SK
SImonae K
1 reviews | Active since Feb 2018
26 Mar 2022, 07:16
Oneplan Pet Insurance is an utter disappointment
Absolutely devastated and utterly disappointed with Oneplan Pet Insurance. After paying for months thinking I have pet insurance, turns out they weasel themselves out of paying. They just failed me and my pet. Stay far away! It would've been better to put this installment into a credit card or savings account and use the money when needed, instead of giving it to common *******. @ Oneplan; please don't even comment with your robotic, PR, keeping up appearances reply.
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Replies (5)
Oneplan Insurance's replyOfficial
26 Mar 2022, 11:25Good day Simonae,
Thank you for taking the time to bring this to our attention, we have attempted to contact you on the listed number; however, it was to no avail.
We do sincerely apologize for any inconvenience which has been caused. We do have your fur-baby's best interest at heart and wish that she is having a speedy recovery.
Kindly noted upon receiving the invoices for the in-hospital claim, we discovered that the services rendered on the invoice were only diagnostic tests and medication which falls under the cover limit for the Casualty benefit.
For a claim to be considered under In-Hospital Admission, the invoice must reflect details of a a in-hospital corrective procedure. Should a diagnostic procedure result in a confirmed diagnosis the cost of the in-hospital corrective procedure will be covered under the authorized Hospital admission cover limit. Kindly note that all in-hospital claims must meet our admission matrix which is found in your policy schedule.
The claim for your fur-baby was approved and covered under the Casualty benefit up to the respective cover limit of R1300 due to the diagnostic tests and medication that was provided. Kindly note according to our policy schedule it states that, you may claim for follow up visits for the same event until the event limit has been reached within a period of 14 days ‐ for example, if your limit is R500 and your previous claim was only for R250, you can still claim another R250 for the follow-up vet visit for the same issue. You may not claim for the same event under a new cover within the fourteen (14) day waiting period. The second Casualty claim could not be approved due to claim falling within the 14-day period and the cover limit was reached.
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, please note that this is by no means a ploy to refuse payment of the claim. We do have your fur-babies 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 policy to ensure all our clients receive fair service and cover.
We once again apologize for any inconvenience caused.
Kind Regards,
Oneplan
Thank you for taking the time to bring this to our attention, we have attempted to contact you on the listed number; however, it was to no avail.
We do sincerely apologize for any inconvenience which has been caused. We do have your fur-baby's best interest at heart and wish that she is having a speedy recovery.
Kindly noted upon receiving the invoices for the in-hospital claim, we discovered that the services rendered on the invoice were only diagnostic tests and medication which falls under the cover limit for the Casualty benefit.
For a claim to be considered under In-Hospital Admission, the invoice must reflect details of a a in-hospital corrective procedure. Should a diagnostic procedure result in a confirmed diagnosis the cost of the in-hospital corrective procedure will be covered under the authorized Hospital admission cover limit. Kindly note that all in-hospital claims must meet our admission matrix which is found in your policy schedule.
The claim for your fur-baby was approved and covered under the Casualty benefit up to the respective cover limit of R1300 due to the diagnostic tests and medication that was provided. Kindly note according to our policy schedule it states that, you may claim for follow up visits for the same event until the event limit has been reached within a period of 14 days ‐ for example, if your limit is R500 and your previous claim was only for R250, you can still claim another R250 for the follow-up vet visit for the same issue. You may not claim for the same event under a new cover within the fourteen (14) day waiting period. The second Casualty claim could not be approved due to claim falling within the 14-day period and the cover limit was reached.
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, please note that this is by no means a ploy to refuse payment of the claim. We do have your fur-babies 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 policy to ensure all our clients receive fair service and cover.
We once again apologize for any inconvenience caused.
Kind Regards,
Oneplan
Oneplan Insurance's reply26 Mar 2022, 11:25
Official
Good day Simonae,
Thank you for taking the time to bring this to our attention, we have attempted to contact you on the listed number; however, it was to no avail.
We do sincerely apologize for any inconvenience which has been caused. We do have your fur-baby's best interest at heart and wish that she is having a speedy recovery.
