Health Insurance - What kind of doctors are covered?


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Which kinds of healthcare professionals are covered under your health insurance policy? Let’s find out!

It’s important before you jump onto any policy or start putting through claims that you are 100% sure of what you’re covered for. So before you waste your time, take a moment to read about what doctors you’re covered for with Oneplan (and which ones you aren’t)

The more you know, the more prepared you are and that’s how we like it! First, let’s dive into some health insurance basics.

What is health insurance?

Health insurance is the number one way to make sure you can afford private healthcare when and where you need it. Visiting the doctor is expensive. Medication is expensive. Going to the hospital? Yes, it’s expensive.

Every South African deserves the right to excellent quality healthcare, but the average South African is nowhere close to being able to afford the prices of private hospitals. That’s why health insurance exists, to give you an equal footing when it comes to healthcare you can trust.

Read more: what does health insurance actually cover?

What am I covered for with health insurance?

Well, that all depends on your policy. All health insurers are different and the only way to really know what you’re covered for is to go through your policy with your broker.

In general, health insurance should cover you for accidents, illness, casualty cover and routine health care costs. Of course for this blog, we’ll be focusing on routine care cover because this is where doctor visits fall under.

Discover: The 3 must-have insurance policies for all South Africans

What counts as a visit to the doctor?

There are many kinds of doctors out there who have been expertly trained in their field.

The most common doctor you’ll be visiting is a general practitioner (GP) for your routine checkups and consults. A GP is a medical practitioner who hasn’t gone into a specific field of expertise but rather treats and diagnoses all illnesses and patients of all ages.

For your GP to be covered by Oneplan, they need to have a valid Medical Doctor qualification and be a practising member of the Health Professions Council of South Africa.

Your GP is also the person who will refer you or your family members to a specialist if necessary - and specialists also happen to be one the doctors we cover!

Cover for the dentist and optometrist

Two of the other doctors you can visit with a Oneplan policy is a dentist and optometrist. We know how important it is to schedule these yearly checks and the last thing we want is for finances to be the reason you skip them out.

Visiting a specialist with Oneplan

Of course, specialists are doctors and very important ones at that. If your doctor refers you to a specialist, will you be able to cover the cost?

If you’re a part of our Executive Plan, you get claimable visits to specialists including gynaecologists, oncologists, neurologists and orthopaedics.

Which doctors aren’t covered?

Health insurers unfortunately have to work in line with certain codes and protocols, which is why certain doctors aren’t covered. Here is our list of practitioners that are NOT covered with any of our policies:


  • Acupuncturists
  • Audiologists and Acousticians
  • Bio kineticist
  • Chiropractors
  • Clinical / Medical Technologists
  • Counsellors including Genetic and Psychologist, Psychiatric Nurses and Social Workers
  • Dietician
  • Genetic Counsellors
  • Homoeopaths, Herbalists, Naturopaths and Osteopaths
  • Occupational Therapists
  • Orthodontist
  • Physiotherapists
  • Podiatrist
  • Psychologist
  • Speech Therapists
  • Traditional Healers
  • Professional Nurses


Go to any doctor of your choice

Whilst there may be limits on what kind of doctor you can visit, there are no limits on which GP you want to go to!

Yup, you heard that right. Oneplan (that’s us) lets you keep your doctor or go to any doctor of your choice. So, if you’ve found the perfect family doctor who knows you inside and out, there’s no need to stress about changing!

Additionally, if you’re ever on holiday or in a different province, you can still visit any registered healthcare practitioner (as long as you are in South Africa).

If that sounds good, you’ll find this even better.  Oneplan pays you BEFORE you visit the doctor.

This might be beneficial for you to read: 7 signs that you should go see your doctor ASAP.

What else am I covered for?

Aside from visiting the doctor, all of our plans will cover you for the things that really matter. Through our comprehensive health policies, you can have peace of mind when it comes to:

  1. Scripted medication
  2. Blood tests
  3. X-rays
  4. Maternity pre-birth

If you like the way we do things at Oneplan, you can reach out to us here.


Yours in affordable health insurance,


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