an accident. They chose the cheapest way out possible.
We still have payments due to us which reflect as PENDING on the One Plan app, 3 weeks after submitting invoices for Doctors bills we had to pay upfront.
We have obviously cancelled our One Plan Policy.
And One Plan don’t bother getting hold of us, we want nothing to do with you, stay the hell away from us. And you can keep the money you haven’t paid us back.
Thank you for taking the time to bring this to our attention.
We would like to offer our sincerest apologies for any inconvenience caused. We do have your wife’s best interest at heart and wish that she is coping well. We do take customer feedback seriously to improve our service and processes to ensure that we meet client’s expectations.
Kindly note that we have 5 different plan types for our Health products, which include the Core Plan, Core Plus Plan, Blue Plan, Professional Plan, and Executive Plan, and our Health plans are specially designed to cater to our client’s individual needs.
The Core plan is our entry-level plan, which offers cover for day-to-day as well as very Limited in-hospital cover.
Upon investigation, we discovered the plan type that you and your wife are covered on is the Core plan which does not offer cover for admissions in-hospital due to illness or illness related it only offers Casualty Illness cover.
Kindly note that authorization is granted based on the information that the hospital provides us with. The medical information provided by the hospital did not indicate that the admission was due to an injury caused by an accident. Therefore, a Casualty Illness authorization was granted which covers up to a maximum cover limit of R5600 which we have finalized according to the claims we have received.
It is important to note that your selected plan under which the request was submitted does not include coverage for illness-related hospital admissions and based on the claims received, the Service Providers utilized ICD10 codes that are related to Illness and not Accident, therefore, the claim could only be finalized under the Casualty Illness benefit that is available on the Core plan.
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 was sent to your listed email address.
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. We do have your wife’s best interests at heart, and we will assist with all we can in line with our terms and conditions. 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 would like to offer our sincerest apologies for any inconvenience caused. We do have your wife’s best interest at heart and wish that she is coping well. We do take customer feedback seriously to improve our service and processes to ensure that we meet client’s expectations.
Kindly note that we have 5 different plan types for our Health products, which include the Core Plan, Core Plus Plan, Blue Plan, Professional Plan, and Executive Plan, and our Health plans are specially designed to cater to our client’s individual needs.
The Core plan is our entry-level plan, which offers cover for day-to-day as well as very Limited in-hospital cover.
Upon investigation, we discovered the plan type that you and your wife are covered on is the Core plan which does not offer cover for admissions in-hospital due to illness or illness related it only offers Casualty Illness cover.
Kindly note that authorization is granted based on the information that the hospital provides us with. The medical information provided by the hospital did not indicate that the admission was due to an injury caused by an accident. Therefore, a Casualty Illness authorization was granted which covers up to a maximum cover limit of R5600 which we have finalized according to the claims we have received.
It is important to note that your selected plan under which the request was submitted does not include coverage for illness-related hospital admissions and based on the claims received, the Service Providers utilized ICD10 codes that are related to Illness and not Accident, therefore, the claim could only be finalized under the Casualty Illness benefit that is available on the Core plan.
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 was sent to your listed email address.
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. We do have your wife’s best interests at heart, and we will assist with all we can in line with our terms and conditions. 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