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Prenatal healthcare is one of the biggest expenses of a pregnancy, even if you're on a medical scheme. Prenatal healthcare includes:
Depending on your chosen scheme, gynae, GP or midwife consultations might be covered by your Medical Aid (at medical aid rates, of course), and benefits might also be offered for ultrasounds, blood tests and prenatal tests. Be sure to check what your medical aid does and does not cover! Expecting moms should choose a medical scheme that offers comprehensive or hospital plan cover to properly provide for their medical needs during a pregnancy (complicated or not).
Comprehensive cover would pay the Medical Aid rates for your essential prenatal consultations, as well as in-hospital childbirth. It would also cover your antenatal consultations (again, at Medical Aid rates).
On a comprehensive plan with a savings account, most of your out of hospital expenses will be paid from the available savings. If your specialist in hospital charges you more than the Medical Aid rates, Gap Cover would be good addition.
If a mother wants a home birth, some Medical Aids may cover the associated costs, including a registered midwife.
A Hospital Plan will cover the hospital-related expenses of an in-hospital birth (theatre costs, X-rays, blood tests, etc). There are Medical Aid plans that also offer limited out-of-hospital maternity benefits as maternity cover is a once-off expense.
What about cover for pregnancy complications?
For a pregnancy without complications, between 10 and 12 consultations can be expected to carry out various checks and screenings. However, any complications during a pregnancy can increase the number of OB visits and routine tests required to help you and your baby remain safe and healthy.
Complications or the need for extra precautions can be due to many different factors and there could be various extra treatments required. For example, if you are overweight or underweight during your pregnancy, or have pre-existing health conditions such as diabetes or hypothyroidism (an underactive thyroid), you may also need to see a dietician to ensure you eat the right foods.
Remember, too, that a hospital plan is exactly that: a hospital plan. If you give birth in a facility that is technically not a hospital, your hospital plan will probably not cover it.
While a medical scheme cannot refuse to accept a pregnant woman who applies for cover, you won't have cover immediately. A Medical Aid can impose either a 12-month pre-existing waiting period, if you are pregnant before you apply, or a 3-month general waiting period, depending on your history of cover. That's why it's best to take out Medical Aid for your general medical expenses, and not for a single medical event.
It's important to find the best value for your requirements if you plan to have a family soon. You'll need to compare the benefits available for your budget, so you can find a value-for-money plan that won't compromise on quality. This is why it's helpful to compare Medical Aid quotes from a range of providers.
Inform your Medical Aid provider the moment you find out you're pregnant so you can start claiming for gynaecologist visits if you have maternity benefits, or request pregnancy cover.
Letting your medical scheme know as soon as possible will also enable you to book your delivery at a private hospital or clinic sooner, as you'll likely need an authorisation number before you can do so.
Plus, it will also allow you to plan and budget more accurately for the expenses that are not covered. This is where Gap Cover could also help.
Depending on your chosen Medical Aid plan, your newborn baby may be covered automatically if you inform your Medical Aid with the relevant forms as soon as possible so your rates can be adjusted.
Depending on the plan, the full rate for a specialist consultation or test may not be covered during a pregnancy, so you might have to pay the difference.
Gap Cover could come in very handy during a pregnancy as it would cover specialist charges over and above the Medical Aid rates (usually shown as a percentage) for in-hospital expenses as well as any other in-hospital co-payments. This would allow you to keep certain consultations or procedures without paying out of your own pocket to make up the shortfall the Medical Aid rates won't cover.
Yes, many Medical Aid schemes have waiting periods before they will pay for pregnancy-related costs. The waiting periods may vary depending on whether you've recently got Medical Aid for the first time, or if you've recently joined a new Medical Aid but have had cover before.
So if you're pregnant when you sign up to Medical Aid as a new joiner, they probably won't pay for your current pregnancy or birth, but could cover your next one.
This article is for informational purposes only and should not be construed as financial, legal or medical advice.