Universal Healthcare Standard Plan
Overall, the Universal Healthcare Standard Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and in-hospital procedures to Members. Universal Healthcare Health Insurance Plans are available to employees who earn less than R20,000 per month. Universal Healthcare has a trust score of 2.4.
| 🔎 Medical Health Plan | 🥇 Universal Healthcare Standard |
| 🌎 International Cover | None |
| 👤 Main Member Contribution | Variable |
| 👥 Adult Dependent Contribution | Variable |
| 😊 Child Dependent Contribution | Variable |
| 🔁 Gap Cover | ✅ Yes |
| 😷 Screening and Prevention | None |
| 💶 Medical Savings Account | None |
| 🍼 Maternity Benefits | None |
| 💙 Pre and Postnatal Care | None |
Universal Healthcare Standard Plan – 7 Key Point Quick Overview
- ✅ Universal Healthcare Standard Plan Overview
- ✅ Universal Healthcare Standard Plan Premiums 2023
- ✅ Universal Healthcare Standard Plan Benefits and Cover Comprehensive Breakdown
- ✅ Universal Healthcare Standard Plan Exclusions and Waiting Periods
- ✅ Universal Healthcare Standard Plan vs Plans Offered by Other Providers
- ✅ Our Verdict on the Universal Healthcare Standard Plan
- ✅ Universal Healthcare Standard Plan Frequently Asked Questions
Universal Healthcare Standard Plan Overview
The Universal Healthcare Standard Plan is one of 4. It includes standard cover for 15 chronic conditions, basic radiology and pathology, limited dentistry, optometry, and several in-hospital benefits.
Gap Cover is available on the Universal Healthcare Standard Plan, along with 24/7 medical emergency assistance. According to the Trust Index, Universal Healthcare has a trust rating of 2.7.
Universal Healthcare Health Insurance has the following four plans to choose from:
1. Universal Healthcare Essential Advance Plan
2. Universal Healthcare Essential Plan
3. Universal Healthcare Standard Advance Plan
4. Universal Healthcare Standard Plan
Health Insurance Universal Healthcare Standard Plan Premiums 2023
The Universal Health & Accident Plan offered by Universal Healthcare is based on the principle of cross-subsidization. This means that all policyholders pay the same contribution rate, regardless of age or health status, and anyone may join the plan at any time. To ensure that policyholders are covered as they age or become ill, they are encouraged to contribute to the plan when they are young and healthy.
Depending on when they join the plan, a three-month general waiting period or a 12-month condition-specific waiting period may be imposed on their policy. Depending on the selected option, premiums for the Universal Health & Accident Plan are calculated on a per-person, per-month basis.
The employer or the employee can pay the full premiums associated with the selected plan option and the number of covered lives. The employer pays for the premiums in advance.
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Universal Healthcare Standard Plan Benefits and Cover Comprehensive Breakdown
Standard Plan Primary Healthcare Cover
| 🟥 General Practitioners (GPs) | 5 Universal Healthcare Provider Network General Practitioner events per insured person per year.
Includes dispensing of acute medication.
Wound stitching included. |
| 🟧 Chronic Medication | Fifteen conditions are covered.
Chronic condition registration is required.
Chronic medication must be obtained from a UHPN dispensing doctor or pharmacy.
Stated Benefits are paid monthly per registered condition per insured person. |
| 🟨 Basic Radiology | Subject to the 5 General Practitioner event limits per insured person per year.
A Universal Healthcare Provider Network radiologist must do specified X-rays.
X-rays are paid from a Stated Benefit. |
| 🟩 Basic Pathology | Subject to the 5 General Practitioner event limits per insured person per year.
A Universal Healthcare Provider Network pathologist must do specified Pathology tests.
Pathology is paid from a Stated Benefit. |
| 🟦 Optometry | Limited to one eye test event and one pair of specified single or bifocal lenses and frames at a Universal Healthcare Provider Network optometrist.
Limited to one exam and glasses per insured person every 24 months. |
| 🟪 Dentistry | A stated benefit amount is dedicated to emergency dental procedures.
Must use a dentist that is part of the Universal Healthcare Provider Network.
Covered once per insured person every 12 months. |
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Standard Plan Emergency Benefit
1️⃣ Emergency Accidental Injuries
Hospital Casualty/Emergency Room Benefit
Hospitalization because of an Accidental Emergency Injury | Hospital casualty/ER benefit or Hospitalisation for Accidental Emergency Injury is limited to R100,000 per insured person per 12-month period.
Pre-authorized treatment will pay severity-based amounts up to the benefit limit.
Accident-related hospitalization is covered only if clinically necessary. |
2️⃣ Emergency Medical Illness
Hospital Casualty/Emergency Room Benefit
Hospitalization because of an Emergency Medical Illness | Includes hospital casualty/ER benefit or emergency medical illness hospitalization.
Limited to R25,000 per insured per year.
Pre-authorized treatment will pay severity-based amounts up to the benefit limit.
This benefit only covers emergency medical illnesses and does not cover hospital casualty/ER doctor consultations.
