Top medical aid options if you’re planning a family

Posted on August 20th, 2019

We look at the maternity benefits of some of South Africa’s top medical aids. By Xanet Scheepers and Kathy Malherbe

Medical aid options and their maternity benefits

Choosing the right medical aid is critical in ensuring the healthcare needs of you and your loved ones are taken care of, particularly when you’re planning on expanding your family. “The run-up to the delivery of your baby can get very expensive,” warns Damian McHugh, executive head of marketing and distribution at Momentum Health.

You need to take into consideration that it’s not only the birth you’ll need to pay for, but also things like gynae visits and scans, which all add up in the end.

With many medical aids amending their plans and pricing in September, now is the perfect opportunity for you to sign up to a medical aid if you’re not already a member, or to scrutinise and review your existing cover.

Note that you have to join a medical aid before you fall pregnant, or your pregnancy may not be covered at all. “You should join a medical scheme even before you start planning to conceive,” says Damian. “You don’t want to get caught out and risk a waiting period being imposed before your cover starts. The entire pregnancy journey is very expensive.”

ALSO SEE: 5 questions growing families should ask when choosing medical aid

Important questions to ask your medical aid before you fall pregnant

Whether you’re shopping around for a medical aid, or are already a member of one, ensure you ask the following questions:

  • Do I have to use a specific hospital or doctor?
  • What happens if I want to use a hospital or doctor that’s not on the scheme’s network?
  • Are my maternity benefits additional or subject to my family’s overall limits?
  • What happens if my out-of-hospital benefits run out before my pregnancy is over?
  • Am I covered for delivery by a midwife?
  • Am I covered for a specialist?
  • What type of scans am I covered for?
  • What type of screenings am I covered for? For example, non-invasive prenatal testing and amniocentesis.
  • Am I covered for antenatal classes?
  • How am I covered for my hospital stay and delivery? (Full cover or 100% medical scheme rates)
  • Which kinds of births am I covered for?
  • What benefits are there for my baby’s first year?

Before you choose

The medical aid landscape can be tricky to navigate, so it’s important to compare all the available options and schemes to make sure you find a medical aid that works for you and your family, and is within your budget. Also, take the time to read the information sent to you by the scheme or your broker to ensure you understand what’s being offered.

If you’re already on medical aid

“Before you decide on the best medical aid option, you need an idea of what your typical healthcare costs are,” says Lee Callakopen, principal officer of Bonitas Medical Fund. Reflect on the following over the past 12 months:

  • How much you spent on day-to-day healthcare expenses.
  • If you or any of your dependants were admitted to hospital.
  • How often you visited a specialist.
  • Do any of you have any chronic conditions?
  • The amount you spend on dentistry, optometry and over-the-counter medicine.
  • Whether you exhausted your day-to-day benefits and/or savings in the year.
  • How much you paid in co-payments and/or deductibles.

Now consider which of the expenses listed above were once-off and won’t come up again soon (like childbirth) and which are likely to come up regularly (like flu).

Choosing a medical aid

When comparing the different medical aid options available, consider all the costs involved before you make your final decision, such as:

  • Can you afford your monthly instalments given your monthly income and expenses? The general rule of thumb is your medical aid contributions should be around 10% of your monthly income at an individual or household level.
  • Usually, the lower the cost of the option, the fewer the choices available to the member regarding medical treatment, healthcare providers and medications. However, this can greatly benefit you if you have limited resources available for healthcare, or if you don’t have chronic and existing conditions and are relatively healthy.
  • The cost of co-payments. A medical aid co-payment is a fee the member is liable for when making use of certain medical services. When the medical aid doesn’t cover 100% of the cost, the member is required to pay a certain percentage of the medical service before the medical aid pays their portion.
  • The co-payments usually apply to specialist or elective medical procedures. However, this differs from one medical aid scheme to another and is one reason why you should always do thorough research before deciding which medical aid scheme is the best option for you.

Bonitas also offers the following advice:

  • Disclose all information about your and your dependants’ health. Membership can be suspended or cancelled if you fail to do so.
  • How good is the payment record? Phone your GP’s receptionist to find out whether they have experienced problems with
    pay-outs from particular schemes.
  • Check the scheme’s solvency ratio. According to the law, schemes should have at least 25% of a members’ annual contributions in reserve.
  • Scrutinise the table of benefits. Things might look good on paper, but check what the day-to-day limits are and how much your Medical Savings Account is per year. If it’s small, you could exhaust your day-to-day cover quickly. Also remember, many private hospitals don’t charge medical scheme rates, so check what co-payments you will have to make.
  • Find out if there’s a waiting period or exclusions. Schemes may impose certain waiting periods for new members joining or for a pre-existing medical condition. This is based on the guidelines of the Medical Schemes Act and the specific scheme’s rules.

Medical aid schemes and the maternity benefits they offer

Motherhood and pregnancy are times of great anticipation and joy, and you don’t want it to be overshadowed by financial concerns. We look at the maternity benefits some of South Africa’s top medical schemes offer families, but don’t forget to do your own homework. You also have the option to use an independent broker who will help you choose the medical aid plan best suited to your, and your family’s, needs.

