Medical Aid For Pregnancy And Childbirth
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.
Choose the right cover for your budget
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.
My Daughter is now 6 weeks pregnant is there any medical plan that we can take out for her and the baby
Hi Janette did you manage to find anything to cover your daughter
Hi Kim, I have just found out i am pregnant. what medical aid can still assist me? Please can you help with advise? Thanks so much
Hi Chantelle i have tried every medical aid and hospital plan and not one will cover if you already pregnant its rough i suggest u find a hospital that has a birthing package and save until you have to book your bed . Do u have an email or way we can talk directly
Hi Kim, Thank you so much for your response 🙂 email is {BLOCKED}
Hi Kim, I pick up an interesting topic which I relate to. I’m currently pregnant and it’s my first, thus I’m not covered by medical aid. So can I kindly leave you my email as well, so you can possibly advise on birthing packages. Thanks
Hi we are in the same boat. Me and My Fiance also found out she is 6 weeks or more with our little one. trying to find as much info as possible. any help and guidance would be appreciated
Hi Kim
I am in a similar situation. Please may I request your guidance as I am in a similar situation.
Hi Kim! I am 2 weeks pregnant now, and also not on medical aid. I have been emailing a couple of private hospitals, requesting birthing packages (I need to have a C-section done), and so far it is sooooooo expensive 🙁 Please can you email me some info on the birthing packages?
Hi Kim
I am 2 weeks pregnant and will need a C-Section. Please email me regarding the birthing packages.
Can you kindly send me details of a private hospital in Gauteng or Capetown that has a birthing package please. I am 6 months pregnant
Hi Kim,
I have the same problem as well. my daughter is almost 7 weeks pregnant and I am trying to find a medical scheme that will assist. kindly email me
My Daughter is now 6 weeks pregnant is there any medical plan that we can take out for her and the baby
Good day please send options for birth packages available
5 month pregnant bi medical aid or hospital plan or health insurance
Hi, I have just found out i am pregnant. what medical aid can still assist me? Please can anyone help
What would be the next option for getting a cover for pregnancy delivery.
hi, we have just discovered that we 6weeks pregnant and what I would like to know is does medical aid covers the childbirth
Good day. Please kindly with birth packages without medical aid. Please thank you
Hi am Angel currently 6 months pregnant I want to give birth by c section due a past delivery of my daughter by c section .I don’t have medical aid what must I do to get one at this stage of pregnancy.
Good day, i have just found out i am pregnant is there any medical aid that will cover me.please i need help!!!
hi i just found out i am pregnant and i need medical aid can u please assist me please thanx alot
Hi I’m planning on trying for a baby but i want to get covered by the time I fall pregnant can you please forward me information about ur. medical aid cover
Hey kim I have just found out that I am pregnant and I do not have any medical aid. Please help my email adress is [REMOVED].
I will have to start a company then can assist these types of problems , my wife is now pregnant 17 weeks I have a registered medical company and do not have medical aid now we also have a problem , any suggestions.
Hi!
I am 2 weeks pregnant now, and also not on medical aid. I have been emailing a couple of private hospitals, requesting birthing packages (I need to have a C-section done), and so far it is sooooooo expensive 🙁
Did you and your wife come right? Do you have any advice for me?
Hi, I have been on my medical aid since the 1st of this month, I have in black and white that no waiting period applied for my cover. I have been on the pill for a while but found out yesterday that i am plus minus 3 weeks pregnant, since this is the first diagnoses and the pregnancy was unplanned or unexpected, my doctor says the medical aid will cover me, as it is active and existing already.
Is this right, and will they cover my pregnancy and birth?
Thank you!!
what medical aid were you on that had no waiting period?
i just found out that m pregnant and i have already applied for medical aid.n i recieved a card but is gonna be valid from 1December..i just want to find out if medical aid Will cover me
Hi, I’m 3months pregnant is there any hospital plan that can cover me? Please help urgently
Hi Leticia. Unfortunately there is no hospital plan that will cover your pre-existing pregnancy. It is considered to be a pre-existing condition and therefore subject to a waiting period. You can still take out medical aid cover and other illnesses will be covered as wel as baby, who will be covered from birth. However, you will have to pay cash for your pregnancy/delivery costs for this pregnancy.
