OnePlan Hospital Network

Overview

OnePlan is a popular health insurance provider in South Africa. They provide a variety of plans to suit different budgets and needs, all while giving inexpensive and comprehensive healthcare coverage.

📌 OnePlan health insurance does not offer a hospital network plan, which allows plan members the flexibility to receive treatment at hospitals across the country. However, we will still explore hospital network plans in more detail to help you understand all available options.

What is a medical scheme hospital network?

A hospital network plan is a type of health insurance plan that limits coverage to a specific network of hospitals and healthcare providers with whom the insurer has contracted.

These plans offer lower premiums and out-of-pocket costs compared to plans with broader provider networks, but they require members to use the designated hospitals and providers within the network for their healthcare services, except in emergencies.

Hospital network plans were created to help control the rising costs of healthcare. By contracting with a select group of hospitals and providers, insurers can negotiate better rates and manage healthcare expenses more effectively.

When to Choose Network Plans

A hospital network plan would be a better option for you in several instances, particularly if cost savings, managed care, and streamlined services are your priorities:

• ✅ Firstly, if you are looking to lower your healthcare premiums and out-of-pocket expenses, a hospital network plan offers significant savings due to the negotiated rates between the insurer and the network hospitals. This can make healthcare more affordable, especially if you are on a tight budget.

• ✅ Secondly, if you prefer coordinated and managed care, these plans provide a more integrated healthcare experience, as the network of providers works closely with the insurer to oversee and manage your treatment. This can lead to better health outcomes and a more personalized experience.

• ✅ Thirdly, if you do don’t need frequent access to a wide range of specialists and hospitals outside the network, a hospital network plan can provide sufficient coverage for your needs within the designated network, ensuring you receive high-quality care at a lower cost.

• ✅ If you live in an area with a robust hospital network, this plan ensures that you have access to excellent local healthcare facilities without the need to travel far.

• ✅ Lastly, for individuals who appreciate simplicity in their healthcare management, hospital network plans offer streamlined administrative processes, making it easier to handle claims and understand coverage.

OnePlan Network Hospitals

In order to make its medical aid insurance plans accessible to as wide a distribution of people as possible, OnePlan does not use a hospital network. This means that plan members can visit any hospital in South Africa and receive treatment, benefits dependent. Some of the leading hospitals you can visit include:

• ✅ MediClinic
• ✅ NetCare
• ✅ Life Health Care
• ✅ ER24

OnePlan Network Plans

OnePlan offers a variety of hospital plans that meet different needs and budgets. It’s important to note that OnePlan’s hospital plans are not network plans, meaning they provide coverage without being limited to specific network providers. Here is an overview of their main hospital plans:

📌 Core Plan

This is the most basic plan, offering essential coverage such as doctor’s visits, prescribed medication, optometry services, and accident protection. However, it does not cover specialist visits or hospital stays for illnesses. The Core Plan is designed for those seeking fundamental health coverage at a low cost, starting at R480 per month​.

📌 Blue Plan

This plan provides more comprehensive coverage, including dental care, coverage for dread diseases, and maternity benefits for natural births and emergency caesareans. It also includes trauma counselling and accidental HIV protection services. The Blue Plan starts at R955 per month and offers higher benefit limits than the Core Plan​.

📌 Professional Plan

Targeted at individuals seeking extensive cover, this plan includes higher limits for day-to-day medical expenses, such as doctor’s visits, pathology, radiology, and dental services. It also covers up to R260,000 per insured event for accidents and provides significant illness in-hospital benefits. The Professional Plan starts at R1,330 per month​.

📌 Executive Plan

This is the top-tier plan, offering the most extensive coverage, including specialist visits, advanced in-hospital benefits, and high coverage limits for both accidental and illness-related hospital stays. It provides coverage for up to R335,000 per defined disease per year and comprehensive maternity benefits. The Executive Plan starts at R1,765 per month​.

All these plans include 24-hour emergency medical assistance and ambulance services, ensuring that members receive prompt care in life-threatening situations. OnePlan also offers additional cover options like accident disability and accidental death cover, which vary across the different plans.

These hospital plans are structured to provide flexibility and extensive coverage, ensuring that members can access private healthcare services without being restricted to a network of specific hospitals or providers.

Network Hospital Exceptions

In medical aid insurance plans that include a network of designated hospitals, there are typically several exceptions that allow members to visit non-network hospitals under certain conditions.

Emergency Situations

• ✅ If a member faces a medical emergency that is life-threatening, they can seek immediate care at the nearest hospital, regardless of whether it is within the network. Insurance plans typically cover the initial emergency treatment until the patient is stabilized​.

• ✅ If urgent care is required, and it is not feasible to reach a network hospital, the insurance plan may cover services at a non-network hospital until the patient can be safely transferred to a network facility​.

Lack of Network Availability

• ✅ In areas where no network hospitals are available, members may use non-network hospitals. This often applies to rural or remote areas where network facilities are not accessible​.

• ✅ If a required medical service or specialist is not available within the network, the insurance plan might authorize treatment at a non-network hospital​.

Pre-authorization for Non-network Care

In non-emergency situations, members can sometimes receive authorization from their insurance provider to visit a non-network hospital. This typically requires prior approval and is based on the medical necessity and unavailability of required services within the network​.

Continuity of Care

• ✅ If a patient is undergoing ongoing treatment or is admitted to a non-network hospital before enrolling in the plan, they may continue their treatment at that hospital to ensure continuity of care​.

Provider Referrals

If a network provider refers a patient to a non-network hospital for specific treatments or consultations that cannot be provided within the network, the insurance plan might cover the costs​.

Conclusion

Hospital network plans are insurance plans that limit treatment to a specific network of hospitals, often resulting in lower costs and streamlined care. However, it’s important to note that OnePlan does not offer hospital network plans, providing members with the freedom to choose any hospital for their treatment.

We hope this guide has helped you understand the benefits and limitations of hospital network plans, and the unique flexibility offered by OnePlan.