Planning on having a baby? Here’s what to ask when choosing a medical aid


The most important thing to remember with medical aid and pregnancy is that almost all private medical aids in South Africa have a waiting period (usually between 10 and 12 months) for new members. This means that as a new member, you can’t claim for “pre-existing” conditions, which typically includes pregnancy. So, in most cases you’ll need to already belong to a medical aid when you fall pregnant in order to be covered for maternity, birth and post-natal costs.

ALSO SEE: Your trimester-by-trimester financial plan to prepare for your baby’s arrival

So, assuming you aren’t already pregnant, but are planning to be in future, what should you be looking at when comparing different medical aids?

Here are five questions Fedhealth suggests you ask:

What kind of limits are there on your plan?

Will you be able to visit any gynaecologist you choose, or only those within your medical scheme’s network in order for the costs to be covered? In many schemes, you can choose your own provider even if they’re out of network, but you’ll be liable for a co-payment. The same goes for the hospital you choose to give birth in, and other specialists such as anaesthetists and paediatricians.

ALSO SEE: How to choose a pregnancy doctor

What is covered during your pregnancy?

All private medical aids will cover a certain number of prenatal check-ups with a gynaecologist as well as ultrasound scans, but the number of these differ between providers. In most cases, you can expect to be covered for around 12 consultations and 2 scans. Some schemes also cover the costs of antenatal classes, while others pay a contribution towards them. If you have an “at risk” pregnancy – for example you’re an older mom or are carrying twins or triplets – you may need to have extra tests and checks. Check whether these costs would be covered by your medical aid or not.

What is covered for the birth?

Some medical aids only cover natural births and emergency C-section deliveries, while others cover elective C-section births too. Your medical scheme is also likely to pay different percentages of medical aid rates depending on whether you use an in-network or out-of-network hospital. Different schemes also vary in terms of how many days you’re covered for a hospital stay.

What about home births?

If you think you’re likely to want to have your baby out of a hospital, some medical aids will cover you for home birth and pay a contribution towards using a doula or midwife to assist.

ALSO SEE: Your top 5 questions about birth centres answered

What post-natal benefits are there?

With most medical aids, your newborn will be covered for a certain period after the birth (typically 30-60 days). You’ll also get a certain number of paediatric check-ups in your baby’s first year, as well as coverage for vaccinations. You’ll need to register your baby with your medical aid so that they’re then covered as a separate member going forward. In terms of your own healthcare, you’ll usually also be covered for your six-week check-up after the birth.

ALSO SEE: Your essential baby-admin checklist

Planning for a baby is an exciting time, but it’s also important to get your medical aid in order before you get pregnant so that you get sufficient medical coverage. Having a good private medical aid plan in place can help ensure that you can get access to excellent healthcare without having to pay the full costs out of pocket.

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