The Unlimited does not sell a hospital plan. Its health product is called Medical Insurance, and in South Africa that is a legally different thing from a hospital plan. Getting this wrong is expensive, so it is worth two minutes.
Contact
- Customer care, claims and emergencies: 0861 990 000
- Monday to Saturday, 07:00 to 19:00. WhatsApp chatbot available 24/7
- The Unlimited Group (Pty) Ltd, FSP 21473
Medical insurance is not a medical scheme
A hospital plan is a medical scheme option, registered under the Medical Schemes Act and regulated by the Council for Medical Schemes. It must cover Prescribed Minimum Benefits in full, cannot refuse you for being ill, and pays the hospital.
Medical insurance is an insurance product. It pays defined amounts for defined events, it is not obliged to cover Prescribed Minimum Benefits, and it can decline or price you on your health. It is regulated as insurance, not as a medical scheme. Both are legitimate; they are simply not substitutes, and a policy of this kind will not carry you through a long hospital admission the way a scheme option does.
What The Unlimited publishes for the product
- From R672 a month
- Unlimited GP consultations through a network of over 4 100 GPs
- Basic dentistry and optometry
- Basic pathology and radiology
- Acute and chronic medication
- Access to emergency hospital care benefits
Read that last line as it is written. Access to emergency hospital care benefits is not the same as comprehensive in-hospital cover. Ask, in writing, what the rand limit is per event and per year, what happens to a planned admission as opposed to an emergency one, and where the cover stops.
The questions to ask before signing
- What is the annual and per-event limit on the hospital benefit?
- Is a planned operation covered at all, or only emergencies?
- What are the waiting periods, and do they differ for chronic medication?
- Am I obliged to use a network GP, and what happens if I see one outside the network?
- Is this an insurance policy or a medical scheme option? The answer must be in the document, not just from the salesperson.
An important thing about network GPs
Unlimited GP visits are the headline benefit and 4 100 GPs is a real network, but it is a network. Check that a GP you can actually reach is on it before you buy, particularly outside the metros, because the benefit is worth nothing if the nearest listed doctor is an hour away. Ask for the network list for your postal code.
A live service notice on their own site
The Unlimited was, at the time of writing, warning that severe weather in parts of the Western and Eastern Cape was affecting emergency medical response times through its service partners. That is a temporary notice, but it makes the general point: emergency benefits on any policy depend on a third-party response provider, and it is worth knowing who yours is before you need them.
If a claim is declined
- Get the reason in writing with the clause relied on, and the claim reference.
- Use the internal complaints process first.
- An insurance complaint goes to the National Financial Ombud Scheme. Note that the Council for Medical Schemes cannot help you here, because this is not a medical scheme — which is the practical consequence of the distinction at the top of this page.