MK
Maryke K
1 reviews | Active since Sept 2011
31 Jul 2024, 13:31
ONEPLAN NOT COVERING CHILDREN WITH MENTALL ILLNESS CHRONIC MEDICATION (AFTER MONTHS OF CLAIMING)
I have been claiming my daughters chronic medication for months, today I try to load funds via the app and the request gets rejected, I phoned in and the lady informed me that Oneplan do not cover people/children with mental illnesses medication. This is a chronic disease and I use the R275.00 per month to make it possible for me to afford my daughters medication. On the app they call it script medication. I do have a script for the medication. Just wondering what is the difference between a mental illness that you are born with and heart decease? Which one will kill you faster if you do not have your medication? I am devastated. As a single mother with a father not paying maintenance this was my only outcome.
If any other Insurance company is willing to assist me/my daughter, please let me know.
What happens to children like this if their decease is not important enough for the world to acknowledge?
Hopefully this review will also show on the Oneplan website for people to make an informed decision.
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Replies (1)
Oneplan Insurance's replyOfficial
31 Jul 2024, 16:16Dear Maryke,
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 daughter'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.
Upon investigation, we discovered that there were no previous medication claims approved for the listed chronic medication invoice that we received confirming that we did not previously cover the medication due to it being a general exclusion on the policy.
Kindly note that medication dispensed to treat mental health conditions is regrettably related to our general exclusions which are things not funded for by the Insurer and fall within the bounds of our very few excluded conditions. As per our policy terms and conditions under Section 7.13 of your policy schedule it states: We will not be liable for expenses, hospitalization, injury, sickness or disease and/or complications directly, or indirectly caused by or related to the following Mental illness, psychiatric disorders, symptoms, and related treatment and hospitalization.
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 daughter'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.
Upon investigation, we discovered that there were no previous medication claims approved for the listed chronic medication invoice that we received confirming that we did not previously cover the medication due to it being a general exclusion on the policy.
Kindly note that medication dispensed to treat mental health conditions is regrettably related to our general exclusions which are things not funded for by the Insurer and fall within the bounds of our very few excluded conditions. As per our policy terms and conditions under Section 7.13 of your policy schedule it states: We will not be liable for expenses, hospitalization, injury, sickness or disease and/or complications directly, or indirectly caused by or related to the following Mental illness, psychiatric disorders, symptoms, and related treatment and hospitalization.
Please take note that we are not regulated by the Medical Schemes Act but by the Short-Term Insurance Act and have to abide by certain rules. 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. Insurance or indemnity insurance covers up to a respective cover limit. This information is also stated in the policy wording that was sent to your listed email address which included a list of our policy general exclusions.
Certain terms and conditions are always applicable, and these are included in all policy documents before and during your experience with us. We will assist with all we can in line with our terms and conditions. Please note that this is by no means a ploy to refuse payment of the claim. We will gladly assist with all benefits that have provisions in the policy terms and conditions. Oneplan subscribes to its TCF principles and will take all reasonable steps to ensure fair and equal treatment of all our clients.
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.
Kind Regards,
Oneplan
Once again, we apologize for any inconvenience caused.
Kind Regards,
Oneplan
Oneplan Insurance's reply31 Jul 2024, 16:16
Official
Dear Maryke,
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 daughter'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.
Upon investigation, we discovered that there were no previous medication claims approved for the listed chronic medication invoice that we received confirming that we did not previously cover the medication due to it being a general exclusion on the policy.
Kindly note that medication dispensed to treat mental health conditions is regrettably related to our general exclusions which are things not funded for by the Insurer and fall within the bounds of our very few excluded conditions. As per our policy terms and conditions under Section 7.13 of your policy schedule it states: We will not be liable for expenses, hospitalization, injury, sickness or disease and/or complications directly, or indirectly caused by or related to the following Mental illness, psychiatric disorders, symptoms, and related treatment and hospitalization.
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 daughter'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.
Upon investigation, we discovered that there were no previous medication claims approved for the listed chronic medication invoice that we received confirming that we did not previously cover the medication due to it being a general exclusion on the policy.
Kindly note that medication dispensed to treat mental health conditions is regrettably related to our general exclusions which are things not funded for by the Insurer and fall within the bounds of our very few excluded conditions. As per our policy terms and conditions under Section 7.13 of your policy schedule it states: We will not be liable for expenses, hospitalization, injury, sickness or disease and/or complications directly, or indirectly caused by or related to the following Mental illness, psychiatric disorders, symptoms, and related treatment and hospitalization.
Please take note that we are not regulated by the Medical Schemes Act but by the Short-Term Insurance Act and have to abide by certain rules. 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. Insurance or indemnity insurance covers up to a respective cover limit. This information is also stated in the policy wording that was sent to your listed email address which included a list of our policy general exclusions.
Certain terms and conditions are always applicable, and these are included in all policy documents before and during your experience with us. We will assist with all we can in line with our terms and conditions. Please note that this is by no means a ploy to refuse payment of the claim. We will gladly assist with all benefits that have provisions in the policy terms and conditions. Oneplan subscribes to its TCF principles and will take all reasonable steps to ensure fair and equal treatment of all our clients.
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.
Kind Regards,
Oneplan
Once again, we apologize for any inconvenience caused.
Kind Regards,
Oneplan