Your health insurance policy explained: What classifies as a doctor's visit?


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health insurance policy explained

Knowing exactly how your health insurance policy works, what you’re covered for and what everything means can be tricky sometimes but that’s what we’re here for. Let’s take a look at what classifies as a doctor’s visit, what you’re covered for and everything in between.

Medical insurance is often seen as a luxury that few can afford. Well, not anymore. Health insurance policies (like the policies we offer), were created to help you afford medical cover in exchange for a monthly premium. Now just because health insurance is seen as a ‘cheaper option’, that doesn’t mean the quality of your policy is compromised.

On the contrary actually. With Oneplan, you are offered many benefits with your insurance policy. This is especially true when you need to visit the doctor. Sinus infections, colds or even a tummy bug have an annoying way of sneaking up on you so what do you do when you’re feeling under the weather?

You see a doctor, of course! When you’re sick, the last thing you want to worry about is if your doctor’s visit is covered by your insurance policy or not. This is why we’re discussing everything you need to know about heading to the doctor.

Explore: Questions you should ask before getting health insurance

What classifies as a doctor's visit?

First things first, what exactly is a doctor’s visit?

Let’s start right at the beginning - what type of doctor are you referring to? We all know there are many kinds of doctors out there but in this case, we are talking about a “General Practitioner” (GP). Specialist cover is a story for a different day.

A GP means a medical doctor who doesn’t specialise in any particular field of medicine but deals with all illnesses and patients of all ages (also known as a family doctor). A GP needs to have obtained a qualification as a Medical Doctor and is a practising member of the Health Professions Council of South Africa.

It’s that simple! When you’re feeling under the weather, you can head out to your GP without any worry because you’ll be covered.

Did you know that with Oneplan, we give you the money before your doctor’s visit? That’s what your Onecard is for!

Read: How much is health insurance? And what am I covered for?

The beauty of the Onecard?

By now, you’re probably thinking, “uh, what’s a Onecard?”

This magical card is here to make your life that much easier!

Our health insurance policies were created to suit your budget and your lifestyle while making sure you receive the best possible care when you need it most.  

When it comes to visiting the doctor, other insurers will ask you to pay your doctor upfront, followed by you filing your claim along with additional paperwork and then waiting for your reimbursement. This can take both time and money away from you that you don’t have.

Not us. We don’t believe in making you have to wait until payday to see your doctor. Doctor’s visits can cost a pretty penny, not to mention if you need additional tests, treatments or scripted medications.

Money in your pocket before you see the doc

Having to unexpectedly empty your pockets can put a serious strain on your monthly budget. This is why we created a unique transactional card known as the Onecard.

When you join the Oneplan Family, you will receive your very own Onecard. This card is just like a debit card. All we do is preload the funds you need onto it for day-to-day doctor visits and healthcare.

When you start to struggle with the sniffles or a horrible cough and feel the need to see a doctor, simply log into the smart Oneplan App. That’s where you can preload your claim in the claims section and we will transfer the funds needed onto your Onecard within seconds!

You can then use this card to swipe at your doctor’s rooms, the same way you would use a credit or debit card (we told you it’s magical!).

Read: How to use your Onecard to get funds for a doctor’s visit

How to claim with your Onecard and Oneplan App

As we mentioned, your day-to-day cover is preloaded onto your Onecard before you see your provider. This means we pay you BEFORE you see the doctor, which is pretty awesome (if we do say so ourselves)!

How do I use my Onecard?

  1. Log into the Oneplan App
  2. Select “Load Claim”
  3. Select the type of event you want to claim for
  4. Use the drop-down arrows to select the date and the member
  5. Hit Proceed

What happens next?

Once you have hit the Proceed button, our team of insurers will then transfer funds over to your Onecard. Just note that the amount transferred will be according to the limit outlined in your plan. So make sure to familiarise yourself with that specific section!

Submitting your invoice

When your doctor’s visit is over and you’ve paid, you can then submit your detailed invoice to our team. And no, you don’t have to go through the hassle of sitting through a pile of paperwork and complicated insurance lingo. All you need to do is log onto the Oneplan App and upload the invoice. It really is as a few simple taps on your phone screen!

If you already used your own funds to pay the bill, don’t worry, we’ve got a refund option on the App too (we never want you to be stressed about your budget)! Just head over to “My Claims” and then “Claim Refunds” and voila!

Just make sure to let us know if you’d like the refund to be processed into your personal bank account OR to your Onecard (this could come in handy).

Find out: How to check the balance on your Onecard

Choose any doctor you like

Your doctor knows you well. Some of us have been going to the same doctor since we were kids so we get it, you don’t want to lose them.

And with Oneplan, you don’t have to.

Other health insurers will give you a list of doctors they cover. These doctors are chosen to be ‘contracted’ into these various plans and therefore if you want the costly bills from your visit to the doctor to be covered, you have to go to one of these doctors.

No exceptions.

Then you find out that your doctor, the person who has seen you at your worst and helped you get better, the doctor who your family loves and is comfortable with, is not covered on your new health insurance plan. Trusting someone new with your health is difficult so we are not going to make you do that. You can keep your doctor.

With the help of our Onecard and the fact that we pay you before you see your doctor, you are able to go to any licensed GP! Easy, peasy. 

As you can tell, we do insurance a little differently. We offer real insurance for real people and we love that we have the flexibility to cover anyone and everyone while keeping your budgets in mind!


Yours in affordable and comprehensive health insurance,

The Oneplan Team

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