Hi Kim… My wife joined a my medical aid on the 01 April 2016, on the 27 May 2016 we then found out at a gynecologist that she was 11 weeks pregnant with twins, the reason why we went to consult is that we didn’t see her periods for two months now. After that first consultation on the 27 May 2016 we started using the medical aid and she is already admitted twice at the hospital and all those claims were paid by the medical aid,also her check ups were paid by the medical aid.So now the doctor wants authorization since delivery is on the 14 November 2016, the medical aid wants to know when she joined. Any chances of getting covered or being rejected?
Hi Medline SA Team,
I am 15 weeks pregnant and I am on medical aid, so that all covered. I am actually looking to get gap cover but I see there is a pre-existing condition waiting period for pregnancy ranging from 9 months to 12 months. Would you be able to advise or refer me to anyone that offers gap cover with no pregnancy waiting period?
Thank you for your help.
Hi there, we also just find out that my son’s fiancé is pregnant, hes on a medical aid but she’s only on a hospital plan. Both of them are not earning a lot and I am also desperately trying to get assistance or guidance on how to help them. Anyone who could maybe give us guidance. She’s about 5 weeks pregnant. Thanks so much.
Hi please contact me re the birth packages you are talking about.
Hi There
My daughter is 8 weeks pregnant and cannot find a medical aid to help her. I see you are suggesting birthing packages can you please contact me in regards to that
My daughter is 9 weeks pregnant with no medical aid. Heard about St Mary’s in Springs need more information on hospital.. Any suggestions… Don’t want to go to government hospital and also can’t afford private apparently St Mary’s charge R11000 for everything… Has anybody experienced giving birth in this hospital
Hi I’m 19 weeks pregnant & I’m looking for a medical aid to cover this pregnancy & child birth please help.
Hi my name is Damian my partner is 12 weeks pregnant no medical but we are willing to pay for the delivery cost, any hospital institution you can refer me to, thanks in advance
Hi Kim,
Can you please send me more details on which hospitals have birthing packages?
Thank you
Good Day :-),
I kindly and so desperately want to ask for your best possible advise to help me in my dilemma please?. I urgently need help with a medical aid that will be able to cover my doctor vists and all of the costs with the delivery of my baby the 27th September 2017 (I am exacly 13 weeks pregnant today. I suppose its pretty much impossible to get a Medical aid If you are already pregnant, but I’ve read through some of the questions and answers that there is Great Birthing Package which one can take if you are already pregnant .
Please please please I need help so badly :-). I have done research for a while now and the feedback I got isn’t quite as helpful.
You can kindly email me at anytime of the day and I will reply with immediate effect.
My email address is jeneenvdm@gmail.com
Thank you in advance ,
So much Appreciated 🙂 . xxxx
@the medline SA team… my daughter is pregnant and while I understand med aids wont cover the pregnancy or birth (im currently paying cash for a private gynae and will pay cash for the birth) I still want to find a good medical aid for my daughter that will cover baby as soon as it is born, is there med aids that will do this… no waiting period?
Hi Kim will you contact me on my email about birthing options/plan.
Just found out that I’m pregnant i want a reasonable medical aid or some cover that will cover for the delivery
I would like to join medical aid I’m pregnant but I want to pay cash.
I just switched over from one medical scheme to another (no break in between). Little did I know that I would fall pregnant within the time of moving between the two. I am 3 weeks and left the old medical aid scheme 30 April 2017 and joined the new one 1 May 2017. Would I still be covered?
Hi, PLEASE help I just found out I am 6 weeks pregnant. I’m not on medical aid. A lot of medical aid don’t take a person that is already pregnant. Your assistance will greatly be appreciated.
Kind Regards
Ntombi
Hi i am pregnant and currently looking for a medical or hospital plan to cover me.Can you assist me please.Thanks in advance.
Hi Kim please contact me regarding birthing packages I recently found out that I’m pregnant.
Good Day
I just find out that I am pregnant and I don’t have any medical can u please advise on what steps to take
As many we pay for medical aid hospital plan no one want to cover us but they will take our money from us
It’s best I start to save my money then wasit on the sick medical aid
Hi, I’m looking for the cheapest medical aid that will cover only my baby immediately after birth in case of I emergency.
Hi, please help I just found out I am pregnant. I’m not on medical aid. A lot of medical aid don’t take a person that is already pregnant. Your assistance will greatly be appreciated.
Kind Regards
Nkabi
Hi there, recently found out that I’m pregnant and am not covered. Can I still join a medical aid although the birth won’t be covered? It’s more to cover the baby when born. Also, what options do I have for birthing packages?
