Consulting with a private gynaecologist and having a baby in a private hospital is expensive in South Africa. Depending on where in the country you are located, gynaecologists may charge around R700 per consultation for antenatal monitoring and delivery charges in private hospitals hover around the R10,000 to R20,000 mark (2013 prices). Without medical aid, many women would not be able to afford these services and instead have to opt for a government hospital. Medical aid in South Africa, unlike private medical insurance in many countries, covers pregnancy and childbirth costs but only if you have been e member prior to falling pregnant.
Maternity Benefits on Medical Aid
The maternity benefits on medical aid are essentially the same among all schemes. If you have full cover with day-to-day benefits then your antenatal consultations as well as the childbirth costs in hospital will be covered by your medical scheme. However, if you only have a hospital plan then you will need to pay for these antenatal consultations from your own pocket. The delivery costs will be covered by a hospital plan since you will be admitted in a private hospital for childbirth.
Your medical aid will cover both a natural birth or a caesarean section (C-section). But many gynaecologists and obstetricians charge higher rates than what is paid by your medical aid. Therefore you may have to top up the payout from your own pocket unless you have medical aid gap cover. The hospital charges are usually covered in full by your medical scheme. Even baby’s stay in the nursery or a neonatal ICU should there be complications will be paid for by your medical aid.
Newborns are automatically covered on the mother’s medical aid upon birth. However, parents are required to inform the medical aid as soon as possible about the new member and the monthly premiums will be amended accordingly. Failure to do so within 30 days may mean that your baby will lose medical aid cover. Some schemes will give you up to 90 days to register your baby under your medical aid before cover lapses.
Pregnant With No Medical Aid
One of the common situations faced by medical aids is when women who want to join the scheme are already pregnant. Medical aids will not refuse a pregnant woman membership. But if they are already pregnant at the time of joining then the current pregnancy and childbirth will not be covered.
Apart from GEMS (Government Employee Medical Society), no other medical aid in South Africa will make any concession in this regard. It is therefore important for every person to sign up for medical aid when they are young, healthy and can afford cover. Up until a few years ago, many medical aids were somewhat flexible and would allow a pregnant woman within her first month of pregnancy, or even within the first trimester, to join the scheme and be covered for the existing pregnancy.
However, this has fallen away in recent years as many women join the scheme when already pregnant, utilise the maternity benefits and leave the scheme immediately after.The total contributions during membership may not cover the pregnancy and childbirth costs. There are also other reasons why schemes have adopted this position but it is entirely in the interests of its member base.
Pre-Existing Pregnancy Is A Pre-Existing Condition
A woman who is already pregnant at the time of joining a medical scheme is considered to have a pre-existing condition. All medical aids apply a 12 month waiting period for any pre-existing condition, be it a disease or a physiological state like pregnancy. Many woman have argued the point that pregnancy is not a disease. However, medical aid rules apply to pre-existing conditions and pregnancy is a condition.
Medical aids have to ensure the integrity of its resources which is the collective pool of funds of all its members. Medical aid members pay their monthly contributions irrespective of whether they use any benefits or not. Some members pay for years without claiming once from a medical aid.
The scheme works on the basis that most members will be healthy and not claim while a smaller number of members will need to be funded for medical care. When a new member joins the scheme and needs immediate medical care, they essentially drain the accumulated resources of other members. Therefore waiting periods have been put in place to prevent this situation from arising.
It is no different with pregnancy. The only time when medical aids will make a concession is if you have been a member on a medical aid but have terminated your membership within the past 90 days. However, there may be other criteria that applies in these cases like the duration of your previous membership.
Alternatives For Pregnant Woman
Be very careful when looking for financial products that will cover your pregnancy and delivery costs for a pre-existing pregnancy. Medical aid does not cover it. Even though some medical aids did so in the past and GEMS continues to do so, the situation can change quickly as schemes are facing a number of financial difficulties in recent times.
Other products like a hospital cash plan or medical insurance will not cover your pre-existing pregnancy either. And many private hospitals do not accept these financial products as they would with a medical aid. Your only option if you are pregnant and want to have you baby in a private hospital is to pay cash for the procedure. These cash fees will have to be paid upfront, well before the actual due date.
Many private hospitals have delivery packages where a single price applies to all costs of childbirth. These packages may include your baby’s stay in the nursery but will not cover neonatal ICU stay. Your gynaecologist and obstetrician will also charge an upfront fee for delivery, be it natural birth or a caesarean section.