How does health insurance work? Access to private healthcare: Plain & Simple


Jade Poole from I Write Words


What is health insurance, how it works and how you can get instant access to private doctors and hospitals with it

The plain and simple explanation of how health insurance works is that it helps protect you from the high costs of private healthcare.

With health insurance, it will help pay for hospital stays, doctor visits, prescription medications and important routine and preventive care.

Without health insurance, your entire life savings could be wiped out with just one medical bill.

Did you know that health care costs are a leading causing of bankruptcy?

Why do I need health insurance?

Health insurance is basically an affordable alternative to medical aid. It helps cover the costs of private healthcare.

Just like car and home insurance, health insurance is the cover you need to protect you from unexpected costs.

You can’t predict when you are going to be in a car crash or when your home might burn down, just as you can’t predict when you might need urgent medical attention for a disease or emergency.

The thing is, some may argue that health insurance is the most important form of insurance.

If your car is involved in an accident, you can maybe carpool with a friend or take the bus until you have enough money to fix it.

But, if you break your leg, you can’t try and fix this yourself and limp around waiting until you can afford to see your doctor.

Is health insurance basically a hospital plan?

It depends on who you choose as your health insurer. With Oneplan (that’s us), each of our plans includes cover for doctor visits and routine care.

This means we cover you for check-ups, X-rays, blood tests, dental care, eye care and emergency care.

The great thing about having more than just cover for emergencies, is that you can go to the doctor when you are sick and go for annual check-ups to keep you in good health.

Can I afford health insurance?

This will depend on your health insurer and your own budget.

But what you need to keep in mind when it comes to health insurance, is that you are deciding to cover yourself RIGHT NOW for extremely high unexpected costs of the future.

A real-life example

Our Core Plan, which costs R365 a month covers you for:

●        Day-to-day care - Doctor visits and routine care

●        Hospital benefits - Illness, accident, maternity cover and emergencies

Let’s say you are involved in a car accident and need of urgent care.

If you have health insurance, you can phone our emergency line and we will send an ambulance to take you to the nearest private hospital.

Your hospital bill comes to R67 000 for treatment, surgery and doctor costs.

If you didn't have health insurance, you have to pay this money from your own pocket.

With health insurance, this will fall under Accident Cover, we cover you for up to R140 000 per insured event.

This means your hospital bill is covered (depending on your excess and limits - we will get to these in a bit).

What it comes down to

So, would you rather spend R365 a month or wait until something goes wrong and you have to spend thousands of rands of your own money?

The fine print of health insurance

We always encourage our Oneplan Family to read their policy insurance document. We get that the legal lingo can sometimes be difficult to understand, and it's for this exact reason we created our Simple Guide to Health Insurance.

You need to always know exactly what you are an aren’t covered for so that when the time comes to claim, you are not disappointed.

What is my excess?

Excess is the amount you will have to pay in for a claim.

What is an exclusion?

Exclusions are any conditions or illnesses that you cannot claim for during a specific period of time.

What are waiting periods?

Waiting period is a period of time that starts as soon as you take out your policy and is the number of days that has to pass before you can claim.

How does claiming work?

This is one of our favourite questions.

Day-to-day care

If you have health insurance with Oneplan, then we pay you BEFORE you see the doctor.

We do this through our awesome Onecard.

The moment you sign your policy, we send you a Onecard. This card is like your own personal debit card for private healthcare.

When you need to see the doctor, simply login to the Oneplan Smart App, upload your claim and the funds are transferred to you within seconds.

Pre-authorisation for an accident needing hospital care

Call us to report the accident

We will do an immediate pre-authorisation and send your certificate of insurance to the hospital

Should I get health insurance?

Unless you are prepared to pay for private healthcare out of your own pocket, then yes.

Save yourself from surprise medical costs. Protect your health. Protect your wallet. It’s that simple.

Yours in health,


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