Everything an insurance whizz needs to know about the difference between insurance exclusions and waiting periods.
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 policy contracts: insurance exclusions and waiting periods.
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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.
Learn more: What is medical insurance? We have the answers…
The Oneplan way
Before we unpack what insurance exclusions and waiting periods 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
- Keep your doctor – we let you go to the doctor of your choice (NO NETWORKS)
- 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!
Insurance 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, which doesn’t have any waiting period. 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 – 90 days
- Optometry (Eye doctor) – 12 months
Insurance 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 health insurance exclusions, but a full list can be found in your policy schedule:
- Nuclear weapons, nuclear material or acts of war including military rising, rebellion or revolution.
- Cosmetic procedures.
- Anything illegal.
- Cost of treatment for infertility / fertility inclusive of surgical procedures and/or medical treatment e.g. hormone replacement therapy, sterilisation, vasectomy.
- Costs, tests and examinations required for administration/application purposes.
- 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.
- Congenital disorders, diseases or abnormalities (issues that existed at birth).
- Any birth control procedures.
- Self-inflicted injuries, mental illness, psychiatric disorders, symptoms and related treatment and hospitalisation.
- Cost of procedures, operations and treatments that are not medically justifiable.
- Corrective procedures for optometry related conditions, including laser treatment, and the treatment of eye conditions.
- Any treatment relating to non-disclosure, whether intentionally or unintentionally, of a condition.
The final word
Insurance 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 must pass before you can claim – each condition is different and will have varying waiting periods, but you can find all the answers you need about your insurance exclusions and waiting periods in our super comprehensive policy wording document. If you have any other questions, you can reach out to our friendly team of consultants.
Yours in hassle-free insurance,
Oneplan