Hi Stella. Yes, you can still join a medical aid even if the current pregnancy is not covered. Speak to your medical aid about cover for your newborn. Usually your baby will be covered immediately upon birth since you have cover. However, you need to clarify with the medical scheme.
Hi im currently on amedical aid found out i was pregnant before joining them, now they refuse to pay for the birth but i didnt have any waiting period? What to do im giving birth in november
@the medline SA team … Similar question to all above regarding medical aid once pregnant – are there any the offer cover ?
Hi Wendy. There is no medical aid that will cover the current pregnancy if you choose to join a medical aid after falling pregnant. In these instances the pregnancy is considered as a pre-existing condition. However, future pregnancies will be covered once the waiting period have passed. A problem for may South Africans is that medical aid is not affordable. They only look for medical aid cover when they need it. Unfortunately this will not help them because the waiting periods prevent this type of practice.
Hi I also just found out i am about 3 weeks pregnant.
What i want to know will medical insurance or medical cover the hospital stay?
I know it wont cover delivery costs etc:
I also am aware it will cover for the babys stay.
But will it cover for my stay.
Thanks in advance
Good day Kim,
Is it possible for you to mail me more info regarding birthing packages.
Kind regards
Good day
I want to find out I have discovered that I m pregnant and I have been in a medical aid for 3months will I be covered for this pregnancy
Good day
I need to find out ,I m planning to get pregnant from Feb 2018 so will I be covered if I join now medical aid since the waiting period is 12 months ?
Hi Kim, kindly assit i just found out that I’m 8 weeks pregnant and I’m not on a medical aid. Called just about all the medical schemes they all tell me the same thing 12 months waiting period. And I really from the bottom of my heart do not want to to give birth at a government hospital. I’m based in Midrand, Please assist on which hospitals have birthing plan’s and which would you recommend? Also as I was reading on the comments I’ve seen mentions about St Mary’s in Springs need more information on hospital and your thoughts please. Kindly email all you can, thank you so much in advance.
Hi Kim. Please email me info regarding the birthing packages.
Kind regards
Good Morning
I’, currently pregnant … I found out that I was expecting towards the end of September 2017. when I applied for my medical aid with GEMS I did not know at that point I was pregnant. My medical aid started from the 1st of October 2017. Im now 16 weeks pregnant would my medical aid cover me?
Hi please advise
I joined medical aid on 1 Oct
I had my last period 27 Sept and found out I’m pregnant 7 weeks. Will medical aid still cover it? As I was on period when I joined and didn’t know I was pregnant
Hi kim
May you please kindly email me info regarding birthing packages.
Regards
Good day Medline Team. I am based in South Coast/Durban can you please send me birthing packages? I am extremely desperate. Own my own business and due to economic state had to drop my medical aid. Things are better now but I fell pregnant (not on purpose). Now I need a government aided hospital to assist. Worst of all is I have a naval hernia and its worrying me. Any info would be greatly appreciated.
This is pathetic though. I understand the medical aids side but we were planning on getting a medical aid the end of this month and then my baby suprised us. Now I’m sitting without medical aid and what now?! Medical aids should then create contracts that make you stay with the medical aid for a minimum of 2 years. Because some of us aren’t planning on leaving medical aid. Me and my boyfriend both want medical aid which proves we won’t be abusing it or leave after 9 months. And then after those 9 months our baby will be on medical aid too. So 3 extra people for medical aid but yeah.
Hi am currently on a medical aid found out that my daughter was pregnant before joining them, now they refuse to pay for the birth but i dint have any waiting period? What to do she giving birth in August
Hi Kim may you please email me birthing packages (cash) fee
Thanks
Good day,
I would like to please find out which medical aid I can join if already pregnant for 2 to 3 weeks.
Please advise,
Thanks.
Hi Ivor. As far as we are aware, there are no medical aids that will cover the pre-existing pregnancy so late into the pregnancy. However, this should not detract you from joining a medical aid as both Mum and baby may have other needs that will still be covered after the relevant waiting periods.
If you are in Joburg you can use the Birthing team. Their prices are reasonable. You can google them.
Please email me birthing packages I still have had no reply and any help would be welcome. Like I said no medical aid.
Are there any good or decent government hospitals that you can advise?
I had my first child with a midwife and due to my current situation is contemplating a home birth. But I need a midwife. I’m in Amanzimtoti. Does anyone know of midwives in the South Coast?
Any assistance or options available would be greatly appreciated.
Hi guys I’m pregnant and looking for hospital cover that will cover for me at the hospital and im nine weeks