Does health insurance cover specialists?


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Does health insurance cover specialists

Having comprehensive medical care is quickly proving to be a global must-have. So, if the pandemic has you reassessing your medical coverage, then take a look at our exclusive health insurance option and how it’s getting you direct access to specialists – whenever you need!

Wait, what are specialists?

Feeling a little left out because you aren’t exactly sure what a specialist physician is? Don’t panic (or feel embarrassed) because we’ve got your back … and a great definition!

A specialist physician is a highly trained doctor that is incredibly skilled in a specific discipline or field of medicine. Now these doctors, who have completed their advanced education and training, are essential when it comes to getting a proper diagnosis or treatment for a complexed or serious medical condition.

Let’s look at some examples

1.     Oncologist (They hone in on the study of cancer)

2.     Gynaecologist (They assess the female reproductive system)

3.     Orthopaedic (They focus on bones, tendons, joints and muscles)

4.     Cardiologist (They deal with your heart and blood vessels)

5.     Neurologist (They look at the brain and nervous system)

And so much more!

The truth about specialists

Now given the fact that they are actually experts in their respective fields, it’s easy to see how access to these doctors will come with a rather hefty price tag. In fact, many individuals incur medical debt trying to see these physicians. This is because you are not only getting access to their expertise but exceptional medical care for whatever health-related issue you may have! So, while they may be incredibly expensive to see, they are crucial to your health and overall wellbeing.

See them as your superheroes in lab coats that swoop to your rescue at your immediate beck and call.

How do I gain access to a specialist?

Well, the short answer is with our exclusive Executive Healthcare plan!

We don’t want to brag but when it comes to medical insurance, it really doesn’t get better (or more holistic) than our Executive Plan. It offers you MORE cover, GREATER benefits and EXCEPTIONAL medical access. And while you may have thought that the perks ended there, you’d be wrong because this plan also covers your specialist’s visits!

All you have to do is head to your general practitioner and get a referral for a registered specialist. You will then send that referral letter to our team so that we can authorise your claim.

Just a little heads up though that there is a standard 3 month waiting period for all specialist cover.

So, what does that mean for you? Well, it means that you are going to have to be a little patient. From the very inception of your policy (read as: join our Oneplan family) you are going to have to wait 3 months before you are able to claim for any specialist event.

A few T’s & C’s

We know that no one likes reading the terms and conditions of any document, so we thought we’d put this one in the middle of the blog so it’s a little unavoidable (sneaky we know). But we are doing this for a good reason, so please do pay attention, we promise to dazzle you with the rest of the Executive Plan benefits in a second.

It is important to note that while being a Oneplan family member means that you are able to choose your doctor of choice, it does not include coverage for the following:

  1. Traditional healers
  2. Dieticians
  3. Homoeopaths
  4. Psychologists

Now, this information is covered in your policy document. And don’t panic, we’ve scrapped all the heavy jargon and intimidating insurance lingo, so it is an easy read.

Alright, let’s get back on the topic of our most holistic medical insurance plan and look at some of its other benefits, why don’t we?

What else am I covered for?

  1. Doctor visits (GP cover) - Up to R495 per visit
  2. Scripted medication - Up to R280 per script
  3. Blood tests - Up to R625 per event
  4. X-rays - Up to R625 per event
  5. Dentistry - Up to R825 per event (max of 3 visits a year)
  6. Specialist cover - Up to R2 000 per visit. 3 visits per family per year.
  7. Optometry - Up to R1 600 every 24 months
  8. Maternity pre-birth - Up to R630 per visit (3 visits per pregnancy with an annual limit of R2220)

But it doesn’t end there, there are also incredibly comprehensive hospital benefits too, but we think we’ll end this blog with a slight cliff-hanger. Pop us a call to find out the rest of the perks!

Yours in comprehensive health insurance,

The Oneplan Team

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