Kindly noted upon receiving the invoices for the in-hospital claim, we discovered that the services rendered on the invoice were only diagnostic tests and medication which falls under the cover limit for the Casualty benefit.
For a claim to be considered under In-Hospital Admission, the invoice must reflect details of a a in-hospital corrective procedure. Should a diagnostic procedure result in a confirmed diagnosis the cost of the in-hospital corrective procedure will be covered under the authorized Hospital admission cover limit. Kindly note that all in-hospital claims must meet our admission matrix which is found in your policy schedule.
The claim for your fur-baby was approved and covered under the Casualty benefit up to the respective cover limit of R1300 due to the diagnostic tests and medication that was provided. Kindly note according to our policy schedule it states that, you may claim for follow up visits for the same event until the event limit has been reached within a period of 14 days ‐ for example, if your limit is R500 and your previous claim was only for R250, you can still claim another R250 for the follow-up vet visit for the same issue. You may not claim for the same event under a new cover within the fourteen (14) day waiting period. The second Casualty claim could not be approved due to claim falling within the 14-day period and the cover limit was reached.
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, please note that this is by no means a ploy to refuse payment of the claim. We do have your fur-babies 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 policy to ensure all our clients receive fair service and cover.
We once again apologize for any inconvenience caused.
Kind Regards,
Oneplan
Thank you for taking the time to bring this to our attention, we have attempted to contact you on the listed number; however, it was to no avail.
We do sincerely apologize for any inconvenience which has been caused. We do have your fur-baby's best interest at heart and wish that she is having a speedy recovery.
Kindly noted upon receiving the invoices for the in-hospital claim, we discovered that the services rendered on the invoice were only diagnostic tests and medication which falls under the cover limit for the Casualty benefit.
For a claim to be considered under In-Hospital Admission, the invoice must reflect details of a a in-hospital corrective procedure. Should a diagnostic procedure result in a confirmed diagnosis the cost of the in-hospital corrective procedure will be covered under the authorized Hospital admission cover limit. Kindly note that all in-hospital claims must meet our admission matrix which is found in your policy schedule.
The claim for your fur-baby was approved and covered under the Casualty benefit up to the respective cover limit of R1300 due to the diagnostic tests and medication that was provided. Kindly note according to our policy schedule it states that, you may claim for follow up visits for the same event until the event limit has been reached within a period of 14 days ‐ for example, if your limit is R500 and your previous claim was only for R250, you can still claim another R250 for the follow-up vet visit for the same issue. You may not claim for the same event under a new cover within the fourteen (14) day waiting period. The second Casualty claim could not be approved due to claim falling within the 14-day period and the cover limit was reached.
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, please note that this is by no means a ploy to refuse payment of the claim. We do have your fur-babies 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 policy to ensure all our clients receive fair service and cover.
We once again apologize for any inconvenience caused.
Kind Regards,
Oneplan
SK
SImonae K's updateReviewer Update
26 Mar 2022, 15:30 Please supply a list of all ' in-hospital corrective procedure' covered as this is just another ambiguous term used by One Plan to reject anything they don't deem necessary. A qualified, registered Vet admitted my dog after she collapsed and performed life-saving services. Because the services included diagnostic tests (which is necessary! how else must the Vet determine what is going on) and subsequent medication (also necessary! when a condition/ illness is diagnosed, it needs to be treated) now you don't want to cover it under the hospital benefit. She was in hospital for a whole day. As per your own definition on my Policy this does not fall under the Casualty benefit. The second claim was for over R3 000 (which was a follow-up with a specialist), of which only R1300 was paid, after I claimed through the Casualty benefit as per policy definition. I re-read my whole policy today and found numerous ambiguous terms which clearly allows for numerous opportunities to reject claims as your non-veterinary claims committee decides. For the R6 000 I've paid thus far, my only successful claim has been R1 300. It is not worth throwing away my hard earned money and only getting disappointment in return! I guess it's a hard lesson learned thinking an insurance company would be anything better than *****.