Bonitas Maternity and Child Care benefit

What is usually covered in the maternity benefit?

This differs from scheme to scheme and according to the plan you’re on. Bonitas pays for:

  • Private room
  • Maternity consultations
  • 2D ultrasound scans
  • Postnatal consultations
  • Antenatal classes with a midwife
  • Amniocentesis
  • Newborn hearing screening (in or out of hospital)
  • Congenital hypothyroidism screening for children younger than one month
  • Childhood immunisations
  • Paediatric consultations.

The availability of these benefits depends on the plan you have chosen. Your delivery will be covered by your hospital benefit.

Birth options covered

  • Medically necessary C-sections on all plans.
  • Home births.

Bonitas Baby Bag

All pregnant members can register to receive a baby bag filled with a range of useful goodies you’ll need once your baby arrives.

Babyline

Babyline is a dedicated children’s health advice line, available 24 hours a day, 365 days a year. The service is run by paediatric trained nurses who assist with any queries related to your little one’s health and wellness. The benefit is available on all Bonitas plans, for children under three years.

It provides the following home-care advice:

  • Clinic/primary care/GP referral for the same day.
  • Clinic/primary care/GP referral for the next day.
  • After-hours care within the next six hours.
  • Immediate referral to emergency room.

Child Care Benefit

Bonitas also offer a separate benefit for consultations with a paediatrician for children under two as well as additional GP consultations for children under 12 years.

Visit bonitas.co.za for more info.

Fedhealth Maternity Benefits

Fedhealth’s new flexiFED option range was designed with members’ life stage in mind and offers generous maternity and childhood benefits on their flexiFED 2 and 3 options. The difference lies in the fact that they cover many of their great benefits from Risk – meaning the member doesn’t have to exhaust their day-to-day benefit during pregnancy and birth.

What is covered in the maternity benefits?

  • All pregnant members can join the Fedhealth Baby Programme for a beautifully designed Fedhealth baby bag filled with baby goodies, and expert advice that can be accessed 24/7.
  • All members and dependants can also register for the Fedhealth Family Room online member portal and join their Baby Bumps community for interesting reads and rewards.

The following maternity benefits are covered from Risk – depending on the option. Any other maternity expenses will be covered from the member’s Savings and Wallet.

Depending on the option you have chosen, they cover:

  • Two antenatal scans and either eight or 12 ante- and postnatal consults with a midwife, network GP or gynae
  • A doula benefit
  • A postnatal midwifery benefit
  • Private ward cover.

Once your baby is born, there’s also great childhood benefits paid from Risk, such as:

  • Paediatric consults without referral up to either 12 or 24 months
  • An infant hearing screening test
  • Childhood immunisations
  • Childhood illness specialised drug benefit for up to 18 years of age.

What birth options are covered?

  • On the myFED option there is a R11 500 co-payment on the hospital account for elective C-sections, but on the flexiFED and maxiFED option ranges there is no co-payment for elective C-sections.
  • Members should just note that any shortfalls caused by non Fedhealth-network specialists charging higher rates than the Fedhealth rate, will be for the member’s own account. A product like Sanlam Gap Cover could be an affordable way to cover these shortfalls.
  • Home births are also covered as well as the hiring of a water bath.

Visit fedhealth.co.za for more info.

ALSO SEE: The facts about having a home birth

Momentum Health Maternity Programme

Momentum Health provides a comprehensive maternity programme with various benefits. However, these benefits vary depending on the option you select.

Antenatal visits

  • On the Ingwe and Impact options, you have cover for up to four antenatal visits including a urine dipstick test at your Ingwe or Impact Primary Care Network GP, gynaecologist or a registered midwife.
  • On the Custom, Incentive, Extender and Summit options, you have cover for up to 12 antenatal visits including a urine dipstick test at a GP, gynaecologist or a registered midwife.

Scans

On all options, you have cover for two foetal growth/maturity scans.

Paediatrician visits

On the Custom, Incentive, Extender and Summit options, you have cover for two paediatrician visits in your baby’s first year.

Pathology tests

On the Incentive, Extender and Summit options, they also cover routine pathology tests that may be needed during your pregnancy. You can visit momentum.co.za to find out what these tests are.

Midwives

In addition to the above, Momentum Health also offers access to midwifery trained maternity coaches, who are available telephonically to answer questions about the pregnancy, including any postnatal and newborn issues. If you have a high-risk pregnancy, the maternity coach will contact you on a regular basis to offer advice, support and encouragement.

Doula benefit

You have access to the doula benefit if:

  • You will be making use of an Associated gynaecologist, and
  • You agree to opt for a natural delivery, and
  • The doula is DOSA or WOMBS accredited.

 ALSO SEE: 5 reasons to consider a doula for labour support

BellyBabies benefit

BellyBabies is an exciting offering that provides expecting parents with expert antenatal and postnatal support.

BellyBabies offers the following:

  • Access to an online antenatal course with 50 concise educational videos that you can watch in the comfort of your home.
  • Video consultation with a lactation specialist to help you and your baby to establish and maintain a happy breastfeeding routine.