Only emergency medical illness stabilization requires hospitalization. |
3️⃣ Emergency Medical Services
Response to an accident scene or medical emergency and transportation (via road) to the nearest private or public hospital within South Africa | The emergency service and health event severity indicate that insured persons can receive up to R25,000 annually. |
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Universal Healthcare Standard Plan Exclusions and Waiting Periods
Universal Healthcare Standard Plan Exclusions
The Standard Plan from Universal Healthcare offers comprehensive healthcare coverage. However, some exclusions are common in South African health insurance policies. Among these exclusions are the following:
- ✅ The Standard Plan does not cover pre-existing medical conditions before the policy’s inception.
- ✅ Cosmetic treatments, such as plastic surgery or Botox injections, are generally not covered by the Standard Plan unless deemed medically necessary.
- ✅ Alternative therapies, such as acupuncture or homeopathy, are typically not covered by the Standard Plan.
- ✅ Fertility treatments, such as in-vitro fertilization (IVF), may be excluded from the Standard Plan or covered only under certain conditions.
- ✅ The Standard Plan may exclude or limit coverage for substance abuse treatment under certain conditions.
Typically, experimental treatments or procedures that have not been proven effective are excluded from the Standard Plan.
Universal Healthcare Standard Plan Waiting Periods
Universal Healthcare’s Standard Plan offers a range of benefits and coverage options. However, like other health insurance policies in South Africa, the plan has waiting periods for certain services. The waiting periods for the Universal Healthcare Standard Plan are typical for health insurance policies in South Africa, and they include the following:
- ✅ General waiting period: A general waiting period of three months must pass before a policyholder can claim on their health insurance policy. This waiting period applies to all benefits provided by the Standard Plan.
- ✅ Condition-specific waiting period: A condition-specific waiting period of 12 months must pass before a policyholder can claim treatment related to a pre-existing medical condition. This waiting period applies to any pre-existing medical conditions the policyholder had before the start of their cover.
- ✅ Maternity waiting period: A maternity waiting period of 10 months must pass before a policyholder can claim maternity-related services, such as prenatal care, childbirth, and postnatal care.
It is important to note that the waiting periods for the Universal Healthcare Standard Plan may vary depending on the specific plan and cover options selected by the policyholder. Therefore, we urge prospective members to review the terms and conditions of the policy to understand the coverage and waiting periods before enrolling.
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Universal Healthcare Standard Plan vs Plans Offered by Other Providers
Medical Cover Comparison :
| 🔎 Medical Health Plan | 🥇 Universal Healthcare Standard | 🥈 Clientèle Health Standard H.E.L.P | 🥉 Dis-Chem Health Accident Cover |
| 🌎 International Cover | None | None | None |
| 👤 Main Member Contribution | Variable | R460 | R123 – R288 |
| 👥 Adult Dependent Contribution | Variable | R460 | R123 – R288 |
| 😊 Child Dependent Contribution | Variable | R460 | R110 – R156 |
| 🔁 Gap Cover | ✅ Yes | None | ✅ Yes |
| 😷 Screening and Prevention | None | ✅ Yes | ✅ Yes |
| 💶 Medical Savings Account | None | None | None |
| 🍼 Maternity Benefits | None | ✅ Yes | ✅ Yes |
| 💙 Pre and Postnatal Care | None | ✅ Yes | None |
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Our Verdict on the Universal Healthcare Standard Plan
According to our research, Universal Healthcare Standard Plan provides comprehensive healthcare coverage to individuals and families at an affordable cost. The plan covers a range of benefits, including hospitalization, chronic medication, and primary healthcare services. The Standard Plan also offers various add-on benefits, such as maternity care, dental care, and optometry services.
Furthermore, we discovered that Universal Healthcare Standard Plan is based on cross-subsidization, which means that policyholders contribute to the plan. At the same time, they are young and healthy to ensure they are covered when they are older or sicker.
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Universal Healthcare Standard Plan Frequently Asked Questions
What is the Universal Healthcare Standard Plan?
The Universal Healthcare Standard Plan is an entry-level to all-round (day-to-day and in-hospital) healthcare cover option offered by Universal Healthcare in South Africa.
What benefits are covered under the Universal Healthcare Standard Plan?
The Standard Plan covers a range of benefits, including hospitalization, chronic medication, and primary healthcare services. It also offers add-on benefits like maternity care, dental care, and optometry services.
How does the Standard Plan ensure affordability?
The Universal Healthcare Standard Plan is based on cross-subsidization, which means that policyholders contribute to the plan. At the same time, they are young and healthy to ensure they are covered when they are older or sicker.
What waiting periods are in place for the Standard Plan?
The Universal Healthcare Standard Plan has a general waiting period of three months and a condition-specific waiting period of 12 months.
Can policyholders manage their accounts and claims online?
Yes, the Universal Healthcare Standard Plan offers a user-friendly online platform that allows policyholders to manage their claims online.
What healthcare providers are included in the Universal Healthcare Standard Plan?
The Standard Plan offers access to a network of healthcare providers, including general practitioners, specialists, and hospitals.
What is the cost of the Universal Healthcare Standard Plan?
The cost of the Standard Plan varies depending on the specific cover options the policyholder selects. Universal Healthcare calculates premiums on a member-to-member basis to provide the best possible coverage.
Are pre-existing medical conditions covered under the Standard Plan?
No, pre-existing medical conditions are not covered under the Universal Healthcare Standard Plan. A condition-specific waiting period of 12 months must pass before a policyholder can claim treatment related to a pre-existing medical condition.