SK
SImonae K's update26 Mar 2022, 15:30
Reviewer Update
Please supply a list of all ' in-hospital corrective procedure' covered as this is just another ambiguous term used by One Plan to reject anything they don't deem necessary. A qualified, registered Vet admitted my dog after she collapsed and performed life-saving services. Because the services included diagnostic tests (which is necessary! how else must the Vet determine what is going on) and subsequent medication (also necessary! when a condition/ illness is diagnosed, it needs to be treated) now you don't want to cover it under the hospital benefit. She was in hospital for a whole day. As per your own definition on my Policy this does not fall under the Casualty benefit. The second claim was for over R3 000 (which was a follow-up with a specialist), of which only R1300 was paid, after I claimed through the Casualty benefit as per policy definition. I re-read my whole policy today and found numerous ambiguous terms which clearly allows for numerous opportunities to reject claims as your non-veterinary claims committee decides. For the R6 000 I've paid thus far, my only successful claim has been R1 300. It is not worth throwing away my hard earned money and only getting disappointment in return! I guess it's a hard lesson learned thinking an insurance company would be anything better than *****.
Oneplan Insurance's replyOfficial
28 Mar 2022, 09:42Good day Simonae,
Thank you for taking the time to bring this to our attention.
Kindly refer to the Admission Matrix on your policy schedule which outlines the terms that need to be met in order for your fur-babies claim to be considered under the in-hospital cover. The services rendered by the vet were diagnostic tests and medication, as per our policy terms and conditions this is covered under the Casualty Benefit.
Kindly note according to our policy schedule under the heading "What is Not Covered" on the Oneplan Pet Hospital Admission Cover Section (point 2) it states, Admission and/or hospitalization exclusively for diagnostic procedures, monitoring and/or observing is not covered under the in-hospital benefit, however this will be covered under the day-to-day benefit.
The time frame between the initial claim and the specialist follow-up visit was within 14-days, therefore the 14-rule was applicable. A copy of our Complaints Resolution Policy was sent to your listed email address along with the repudiation letter for your perusal.
The terms and conditions of the policy must be adhered to and app**** fairly for all clients, please note that this is by no means a ploy to refuse payment of the claim. We do have your fur-babies best interests at heart, and we will assist with all we can in line with our policy terms and conditions.
Once again, we apologize for any inconvenience caused. One of our consultants will be in contact with you to further discuss the matter at hand.
Kind Regards,
Oneplan
Thank you for taking the time to bring this to our attention.
Kindly refer to the Admission Matrix on your policy schedule which outlines the terms that need to be met in order for your fur-babies claim to be considered under the in-hospital cover. The services rendered by the vet were diagnostic tests and medication, as per our policy terms and conditions this is covered under the Casualty Benefit.
Kindly note according to our policy schedule under the heading "What is Not Covered" on the Oneplan Pet Hospital Admission Cover Section (point 2) it states, Admission and/or hospitalization exclusively for diagnostic procedures, monitoring and/or observing is not covered under the in-hospital benefit, however this will be covered under the day-to-day benefit.
The time frame between the initial claim and the specialist follow-up visit was within 14-days, therefore the 14-rule was applicable. A copy of our Complaints Resolution Policy was sent to your listed email address along with the repudiation letter for your perusal.
The terms and conditions of the policy must be adhered to and app**** fairly for all clients, please note that this is by no means a ploy to refuse payment of the claim. We do have your fur-babies best interests at heart, and we will assist with all we can in line with our policy terms and conditions.
Once again, we apologize for any inconvenience caused. One of our consultants will be in contact with you to further discuss the matter at hand.
Kind Regards,
Oneplan
Oneplan Insurance's reply28 Mar 2022, 09:42
Official
Good day Simonae,
Thank you for taking the time to bring this to our attention.
Kindly refer to the Admission Matrix on your policy schedule which outlines the terms that need to be met in order for your fur-babies claim to be considered under the in-hospital cover. The services rendered by the vet were diagnostic tests and medication, as per our policy terms and conditions this is covered under the Casualty Benefit.