Hello Doctor

With Hello Doctor, you can talk to, or text a doctor any time of the day or night, using your phone, tablet or computer when you join the Momentum Health Maternity programme.

Momentous Baby Programme

If you are a Premier member of Momentum’s wellness and rewards programme, Multiply, you also have access to the Momentous Baby benefit. This includes a fantastic hamper filled with baby products.

Visit momentum.co.za for more info.

Discovery Health Medical Scheme Maternity Benefit

 Discovery offers comprehensive maternity and post-birth benefits supported by access to 24/7 support, advice and guidance through the My Pregnancy and My Baby programmes on the Discovery app and website. The healthcare services are covered from the Maternity Benefit at the Discovery Health Rate. This cover does not affect your day-to-day benefits and depends on the plan you choose.

During your pregnancy, you are covered for the following:

  • Antenatal consultations. You are covered for up to 12 visits at your gynaecologist, GP or midwife, based on the plan you choose.
  • Ultrasound scans and prenatal screening. You are covered for up to two ultrasound scans and one nuchal translucency. You are also covered for one Non-Invasive Prenatal Test (NIPT) if you meet the clinical entry criteria.
  • Blood tests. A defined basket of blood tests per pregnancy are included in the maternity benefit.
  • Private ward. You have cover for up to R1 880 per day in a private ward for your delivery in hospital, on the Executive and Comprehensive plans.
  • Essential registered devices. Executive and Comprehensive plans have cover for up to R5 000 for essential registered devices e.g. breast pumps and smart thermometers with a co-payment of 25%.
  • Antenatal classes or consultations with a nurse. You are covered for up to five pre- or postnatal classes or consultations with a registered nurse.

For two years after birth, the following is covered:

  • GP and specialist visits. Your baby is covered for up to two visits with a GP, paediatrician or an ENT. Cover depends on the plan you choose.
  • Six week consultation. You are covered for one six week post-birth consultation with a midwife, GP or gynaecologist.
  • Nutrition assessment. You are covered for one nutrition assessment with a dietitian.
  • Mental health. You are covered for up to two mental health consultations with a counsellor or psychologist
  • Lactation consultation. You are covered for one lactation consultation with a registered nurse or lactation specialist.

Visit discovery.co.za for more info.

Medihelp Medical Scheme Maternity Benefits

 Medihelp offers enhanced maternity benefits in addition to other insured benefits. You will need to consult with a consultant or view their brochure at medihelp.co.za to see what maternity benefits are covered under the various options the scheme have on offer.

The enhanced maternity benefits include the following:

  • Free registration for and participation in the Medihelp HealthPrint pregnancy and baby programme with support and baby goodies.
  • Up to 12 antenatal and postnatal consultations per family at a gynaecologist, GP or midwife (up to eight on the Prime 2 option).
  • One amniocentesis screening per pregnancy.
  • Two 2D ultrasound scans per family.
  • Flu vaccination during your pregnancy at Clicks/Dis-Chem pharmacy clinics.

Child benefits

  • Child flu vaccination at Clicks/Dis-Chem pharmacy clinics.
  • Babies under a year receive two additional visits to a GP or specialist
  • Full schedule of standard child immunisations covered up to 7 years at Dis-Chem and Clicks pharmacy clinics.

HealthPrint

HealthPrint is a free online health and wellness platform specifically designed for Medihelp members to add value in a unique and individualised manner to your experience. Under HealthPrint, members have access to a pregnancy and baby programme which offers the following:

  • Once you’ve registered for the baby programme, you will receive a special gift for your baby.
  • Through HealthPrint, you can also access information about your pregnancy benefits and the procedures to access benefits, as well as receive a regular newsletter.
  • Children of members of Medihelp MultiSport get free membership of MultiSport and a kids’ MultiSport T-shirt (under 12 years).

Visit medihelp.co.za for more info.

FAQ questions

Can I join a medical aid if I’m already pregnant?

You can, but your pregnancy and birth will not be covered. According to the Medical Schemes Act 131 of 1998, medical aid schemes are entitled to impose a 12-month condition specific waiting period for any pre-existing medical condition, such as pregnancy. The waiting periods must be imposed for specific pre-existing conditions to protect the interest of current members of the scheme. When a waiting period is applied to pregnancy, the pregnancy and birth will not be covered, but your baby will be covered from the first day of life, if you register them on your medical aid within 30 days.

What if I didn’t know that I was pregnant when I joined?

Underwriting still applies. But, if you were unaware of your pregnancy, it cannot be considered as pre-existing. However, before cover is granted, the timing and specific circumstances regarding your pregnancy will be investigated.

Xanet Scheepers

About Xanet Scheepers

Xanet is an award-winning journalist and Living and Loving’s digital editor. She has won numerous awards for her health and wellness articles and was a finalist for the Discovery Journalist of the Year in 2009 and again in 2011 for the Discovery Best Health Consumer Reporting and Feature Writing category. She is responsible for our online presence across social media channels and makes sure our moms have fresh and interesting articles to read every day. Learn more about Xanet Scheepers.