OnePlan’s health insurance – a great alternative to medical aid in 2019

Everyone surely has the right to a decent standard of healthcare. Every country should provide its citizens with a good public health system which is largely financed by the government.

South Africa doesn’t offer this now, but its citizens will see the full implementation of National Health Insurance (NHI) by 2026. The idea is for the country to move to universal health coverage where everyone receives quality healthcare.

Currently, South Africans choose between health insurance, medical aid or nothing at all, making use of state hospitals and doctors.

The healthcare one receives in South Africa today is determined by one’s economic class, with most South Africans not being able to afford medical aid.

Whether one opts for health insurance or for medical aid, the duty of the healthcare professionals is to provide quality healthcare. If they both provide quality healthcare, what is the difference between health insurance and medical aid and what makes one choose one over the other?

The rise of health insurance in South Africa

Why did health insurance come about if medical aid was providing quality healthcare?

It’s the very high cost of medical aid that has brought about low-cost primary health insurance plans.

There are major differences

Many people don’t really know the difference between medical aid and health insurance. They use the terms interchangeably as though they were one and the same. The reality is that there are some major differences between them.

You’ll often find that members of a medical aid have to use healthcare specialists in the network. The amount paid out will depend on what medical treatment you need.

Health insurance on the other hand gives you a fixed amount regardless of the treatment you have or which healthcare providers you use.

Health Insurance – Less Comprehensive Cover

There are quite a few new health insurance products too that have also been introduced because of the soaring medical aid premiums.

Insurance underwriters developed these products which come with premiums which are far more affordable to South Africans. The only disadvantage is that they provide less comprehensive cover.

We look at a few differences between health insurance and medical aid –

HEALTH INSURANCE MEDICAL AID
Governed by short- or long-term insurance Act. Governed by Medical Schemes Act.
Only emergencies accepted at private hospitals Accepted by private hospitals.
Don’t have to provide cover for PMBs. Full cover for PMBs or Prescribed Minimum Benefits.
Dread disease only covered on one Plan. Limited to events per year. Comprehensive cover for dread disease.
Pays you before you see a doctor. Pay doctor first and wait weeks to get money back.

Regarding the PMBs mentioned above, medical aid providers have to provide these Prescribed Minimum Benefits for chronic disorders such as diabetes and asthma.

Health insurance providers aren’t subject to the same legislation. They don’t have to take these requirements into account.

OnePlan – Simple, Accessible, Affordable Health Insurance

OnePlan offers health insurance. They say they do health insurance better than other health insurance providers, offering out of hospital benefits. They make insurance simple and accessible without compromising on value.

They say their insurance is for people who can’t afford medical aid. OnePlan Health Insurance offers an affordable alternative to costly medical aid plans that most South Africans can’t afford.

They were launched in July 2010 for the purpose of providing a different kind of health cover to  South Africans. They were formed as a product of OneCard Management Services, and have their share of good and bad reviews on HelloPeter.

If you need to contact OnePlan health insurance, you can call them on 010 001 0141 or send an email to care@onegrp.coza.

OnePlan does insurance differently, even offering pet insurance. This is huge for pet lovers, and their products are also offered at a price their clients can afford. Their clients have control over how much insurance they want.

Health plans to suit every budget

They offer several health plans – Core-, Blue-, Professional and the Executive Plan. Their Core Plan, their most basic, is R365 a month while their Executive Plan is R1 180 a month.

Between these health insurance plans, you get a lot covered too – dental care, maternity, hospital care and  doctor’s visits starting from as little as R365 a month.

Health cover falls under the Short Term Insurance Act. This means that those people interested in these plans can be sure that their premiums will be calculated according to the guidelines of the Act.

With their Core Plan you get –

  • up to R320 per visit to your doctor
  • up to R145 per script
  • you get R405 for radiology and pathology per event
  • up to R550 per dental visit, of which you can visit 3 times during the year
  • maternity visits up to R555 per visit and 3 visits for each pregnancy. Annual limit of R 1670.
  • casualty illness and accident – up to R4 900
  • optometry cover up to R950
  • accident cover up to R140 000. Up to R280 000 for a family and for each event
  • accident disability – up to R180 000 for duration of policy. Only the principal insured is covered.
  • family death cover – Principal and spouse R7 500 each
  • trauma and assault counselling
  • repatriation services up to R12 200 for the insured person.
  • ambulance and emergency services.

Things such as dread disease and cover to see a specialist aren’t covered with this particular plan but are covered in the other plans. Specialist cover of up to R2 000 per visit is only offered on the Executive Plan.

It pays to research each plan carefully and to choose the one that comes as close to your needs and budget as possible.

OnePlan App and Card

Once you choose one of the plans, you load your claim through the Oneplan App. OnePlan attempts to make everything easier and available for their clients with this app. You simply download the Oneplan App in order to have instant access to your cover. You can upload claims and also chat to any of their team when needs be.

The amount gets paid to your Onecard prior to seeing the healthcare provider. So in effect, it works like a debit card.

Some more differences between short term health insurance and medical aid –

  • To make health insurance premiums more affordable, providers have come up with health insurance solutions that will either limit hospital cover or exclude it. Top plans can include comprehensive day-to-day benefits while entry-level plans may include basic day-to-day benefits only.

If you are hositalised and you’re a medical scheme member, the cost of the treatment will be paid directly to the hospital. With short-term cover, you have to settle the hospital bill yourself, making use of the sum of money that you were paid.

  • Medical Aid will provide in-hospital cover, paying for treatment according to the medical scheme tariff. On the other hand, medical insurance pays out a certain amount for each day the insured spends in hospital. There are some medical aid members who take out medical insurance as a top-up product for when their medical aid savings have run out.
  • Many people who sign up for health insurance don’t do their research first. They just don’t realize how very expensive some treatments in hospital can be. A medical aid plan provides more comprehensive cover, but it doesn’t necessarily include personal accident disability like what health insurance does.

Other benefits that you can expect OnePlan Health insurance are –

  • using the cover to use with medical aid to cover the shortfalls that exist with medical aid
  • personal accident risk cover
  • cover for health events at fixed or specific amounts.
  • cover is paid to the insured, eliminating long waiting periods
  • cover can include death- and funeral cover

As already mentioned, health insurance might also provide death and funeral cover – something which medical aid schemes don’t offer.

Summing Up

You can see that Medical Aid and Health Insurance are two different things entirely. The only real thing they have in common is that both attempt to help you have access to decent health care.

One other important aspect to take into account when comparing the two is that medical aid contributions are deductible for tax purposes. Health insurance isn’t.

Nobody can really say with all certainty which is the better – medical aid or health insurance. One thing is certain though – with South Africa navigating such severe economic times, everyone is looking at ways to cut costs.

Many people are cancelling their medical aids, and when you’re a family, it amounts to having an amount of about R4 000 to R6 000 extra to now spend on groceries. But you have to be very careful about cancelling your medical aid especially when you’ve got your young children to consider or you’re heading into your golden years.

While the weak economy may well be the reason to downgrade or cancel, you’ll need something else. This is where health insurance comes in – an affordable way to have access to good healthcare. Yes, it’s not as comprehensive as medical aid, but something worth considering when medical aids are failing to offer South Africans what they need – quality healthcare at affordable rates.

References:

1. Health. NHI. Available at http://www.health.gov.za/index.php/nhi

2. OnePlan. Explore our Health Plans. Available at https://www.oneplan.co.za/plans/landing