Waiting periods and exclusions: they’re simpler than you think

   

Jade Poole from I write words

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Waiting periods and exclusions

Everything an insurance whizz needs to know about the difference between waiting periods and exclusions.

When we sat down to decide who we wanted to be as an insurance company, one word came to mind. Simple. We wanted every part of your journey with us, from start to finish, to be as uncomplicated as possible. We think we’ve done a pretty good job.

Life gets complicated - but your health doesn’t have to be. We pride ourselves on being insurers that are crystal clear and who don’t hide behind confusing jargon that nobody else understands. So we’re here to unpack two things that you’ll see often in your insurance policy contracts: waiting periods and exclusions.

Health insurance and why you need it

There’s no point in diving into the lingo if you don’t entirely understand just how important health insurance is. Excellent health care is something that everybody deserves - whether they have the money for it or not. Unfortunately, private healthcare is not even something people can dream about because of the incredibly expensive bills.

With us, however, you can have access to outstanding medical facilities when and where you need them.

Nobody is invincible and at the risk of sounding morbid, bad things happen every day. When they do, you want to be prepared. Having a health insurance policy ensures you and your family have comprehensive benefits that support you living your healthiest, most confident life.

Plus, it doesn’t cost as much as you think it does. Paying your monthly premium will open doors to high-quality facilities and routine care that would have been near impossible to afford independently.

The Oneplan way

Before we unpack what waiting periods and exclusions mean, here are the other ways we make your health journey simpler:

  • Private healthcare when you need it most
  • Get paid BEFORE you see the doctor of your choice
  • Keep your doctor - we let you go to the doctor of your choice
  • Cover for day-to-day health costs and emergencies (great out of hospital benefits)
  • Team of nurses on our claims team who understand when something is wrong

Okay, let’s learn about some things!

Waiting Periods

We’ll start with waiting periods. A waiting period could also be known as a qualifying period. It is the contractual amount of time that passes between the date you sign your policy and when your policy becomes open for claims. In other words, it is the time that MUST pass before you are covered and able to claim.

All of our health insurance policies have a minimum of a one month waiting period - unless you are in an accident. If you’re wondering why waiting periods exist, we’ll tell you.

Health insurance is meant to be used as a preventative and protective tool - but a lot of people don’t see it that way. Instead, they decide to get health insurance when they are already sick. If insurance companies were to pay for medical bills straight off the bat, there wouldn’t be any insurance companies. Waiting periods also come into play if you have any pre-existing conditions.

Here are the waiting periods for Oneplan Health Cover: 

  • Doctor visits - 30 days
  • Medication - 30 days
  • Radiology (X-rays) - 30 days
  • Pathology (blood tests) - 30 days
  • Dentist visits - 3 months
  • Optometry (Eye doctor) - 12 months

Exclusions

It’s really easy to get caught up in the fantastic benefits your policy offers, but you need to be aware of what absolutely will not be covered! A lot of people don’t get a good grip on what they aren’t covered for,  which is all a part of being insurance savvy and getting the most out of your policy. We believe whole-heartedly in transparency so we make it clear from the get-go what we won’t cover you for. Here are a few of our exclusions:

  1. Nuclear weapons, nuclear material or acts of war including military rising, rebellion or revolution (we’re sure you can give us a break on this one)
  2. Cosmetic procedures.
  3. Anything illegal.
  4. Cost of treatment for infertility.
  5. Costs, tests and examinations required for administration/application purposes.
  6. Consults or services by anybody not registered with the SA Medical and Dental Council, the SA Nursing Council or the South African Health Service Professions Board.
  7. Congenital disorders, diseases or abnormalities - these are issues that existed at birth.
  8. Any birth control procedures.
  9. Self-inflicted injuries.
  10. Cost of procedures, operations and treatments that are not medically justifiable i.e. all other avenues of traditional treatment must be explored.

The final word

Exclusions are any conditions or illnesses that you cannot claim for, and that you need to be aware of before you sign onto a health insurance policy. A general waiting period is a time that has to pass before you can claim - each condition is different and will have varying waiting periods but you can get all the answers you need right here in our super comprehensive policy wording document.

 

Yours in hassle-free insurance,

Oneplan



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