Starting a family marks an exciting new chapter in one’s life – at times it’s busy and even chaotic, but it’s also filled with joy and unconditional love too. As with any big life event, planning ahead can help you feel calmer and make the experience more enjoyable. So, when it comes to having a baby, a big aspect to plan before you’re even pregnant is joining a private medical aid.
While most medical aids in South Africa offer some level of birth and baby benefits, these differ among schemes – and there are certain conditions involved. Most importantly, all South African medical schemes will impose a waiting period of between 10 and 12 months if you join as a new member, during which you won’t be able to claim for any expenses relating to pre-existing conditions.
This means that if you’re already pregnant and want to join a medical scheme, you won’t be covered for your pregnancy or birth expenses, as it will be considered a pre-existing condition. However, if you do join after you’re already pregnant, note that your baby will be covered as a dependant from the moment they’re born – even if the birth falls within this waiting period.
Still, if you want access to the full range of prenatal benefits, it’s important to plan ahead and join a medical scheme before you fall pregnant. So, assuming you want to start a family in the near future, here are four things you should look out for when comparing maternity benefits across South African medical schemes:
- Know what’s covered during your pregnancy
All private medical aids will cover a certain degree of pregnancy expenses such as prenatal gynaecologist check-ups, blood tests and ultrasound scans – but the exact amount differs between providers. In most cases, you can expect to be covered for around 12 consultations and two scans.
Some schemes may cover the costs of antenatal classes and midwife consultations, while others pay a contribution towards them where you pay in the balance. If you have an “at risk” pregnancy – for example you have a complication with another condition, or you’re carrying twins or triplets – you may need to have extra tests. It’s important to check whether these costs would be covered by your medical aid or not.
- Know your plan’s provider limits
When it comes to maternity benefits, examine the fine print of what you’re being offered. For example, when it comes to prenatal check-ups, can you visit any gynaecologist, GP or midwife, or do they need to be one within your scheme’s network for their fees to be covered? Many schemes let you choose your own provider if they’re out of network, but you’ll usually have to contribute a co-payment.
You should also look at the limits for specialists like anaesthetists and paediatricians that you may need to use while you’re pregnant and after the birth – again, are there different costs involved depending on your choice of provider?
- Look at what cover you’ll get for the birth
In most cases, your medical aid will cover the costs of your birth whether you’re having a natural birth or a caesarean delivery (and whether it’s planned or emergency). However, your medical scheme is likely to pay different percentages of medical aid rates depending on which hospital and provider you use if they’re not in your scheme’s network. You should also look at how many days you’re covered for the hospital stay itself, and what exactly this includes (for example a stay in a shared ward may be covered, while a private room may not). Another option is to consider taking out gap cover as an add on to your medical aid, so that some or even all of the extra costs you may need to pay in relating to the birth will be reimbursed to you.
If you’d prefer to use a birthing clinic or a home birth, check to see your scheme’s position on this. Some medical aids, like Fedhealth, will pay a contribution towards using a doula to support you during the birth – even if it’s a home birth – as well as midwife consultations after your baby is born.
- Look at the cover you’ll get after your baby is born
Once your baby is born, you’re in for a whole different set of expenses, from check-ups and vaccinations to medication if your baby becomes ill. Look carefully at what you’re covered for in the months after your baby’s birth: in most cases, your baby’s health expenses will be covered for one to two months after the birth, as will your own six week check-up.
Many medical aids will also cover you for a certain number of check-ups in your baby’s first year, and coverage for vaccinations. Once your baby is born, you’ll need to register them as a dependant on your medical aid plan so that they’re then covered as a beneficiary on your membership..
If you’re planning on starting a family, having access to medical aid coverage is essential if you plan on using private health services, from hospitals and gynaes to nurses. Plus, if for any reason your birth has complications and your baby has to be admitted to the neonatal ICU, you’ll be in for even more expenses.
Having a baby is an exciting and joyful time as you prepare to welcome your new little bundle of joy into your life. As part of this preparation, it’s worth doing research ahead of time about the medical aid scheme that will give you the best coverage for your pregnancy, birth and once your baby has arrived.
