Medical aids will allow women who are pregnant to join the scheme. However, the childbirth costs for the current pregnancy will not be covered by the scheme. This is part of the pre-existing waiting period for pregnancy and applies to any medical condition that has been present from the time of joining the scheme. However, there are many good reasons for a pregnant woman to join a medical aid as the baby may still be covered as well as other non-pregnancy costs.
South African medical schemes provide comprehensive benefits for pregnancy and childbirth, whether you opt for public or private healthcare services. Fortunately the South African public healthcare system is free for citizens but many prefer private practitioners and facilities instead. For most South Africans, medical aid is often the only way to afford these private healthcare services.
There is no single medical scheme that can claim to offer the cheapest plan for pregnancy and childbirth. The reality is that all medical schemes price their products similarly, and maternity benefits are available on all these plans. It is important to understand that what is known as medical insurance and hospital cash back plans are not medical aids. These products are cheaper but do not offer the same pregnancy and childbirth benefits that is needed to financially cover a private hospital and doctor.
It has become an all too familiar scenario in South Africa. Medical aid members are surprised to find that there are outstanding medical bills even after the scheme pays the providers. Often it is the doctor’s bill that is not paid completely. However, the problem does not lie with the medical aid. It is the onus of the patient to pay the shortfall out of his/her own pocket or by the means of medical gap cover. Failure to make up for the difference can mean dealing with lawyers, debt collectors and even the credit bureau.
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.
The benefits on your medical aid are not immediately accessible once you sign up for cover. This applies to all benefits, including pregnancy and childbirth benefits. You have to wait for a period of time despite paying your monthly contribution. These measures are intended to protect the scheme and members from consumers who join a scheme only to use benefits and terminate membership thereafter. It is therefore important to get cover early in life as possible and overcome these delays to ensure you have adequate cover when you need it.
Any member can leave a medical when they wish provided that the submit appropriate notification to the scheme. It is illegal or fraudulent to do so. But if you joined scheme solely to have your pregnancy and labour costs covered and then resign thereafter, it is a question of ethics. Medical schemes are well aware of this trend and for this reason there are waiting periods imposed for maternity benefits. In fact there is a term for this type of behaviour whether it is to cover the cost of pregnancy/childbirth or treatment for other medical conditions. It is known as anti-selective behaviour.
Medical aid membership is not a requirement for admission into a private hospital. As long as a patient can afford the high fees, a private hospital will admit them and allow them to be treated within the facility. The same applies for expectant mothers who want to give birth in a private hospital but do not have a medical aid. However, the fees that private hospitals do charge may have to be settled upfront and well in advance of the date of delivery.