OnePlan Authorisation Process

Overview

✅ OnePlan is a prominent health insurance provider known for offering comprehensive and flexible health coverage tailored to meet the diverse needs of individuals and families. The company focuses on providing accessible and affordable healthcare solutions, with various plans that provde different levels of coverage, from basic essential services to more extensive health benefits.

✅ OnePlan’s pre-authorisation process is designed to ensure that certain medical procedures, treatments, or services are covered under the policyholder’s plan before they are undertaken.

✅ This pre-authorisation process helps manage costs, ensure appropriate care, and streamline the overall insurance claim process for both the policyholder and healthcare providers.

When is Pre-Authorisation Required by OnePlan?

OnePlan requires pre-authorisation for several specific medical services to ensure that the treatments are covered under the policy and deemed medically necessary. Here are the main instances where pre-authorisation is necessary:

📌 Specialist Consultations

Any visit to a specialist requires a referral from a general practitioner (GP) and pre-authorisation from OnePlan.

📌 Hospital Admissions

Both planned and emergency hospital admissions, including surgeries and overnight stays, require pre-authorisation.

📌 Advanced Diagnostic Procedures

Tests such as MRIs, CT scans, and other high-cost diagnostic procedures need to be pre-authorised.

📌 Elective Surgeries

Any non-emergency surgery must be pre-authorised to ensure coverage.

📌 Chronic Medication

Long-term medication for chronic conditions needs pre-authorisation to confirm the necessity and coverage.

📌 Certain Therapies

Therapies like physiotherapy, occupational therapy, and psychological counselling often require pre-authorisation, especially if they are ongoing.

Importantly, pre-authorization guarantees that the treatment is covered by the policy, which helps to avoid unpleasant surprises when it comes to out-of-pocket costs. It allows for easier claims processing because the permission is already in place, and it helps OnePlan manage expenses by approving treatments that are both required and cost-effective.

Without pre-authorization, OnePlan has the right to reject the claim, which means the policyholder will have to pay for the entire therapy out of pocket.

Added to this, there may be substantial delays in processing the claim, the policyholder may be required to pay for the procedure in advance and encounter challenges in receiving reimbursement.

Policyholders can prevent unneeded costs and complications and make sure their treatments are covered by following the pre-authorization requirements.

What information to provide when requesting authorisation

When applying for pre-authorisation from OnePlan, you need to provide several pieces of information to ensure the request is processed efficiently.

This includes your membership number, which uniquely identifies your policy, and personal details such as your full name and ID number.

You will also need to provide your contact details, including your email address and phone number, to receive updates and communication about your pre-authorisation request.

Medical details are also essential, such as the diagnosis, the proposed treatment or procedure, and the healthcare provider’s details, including their name and practice information.

If the pre-authorisation is for a specialist consultation, a referral letter from your GP is required. In the case of hospital admissions or surgeries, detailed medical reports and justifications from your healthcare provider will be necessary.

How to Get OnePlan Authorisation

To obtain pre-authorisation from OnePlan, follow these step-by-step instructions:

1. Prepare Your Information

☑️ Ensure you have your policy number, full name, ID number, email address, and phone number ready. Get together all relevant medical details, including diagnosis, proposed treatment, and healthcare provider’s details. If applicable, get a referral letter from your GP for specialist consultations.

2. Choose a Communication Method

• ☑️ Phone: Call OnePlan at 010 001 0141. This service is available Monday to Friday from 8:00 AM to 5:00 PM and Saturday from 8:00 AM to 12:00 PM.
• ☑️ For hospital authorisations, admissions, and emergencies, the service is available 24/7.

Email:

• ☑️ For general health authorisations, use [email protected].
• ☑️ For hospital admissions, use [email protected].
• ☑️ WhatsApp: Contact OnePlan via WhatsApp at 083 794 5452 during business hours.
• ☑️ Website Chat: Use the web chat feature available on the OnePlan website during business hours.
• ☑️ App Chat: Use the OnePlan app to access the in-app chat feature. Make sure to download the app and register with your policy number.

3. Submit Your Request

☑️ Provide all the required information, including your medical reports and justifications for the proposed treatment, via your chosen communication method.

4. Wait for Approval

☑️ OnePlan will review your request and notify you of the decision. If approved, you will receive an authorisation number and any specific conditions or instructions related to the approval.

Conclusion

By using this guide, you can ensure your pre-authorisation requests are handled smoothly. OnePlan’s support team is always available to help if needed. We hope you found this guide useful and that it makes your experience with OnePlan even better.