Kindly note according to our policy schedule under the heading "What is Not Covered" on the Oneplan Pet Hospital Admission Cover Section (point 2) it states, Admission and/or hospitalization exclusively for diagnostic procedures, monitoring and/or observing is not covered under the in-hospital benefit, however this will be covered under the day-to-day benefit.
The time frame between the initial claim and the specialist follow-up visit was within 14-days, therefore the 14-rule was applicable. A copy of our Complaints Resolution Policy was sent to your listed email address along with the repudiation letter for your perusal.
The terms and conditions of the policy must be adhered to and app**** fairly for all clients, please note that this is by no means a ploy to refuse payment of the claim. We do have your fur-babies best interests at heart, and we will assist with all we can in line with our policy terms and conditions.
Once again, we apologize for any inconvenience caused. One of our consultants will be in contact with you to further discuss the matter at hand.
Kind Regards,
Oneplan
Thank you for taking the time to bring this to our attention.
Kindly refer to the Admission Matrix on your policy schedule which outlines the terms that need to be met in order for your fur-babies claim to be considered under the in-hospital cover. The services rendered by the vet were diagnostic tests and medication, as per our policy terms and conditions this is covered under the Casualty Benefit.
Kindly note according to our policy schedule under the heading "What is Not Covered" on the Oneplan Pet Hospital Admission Cover Section (point 2) it states, Admission and/or hospitalization exclusively for diagnostic procedures, monitoring and/or observing is not covered under the in-hospital benefit, however this will be covered under the day-to-day benefit.
The time frame between the initial claim and the specialist follow-up visit was within 14-days, therefore the 14-rule was applicable. A copy of our Complaints Resolution Policy was sent to your listed email address along with the repudiation letter for your perusal.
The terms and conditions of the policy must be adhered to and app**** fairly for all clients, please note that this is by no means a ploy to refuse payment of the claim. We do have your fur-babies best interests at heart, and we will assist with all we can in line with our policy terms and conditions.
Once again, we apologize for any inconvenience caused. One of our consultants will be in contact with you to further discuss the matter at hand.
Kind Regards,
Oneplan
SK
SImonae K's updateReviewer Update
28 Mar 2022, 10:15Please just stop regurgitating the same sentences! There are more than enough similar reviews clearly indicating how you fail clients; I just wish I'd seen it sooner. I've followed your internal claims process and was just met with more copy and paste ambiguous sentences. You are weasels and *******. I'm now withdrawing from all engagement with One Plan as it is clear you can't beat the devil on his playground!
SK
SImonae K's update28 Mar 2022, 10:15
Reviewer Update
Please just stop regurgitating the same sentences! There are more than enough similar reviews clearly indicating how you fail clients; I just wish I'd seen it sooner. I've followed your internal claims process and was just met with more copy and paste ambiguous sentences. You are weasels and *******. I'm now withdrawing from all engagement with One Plan as it is clear you can't beat the devil on his playground!
Oneplan Insurance's replyOfficial
28 Mar 2022, 13:21Good day Simonae,
We have attempted to contact you on the listed number numerous times, however the number rings and goes to voicemail.
Kindly provide us with a suitable time or an alternative contact number to contact you on to further discuss the matter at hand.
Kind Regards,
Oneplan
We have attempted to contact you on the listed number numerous times, however the number rings and goes to voicemail.
Kindly provide us with a suitable time or an alternative contact number to contact you on to further discuss the matter at hand.
Kind Regards,
Oneplan
Oneplan Insurance's reply28 Mar 2022, 13:21
Official
Good day Simonae,
We have attempted to contact you on the listed number numerous times, however the number rings and goes to voicemail.
Kindly provide us with a suitable time or an alternative contact number to contact you on to further discuss the matter at hand.
Kind Regards,
Oneplan
We have attempted to contact you on the listed number numerous times, however the number rings and goes to voicemail.
Kindly provide us with a suitable time or an alternative contact number to contact you on to further discuss the matter at hand.
Kind Regards,
Oneplan