Health insurance policy talk: the stuff we don't cover


Jade Poole from I write words

Health insurance policy

While health insurance will quickly prove to be one of your greatest assets, in order for you to truly tap into its power, you will have to understand which services you’ll have to pay for out-of-pocket and which will be covered. This will help you make smarter health choices.

At Oneplan we are all about transparency which is why pride ourselves in helping our clients learn how to navigate health insurance. And that means ensuring that you aren’t just another client to us but rather an educated healthcare consumer.

But in order for you to truly understand health insurance, you have to prioritise your wellbeing - and that starts with familiarizing yourself with your policy document; which many people admittedly don’t do. And while you should always (and we mean always) read the terms and conditions of any legally binding document, when it comes to insurance it’s easy to see why people choose to skim through it and sign on the dotted line.

Most policy documents aren’t easy to read.

You are often exposed to terminology you’ve never seen before, long-winded paragraphs and some admittedly headache-inducing jargon. However, as the gatekeepers to effective healthcare, we’ve opted for simple health insurance and our easy-to-read policy document is proof of that - check it out for yourself here!

Becoming health insurance literate

It’s important that you note that joining Oneplan means joining a family where honesty and transparency lay the foundations of anything that we do. So, while we hope you’ve been dazzled by the numerous benefits associated with our health insurance policies, it’s important that you are aware of our policy exclusions.

Although each of our health insurance plans has various services that aren’t covered, there are a few that are not covered regardless of the plan that you have taken out. So you may want to listen up - these exclusions apply to all of you! And don’t panic about trying to decode these our standardised exclusions. We’ll keep it simple. We promise.

General exclusions aka the stuff we don’t cover

As a quick heads up: We will not be liable for expenses, hospitalisation, injury, sickness or disease directly or indirectly caused by or related to the following:

  1. Cosmetic procedures - We think you are beautiful just the way you are!
  2. Any criminal act as defined by the laws governing the Republic of South Africa - Because crime really doesn’t pay!
  3. Costs, tests and examinations and tests requested for immigration, emigration, visas, insurance policies, employment, admission to schools and universities, court medical reports, muscle- function tests, fitness examinations and test, adoption of children and retirement because of ill health.
  4. Cost of treatment for infertility.
  5. Services rendered by persons not registered with the SA Medical and Dental Council, the SA Nursing Council or the South African Health Service Professions Board.
  6. Congenital disorders, diseases or abnormalities - These are issues that existed at birth.
  7. Any birth control procedures such as, but not limited to, sterilization, vasectomies and tubal ligation.
  8. Self-inflicted injuries.
  9. Cost of operations, treatments and procedures that are not medically justifiable i.e. all other lines of conservative treatment must first be considered.
  10. Nuclear weapons, nuclear material or acts of war including military rising, rebellion or revolution.

There are a few more so make sure to check them out here (they’re on page 20 by the way!).

The bottom line

Understanding and working within the guidelines of your specific policy and its exclusions will help increase your insurance literacy. This information will help you make an informed decision and help you better understand this need-to-know information. So if you want deeper insights into the bills that you will have to cover yourself then we suggest getting in contact with one of our insurance representatives who will happily explain it all to you. Because you deserve to know the ins and out of your own healthcare protection!

Why Oneplan?

Before you get going on your merry way, we wanted to give you a quick outline on why Oneplan is the health insurance of your medical dreams (seriously, we’re kinda awesome):

  1. We front you with cash BEFORE you see the doctor using our smart paperless claims system via the Oneplan App. Claims are loaded simply and quickly and the money you need for your doctor is loaded onto your Onecard within seconds.
  2. We give you the freedom to go to ANY doctor of your choice.
  3. We have a range of health insurance plans for you to choose from, each one including a wide range of benefits. Meaning you can find a plan that suits your lifestyle and your wallet.
  4. You can access your policy and chat to a Oneplan expert through the Oneplan App.
  5. Our benefits include cover for specialists, dental care, optometry, scripted medication and maternity benefits. We also include dread disease and family death cover benefits.

Yours in hassle-free and affordable health insurance,


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