This section is underwritten by Onecard Management Services (PTY) Ltd and the Insurer is ABSA Insurance Risk Management T/A AIRMS
| EXECUTIVE PLAN DESCRIPTION - R565 | |||
| HEALTH COVER | WAITING PERIODS | MAXIMUM OVERALL LIMITS | |
| Medical Practitioner Visits | 30 Days | A maximum of R230.00 per visit paid onto your Onecard™ Annual limits: Single: R 2 070.00 | 2 or 3: R 3 450.00 | 4 plus: R 4 140.00 |
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| Scripted Medication | 30 Days | A maximum of R170.00 per visit linked to a Medical Practitioner linked script paid onto your Onecard™ Annual limits: Single: R 1 250.00 | 2 or 3: R 1 650.00 | 4 plus: R 2 000.00 • Only applicable if prescribed by a Medical Practitioner • No over-the-counter Medication is covered |
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| Repeat Scripted Medication | 90 Days | A maximum of R170.00 per month on a Medical Practitioner linked script paid onto your Onecard™ • If approved this type of medication forms part of the Scripted Medication limits • Repeated Script conditions must be reported within 30 days of diagnosis and may require under writing approval, a loading fee or be subject to an exclusion • All pre-existing chronic conditions (known or unknown) will be excluded |
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| Specialist Visits | 90 Days | A maximum of R1500.00 per visit paid onto your Onecard™ • 3 visits per family per year • Including any medication or tests that may be associated |
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| Dental Visits | 90 Days | A maximum of R225.00 per visit paid onto your Onecard™ Annual limits: Single: R 680.00 | 2 or 3: R 2 380.00 | 4 plus: R 3 060.00 • Dental Procedures covered under Dental Cover |
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| Radiology | 30 Days | A maximum of R450.00 per event paid onto your Onecard™ Annual limits: Single: R 1 800.00 | 2 or 3: R 3 200.00 | 4 plus: R 4 500.00 • Must be referred by a Medical Practitioner |
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| Pathology | 30 Days | A maximum of R450.00 per event paid onto your Onecard™ Annual limits: Single: R 2 400.00 | 2 or 3: R 3 200.00 | 4 plus: R 4 100.00 • Must be referred by a Medical Practitioner |
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| Maternity Pre-Birth | 7 months applicable to new policies only | A maximum of R400.00 per visit paid onto your Onecard™ • 4 visits per pregnancy / Annual limit of R1 600.00 • Please notify Oneplan™ of the pregnancy • If you are out of your waiting period, cover is only active 4 months from the date of conception |
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| Maximum overall limit for Health Cover of:Single: Single: R 14 520.00 | 2 or 3: R 20 200.00 | 4 plus: R 24 240.00 | |||
| HOSPITAL RISK COVER | WAITING PERIODS | INSURED AMOUNTS | |
| Accident Cover | Immediate Cover | Up to R200 000.00 per insured event. Up to R400 000.00 per family per event • Excess of R500.00 per event is applicable |
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| Illness in Hospital | 90 Days | Up to R 40 000.00 per insured event per person. Up tp R100 000.00 family / insured annual limit • Month 1-3 excluded • Month 3-6 excess of 15% of the total claim not exceeding the sum insured • Month 6 onwards excess of 5% of the total claim not exceeding the sum insured |
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| Emergency Illness | Immediate Cover | Up to R4 000.00 in Accident and Emergency Units for life threatening emergency medical treatment • Month 1-3 R600 excess per event • Month 3 onward excess of R200.00 per event • Not intended to replace normal Medical Practitioner visits |
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| Dreaded Disease | 90 Days | Up to R250 000.00 per defined disease per year • Newly diagnosed within the first 3 months will be regarded as a pre-existing condition • Occuring during months 3 to 6 of the policy, the condition will be subject to a full medical report confirming that it is not a pre-existing condition whether it was known or unknown • Pre-existing Dread Disease conditions will not be covered if not specifically agreed in writing |
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| Natural Birth and Emergency Caesareans | 12 Months | Up to R 40 000.00 per insured event per person • This cover forms part of the Illness and Operation annual limits |
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| DISABILITY COVER | WAITING PERIODS | INSURED AMOUNTS | |
| Accidental Disability | Immediate Cover | Up to R130 000.00 for the duration of the policy • Only the Principal Insured is covered • Including loss of limbs on a sliding scale from minor to 100% disability |
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| DEATH COVER | WAITING PERIODS | INSURED AMOUNTS | |
| Family Death Cover | For accidental death there is no waiting period applicable For death related to natural causes, there is a 90 day waiting period | Principle Insured: Spouse/Partner: Children 14-21yrs: Children 6-13yrs: Children 1-5yrs: Children unborn (28 weeks) to 0yrs: | R 10 000.00 R 10 000.00 R 10 000.00 R 5 000.00 R 2 500.00 R 1 250.00 |
| OPTOMETRY COVER | WAITING PERIODS | INSURED AMOUNTS | |
| Optometry | 12 Months | Comprehensive eye test 1 set of Basic Frames (from a choice of 20) Lenses cut to suit frames • This cover can only be used once per 24 months • Basic Mono or bifocal lenses only • Only Eyenet optometrists nationwide can be used |
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| DENTAL COVER | WAITING PERIODS | INSURED AMOUNTS | |
| Dental Procedures | 90 Days | Temporary Filling or Emergency Root Canal per Insured R 400.00 per emergency event R 2 400.00 annual limit per year Temporary Crown per Insured R 1 000.00 per emergency event R 5 000.00 annual limit per year Dental Extraction per Insured R 120.00 per tooth No Annual limits Routine Filling per Insured R 250.00 per tooth R 750.00 annual limit per year Root Canal per Insured R 750.00 per tooth R 750.00 annual limit per year • Upgrades for more Cover are available |
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| ADDITIONAL COVER | WAITING PERIODS | INSURED AMOUNTS | |
| Emergency Assistance | Immediate Cover | 24hr Medical Assistance with an emergency dedicated line • In the event of a justifiable medical emergency, the Insured will be transported by ambulance to the nearest appropriate medical facility |
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| HIV/AIDS Anti-retroviral | 90 Days if newly diagnosed. 12 Months if pre-existing | Up to R10 000.00 per family per year | |
| Personal Protection Program | Immediate Cover | 2 incidents per year In the case of crime related traumas we offer: • Telephonic or face-to-face counselling • Trauma related legal assistance • Shelter facilities in cases of domestic violence In the case of accidental exposure to HIV: • Unlimited access to Care Centre for HIV information and advice • 2 blood tests • 31 day anti-retroviral or prophylactic therapy • STD preventative medication |
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| Please note this plan is for persons under the age of 65 years, persons over 55 years are subject to a loading fee REPATRIATION - This plan includes repatriation cover in the event of death |
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