Are Newborns Automatically Covered By Medical Aid?

All newborn babies are immediately covered on the medical aid which the mother belongs to, provided that premiums are up to date. This automatic cover applies from the moment baby is born. However, mothers need to be aware that they have to notify the medical aid as soon as possible or risk losing cover for their baby. Ongoing medical treatment for the baby after the grace period will then have to be paid out of the member’s own pocket.

Automatic Cover for Babies

The arrival of a newborn is a continuation of the preceding pregnancy and childbirth. Babies are automatically covered for their hospital stay and any medical treatment following birth. Waiting periods will not apply. However, mothers or the main member of the medical aid has to notify the scheme as soon as possible about baby’s arrival. While the hospital will initially inform the scheme that childbirth has occurred, the onus is still on the mother/main member to speak to the scheme.

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The automatic cover that comes into place occurs even though an additional premium for the baby has not bee paid since the last debit order. Most medical aids will allow a grace period of anywhere from 30 to 60 days for members to inform them of the baby’s birth and ongoing cover on the same medical plan. Failure to inform the medical aid that you want baby to continue being covered on the same plan will lead to baby being removed as a child dependant. This means that baby will no long have cover after the 30 to 60 day grace period.

Monthly Contributions for Baby

Medical schemes will charge an additional rate for baby belonging to the plan. Since baby’s premium was not covered in the preceding debit order, the scheme will apply a pro rate rate that is added to the next payment. Newborns are not covered for free as is sometimes thought. Some schemes may have policies where the third child onwards on the scheme is covered for free but this is not the same issue as the newborn cover, if baby is not eligible for such an exclusion or your medical aid plan does not have such a policy.

Remember that even though you are paying for baby’s medical aid cover, you will also need to send the scheme the baby’s birth certificate the moment it is in your hand. Any person on a medical aid, be it an adult or child, needs to provide proper identification to the scheme. Medical aids will in most instances wait for a valid birth certificate from the Department of Home Affairs. So once baby’s birth certificate is in your hands, usually within the first 30 days of life, you should send a copy to the medical aid immediately.

Cover on Father’s Medical Aid

The situation becomes a bit more complicated when a newborn arrives and the mother is not on medical aid. In order for the baby to be covered on the father’s medical aid then the father has to inform the medical aid accordingly. The automatic cover for newborn baby may then not apply although it is a situation that has to be discussed independently with each medical aid in question. The baby will obviously not be automatically covered on the father’s medical aid if the main member in question denies being the parent or legal guardian of the child.

As with any complicated situation such as this, it is important to get clarity from the medical aid directly. Remember that marriage does not immediately qualify a woman to be on her husband’s medical aid unless he adds her on as an adult dependant. A similar situation may apply when the father has cover but the mother does not at the time of childbirth. If the father is intent on adding the baby on the medical aid from the time of birth, even if he is not including the mother, then the medical aid should be informed well before the baby is born.