What does casualty cover entail?


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casualty cover

When you jump onto any health insurance policy, you need to know what’s cracking. Let’s explore everything all the ins and outs of accident and illness casualty cover.

Health insurance is split up into separate types of cover to help organise different plans and figure out how to divide your limits up to between various health-related situations. Some of these cover groups include routine care cover, specialist cover and, what we’re going to be talking about today, casualty cover. 

In a nutshell, casualty cover is cover for the unexpected. For the things that you definitely didn’t see coming, but the thing that you need immediate medical attention for.

What makes up casualty cover?

Two things fall under casualty cover: accident casualty and illness casualty. A casualty is an emergency incident that requires immediate medical attention - meaning you can’t wait for a doctor's consult and need to get to the hospital or emergency room right away. Obviously, the last thing you want to be thinking about when things go pear-shaped is “jeez, how am I going to afford this?”.

And that’s why you get health insurance.

Casualty cover is for emergencies that require immediate attention but do not require you to stay overnight in the hospital. If you head into the hospital for an emergency, your doctor will use something called a “triage category” to determine whether your incident classifies as a casualty. The Triage Category process is outlined to help doctors and insurers categorise incidents in terms of emergency timeframe. How quickly does this patient need to be seen?

Read more: what does health insurance actually cover?

Triage category and cover

Green: 4 hours. If you have been given the green code, that means you will initially qualify for general cover for a GP consult. Emergency cover will depend on your diagnosis after treatment

Yellow: 1 hour. This emergency will not fall under emergency cover. Instead, it will fall under general health cover and you will visit a GP, radiologist, pathologist or the x-ray team.

Orange: 10 minutes. This will fall under emergency casualty cover.

Red: Immediate. This will fall under emergency casualty cover.

The truth of the matter is that people fall ill and people get into harmful accidents, and the costs to bring them back to good health is usually pretty steep. If you don’t have health insurance, that is.

Having casualty cover means that when you have an accident or fall ill, you will have the financial support to receive treatment in a private hospital (the only hospital you really want to be in, right?)

Read this next: Why are second medical opinions so important?

The difference between injury and illness

What is illness casualty cover?

Illness casualty cover refers to most things that happen in the emergency room of a hospital.

Any emergency treatment you need for an illness that does not require an overnight stay will be covered with illness casualty cover. Keep in mind that this cover has a 90 day waiting period, meaning you’ll need to wait 3 months from the inception of your policy before you claim.

What is accident casualty cover?

Accident casualty cover is for when you sustain injuries that require emergency treatment or procedure immediately. This treatment will be triaged as either red or orange, meaning you need treatment within the next hour to prevent permanent damage.

Accident cover has zero waiting period, so you can claim for accidents from the moment you join your policy.

Related: How much is health insurance and what am I covered for?

Casualty cover with Oneplan

Please note that these prices are reflective of the date that this article was written. For up to date pricing, please follow this link.

Our health plans are all designed to give you as much as possible for what you’re paying. Take a look at the plans we have on offer and how much casualty cover is included in each one (you can tap on the links to find out more about each plan!)

Core Plan: R390pm

Casualty Illness Cover: R5000

Casualty Accident Cover: R5000

Blue Plan: R770pm

Casualty Illness Cover: R5000

Casualty Accident Cover: R5000

(The casualty cover on this plan may be the same as our Corel Plan, but the Blue Plan is where you start seeing tons of routine care benefits like visits to the doctor and maternity care)

Professional Plan: 1035 pm

Casualty Illness Cover: R5250

Casualty Accident Cover: R5250

Executive Plan: R1356

Casualty Illness Cover: R5500

Casualty Accident Cover: R5500

At the end of the day, we want you to be covered regardless of what you’re paying in premiums. Health emergencies happen out of the blue, and you want to be prepared for when they do.


Yours in affordable health insurance,


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