Your personalised Oneplan Claim Card will be delivered to your door within thirty (30) days after your first successful debit order. You need to download the Oneplan app, register. After your thirty (30) day waiting period, you can then pre-load funds for day-to-day benefits (subject to applicable waiting periods) using the App to your Oneplan Claim Card in minutes. You can swipe this card like you would a debit card at your doctor after your consultation. After paying the doctor, you will need to submit a detailed valid invoice to finalise your claim. Platforms for loading funds on to your Oneplan Claim Card
• Oneplan App
• Use our WhatsApp channel (0837945452)
• Call centre (0100010141)

With Oneplan, we don’t have specified networks. We make sure you can visit your preferred and trusted registered family doctor and/or hospital nationwide in South Africa. We also have contracts with all major hospitals, namely: Life, Mediclinic, and Netcare.

Oneplan is a health insurance, regulated under South Africa's Short-term Insurance legislation, while medical aids are regulated under the Medical Schemes Act. Demarcation regulations ensure that these products serve different purposes and remain distinct from one another. Unlike medical aids, which are legally required to provide Prescribed Minimum Benefits (PMBs) covering certain emergency and chronic conditions, Oneplan provides cover for specific health events up to the benefit limits of the plan you choose. This allows Oneplan to offer affordable, accessible healthcare benefits and services designed to help members manage their everyday healthcare needs with confidence.

Oneplan sold its first health policy in 2010 and was created to ensure all South Africans have financial inclusion when it comes to affordable and sustainable healthcare.

A waiting period is a set time after your cover starts before certain benefits can be used. This is a standard practise used by both insurers and medical aids to protect the policy against immediate large claims, allowing the product to remain affordable and sustainable so that benefits can continue to be provided to all members over the long term.

A pre-existing condition is any illness, injury, or medical condition that existed before your policy started.

Yes. A 12-month waiting period applies to pre-existing and related conditions for Casualty and Hospital benefits only. This means that claims for these conditions will not be covered under these benefits during the first 12 months of membership.

A related condition is any condition, complication, or treatment that is connected to or develops from a pre-existing condition.
Example: If a member had hypertension (high blood pressure) before joining and later experiences a heart attack caused by the hypertension, the heart attack may be regarded as a related condition.

Exclusions are specific healthcare services, treatments, or conditions that are not covered by the policy, including treatment for mental health conditions and congenital (birth-related) conditions. By defining these exclusions, we are able to keep premiums affordable while providing valuable healthcare benefits to our members. There are general and specific exclusions, and conditions that apply to all our health plan types. These can be found in the policy wording and on our website sign-up journey.

Oneplan works a little differently when it comes to making sure you can get better quickly. You would use your day-to-day benefits for out-of-hospital cover. These have a per-event cover amount limit or invoice amount, whichever is lesser, as well as per-year cover limits. The day-to-day benefits have been tailored to ensure you have cover for Doctors’ Visits, Blood Tests, Medication, X-rays, Optometry, Dentistry, and Pre-Birth Maternity (depending on the plan you choose), ensuring that when the expected, unexpected and everything in between happens, you have the funds available to pre-load using the Oneplan App or via our Claims WhatsApp team.

• Yourself (18 years or older).
• Your spouse or partner.
• Children under 21 (or up to 23 if a full-time student, no age limit for incapacitated children).
• Newborn babies (must be registered within 30 days).
• Foreign nationals with a valid passport and visa.

Yes:
• Pre-birth check-ups with a gynaecologist for the main member or spouse (after 7 months).
• Natural birth and emergency caesareans (after 12 months).
• Newborn hospital care (after 12 months).

Yes. Prescribed medication for both acute and ongoing/chronic conditions is covered under the Scripted Medication Benefit, subject to applicable limits and rules.

Yes, on selected plans (Blue, Professional, Executive). A 6-month waiting period applies, unless it’s a pre-existing condition, where a 12-month waiting period applies.

• Accidents: covered immediately.
• GP visits, meds, X-rays, blood tests: 30 days.
• Dentistry: 90 days.
• Optometrist: 12 months
• Dread disease: 6 months.
• Maternity pre-birth: 7 months.
• Birth (natural or C-section): 12 months.

Yes, we review premiums annually. You’ll be notified in writing 31 days before changes are made.

You have until the 15th of the month to catch up, from the second month onwards. If not paid, your cover is suspended until payment is made.