Oneplan Health Insurance Basics: What Is Accident & Illness Cover?

   

Jade Poole from I Write Words

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Knowing the basics of health insurance will help you to understand exactly what you are covered for and what you are not. In making insurance hassle-free, simple and easy to use, we have put together this expert guide on the basics of accident and illness cover.

If you have ever wondered what the different types of cover mean on in your health insurance policy, then you are not alone.

Before we get into the difference between these two cover types, let’s first explain what health insurance is…

What is health insurance?

Health insurance is a form of medical cover that helps you afford private healthcare.

It works in a similar way to medical aid, in that you pay a monthly premium in exchange for health cover.

The great thing about health insurance is that it is more affordable than medical aid.

Health insurance lets you know exactly how much cover you have for certain events.

How we do this is using cover limits. This means that you are given an exact amount of cover for healthcare claims so that when it comes time to claim, you know what you are covered for and what you are not.

Health insurance is an amazing way to afford private healthcare at an affordable monthly premium.

If you want to know more about it, then have a look at our expert guide to choosing the right health insurance plan.

What is accident cover?

In your health insurance plan, you will notice that there are different cover benefits, a common benefit is known as accident cover.

Accidents, also known as emergencies, are the things you didn’t see coming.

For example, you are involved in an accident like a car crash and you need to immediately be seen by a doctor and are rushed to the hospital.

What you are covered for under accident cover:

●     Treatments and procedures that require hospital admission

●     Re-admission within 6 months for the same or related accident will be deemed as one event and covered under the same cover

What you are NOT covered for under accident cover:

●     Self-inflicted and professional sport injuries

●     Injuries due to the influence of alcohol, drugs or narcotics

●     Third-party claims like Workmen's compensation claims

What is illness cover?

An illness is a disease or sickness that started after your cover began.

If an illness is the result of an accident, it will be covered under illness and not accident cover. For example, if you are in a car accident and contract pneumonia in hospital - this illness will be covered under illness cover.

What you are covered for under illness cover:

●     Treatments and procedures that need hospital admission

●     If your illness comes back in a 6 month period, then it will be covered as part of the initial illness claim.

What you are NOT covered for under illness cover:

●     Mental illness, Psychiatric disorders, Chronic dialysis, Congenital disorders, Sterilisations, Infertility

●     Admissions for investigations or diagnostic procedures, pain control or treatment that cannot be justified medically

●     Third-party claims like Workmen's compensation claims - when you are claiming for something that you already have cover for

What is the difference between an injury and illness?

An injury is a physical cut, bruise, burn, sickness or disease or some kind of harm done to your body that was caused by an accident.

What is casualty accident cover?

These are emergency treatments for accidents that do not require overnight hospital stays.

Casualty refers to the emergency department in a hospital.

What is casualty illness cover?

These are emergency treatments for illnesses that do not require overnight hospital stays.

How much cover do I have for accidents and illness?

Your cover amount will depend on the plan you choose.

The great thing about our plans is that EVERY plan (from our basic through to our more comprehensive plans), include accident and illness cover.

This means that no matter what plan you choose, you have cover for accidents and illnesses. Pretty great, right?

Keep in mind that our Core Plan does not include illness in-hospital cover.

Here is a basic breakdown of our plans:

Core Plan

Casualty Illness

Up to R4900 for life-threatening emergency illness in casualty units.

Casualty Accident

Up to R4900 for accident events in casualty units that does not result in admission.

Accident Cover

Up to R140 000 per insured event. Up to R280 000 per family per event.

Blue Plan

Casualty Illness

Up to R5000 for life-threatening emergency illness in casualty units.

Casualty Accident

Up to R5000 for accident events in casualty units that does not result in admission.

Accident Cover

Up to R190 000 per insured event. Up to R380 000 per family per event.

Illness In Hospital

Up to R45 000 per insured event p/p. Up to R123 750 per insured per year.

 

 

 

Professional Plan

Casualty Illness

Up to R5000 for life-threatening emergency illness in casualty units.

Casualty Accident

Up to R5000 for accident events in casualty units that does not result in admission.

Accident Cover

Up to R220 000 per insured event. Up to R440 000 per family per event.

Illness In Hospital

Up to R55 000 per insured event p/p. Up to R137 500 per insured per year.

Executive Plan

Casualty Illness

Up to R5 200 for life-threatening emergency illness in casualty units.

Casualty Accident

Up to R5 200 for accident events in casualty units that does not result in admission.

Accident Cover

Up to R290 000 per insured event. Up to R580 000 per family per event.

Illness In Hospital

Up to R68 500 per insured event p/p. Up to R171 250 per insured per year.

Get in touch with us

If you have any more questions about health insurance, then get in touch with us and our friendly team can answer whatever you need to know.

Yours in hassle-free health insurance,

Oneplan

 



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