Understanding maternity benefits

14 March 2014

Having a newborn can be expensive so it helps to know how to claim from your medical aid and UIF. Here’s all you need to know.

The joy of having a newborn in the home is usually accompanied by heavy bills so it’s advisable to work out in advance how best you can use available benefits such as medical aid and unemployment insurance.

Get your affairs in order early

Remember that first-time members of a medical aid sheme, meaning those who have never belonged to a medical aid before or join again after a break of 90 days, generally won’t be entitled to benefits in the first three months; also that pregnancy and birth expenses aren’t covered in the first 12 months of your membership if you’re already pregnant when joining. It’s important to plan in advance to avoid any problems related to the waiting periods of medical funds. If you joined without knowing you were pregnant then request the benefits, the fund could decide to cancel your membership for non-disclosure. If you’re unhappy about this approach the Council for Medical Schemes (medicalschemes.com or 0861-123-267).

If you change funds

It could also happen that you’re pregnant and already a member of a medical fund but want to move to another fund. If you’ve been with your fund for more than two years the waiting period before being fully covered by the new fund shouldn’t be more than three months. During this time you’ll be covered for only the prescribed minimum benefits for chronic conditions such as high blood pressure as well as life-threatening conditions, explains Deon Heydenrych of Optivest Health Services. If you’ve been a member for less than two years the new fund could exclude you for 12 months from full cover for an existing condition, pregnancy or childbirth.

What is covered?

Maternity benefits can vary from fund to fund and also depend on the option you choose. Momentum, Topmed, Bonitas and Medihelp cover about 12 gynaecological consultations and two 2D sonar scans. Some funds will cover two routine consultations with a paediatrician after the birth (also at the standard tariff). Most funds will accept registration for pregnancy benefits only after 12 weeks of pregnancy. Not all funds will cover the costs of a planned and scheduled Caesarean section. Some might insist that the procedure is done by a specified doctor or hospital.

Employee benefits

If you aren’t paid your full salary during your maternity leave you could claim from unemployment insurance – as long as you have been contributing monthly. Since 2010 this has also applied to women who aren’t SA citizens but you must have a valid work permit and have contributed to the Unemployment Insurance Fund (UIF). Business owners can also claim from UIF if they’re members of a close corporation but sole proprietors can’t. If your employer pays you a portion of your salary, for example 75 per cent, while you’re on maternity leave, you can claim the other 25 per cent from the UIF. Organisations such as Moms UIF Assist will handle your claim for a fee. You won’t be able to claim if in the past four or five years you’ve claimed anything other than maternity benefits from the department of labour.

How long can you claim?

You can claim for up to 121 consecutive days of maternity leave from the department of labour but it also depends on how long you’ve contributed to the UIF. In a nutshell, for every six months of work you get one month’s benefits to a maximum of four months. You can claim for six weeks if you have a miscarriage in the third term of your pregnancy or if you have a stillbirth.

Top tip:

Your baby is covered immediately by your medical aid but remember to register the birth within 30 days.

- Letitia Watson

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