| HEALTH PLAN DESCRIPTION - R245 | |||
| 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 1 610.00 | 2 or 3: R 2 760.00 | 4 plus: R 3 450.00 |
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| Scripted Medication | 30 Days | A maximum of R150.00 per visit linked to a Medical Practitioner linked script paid onto your Onecard™ Annual limits: Single: R 1 000.00 | 2 or 3: R 1 500.00 | 4 plus: R 1 750.00 • 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 R150.00 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 | - | Not covered on this plan | |
| Dental Visits | 90 Days | A maximum of R200.00 per visit paid onto your Onecard™ Annual limits: Single: R 600.00 | 2 or 3: R 1 400.00 | 4 plus: R 2 000.00 • Dental Procedures covered under Dental Cover |
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| Radiology | 30 Days | A maximum of R350.00 per event paid onto your Onecard™ Annual limits: Single: R 1 400.00 | 2 or 3: R 2 750.00 | 4 plus: R 3 500.00 • Must be referred by a Medical Practitioner |
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| Pathology | 30 Days | A maximum of R350.00 per event paid onto your Onecard™ Annual limits: Single: R 2 000.00 | 2 or 3: R 2 750.00 | 4 plus: R 3 500.00 • 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™ • 3 visits per pregnancy / Annual limit of R1 200.00 • 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: R 8 210.00 | 2 or 3: R 12 760.00 | 4 plus: R 15 800.00 | |||
| 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 R1 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 • Upgrades for more Cover are available |
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| ADDITIONAL COVER | WAITING PERIODS | INSURED AMOUNTS | |
| 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 | |||
