Pregnancy and your medical aid cover

Know what your medical aid covers for your pregnancy. (Image: Supplied)
Know what your medical aid covers for your pregnancy. (Image: Supplied)

There is much to plan and think about when you are pregnant – one of which is medical aid. As a pregnant woman you are not automatically covered for all pregnancy issues, so it is best to check what benefits have a waiting period, and what exactly your medical aid does cover. If you do have maternity benefits, call your medical aid service provider as soon as possible so that you can claim for any gynaecology visits.

Bear in mind that deliveries at private clinics and hospitals need pre-authorisation numbers before you have your baby. By doing your homework carefully, you will have less unexpected or nasty surprises. So sort out the logistics early on in your pregnancy so that you have one less important thing to worry about.

Here are a couple of things you should consider when you are pregnant:

Register for your maternity benefits

Depending on your medical aid plan, you might qualify for maternity benefits over and above your day-to-day or savings accounts. However, you may need to register your pregnancy or birth with your scheme before these benefits are made available. You can do this online or with a quick phone call to the call centre. Some schemes will even give you a pregnancy and baby welcome pack, gift vouchers, or even a photo album once you register.

Gap cover and your pregnancy

A gap cover pays the shortfall between your medical aid payments and the actual cost of your doctors’ fees during your hospital stay. This is often reflected as a percentage of the medical aid rates and is worth investigating. Make sure that you take out gap cover before falling pregnant or realising that you may be hospitalised, because a 12-month waiting period is usually applied to all pre-existing conditions.    

Choose a healthcare provider within your plan’s network

Some schemes and plans will only cover visits to a doctor or hospital with whom they have a special payment agreement. Before deciding on a healthcare provider, hospital, or birth centre, check which ones are covered on your plan’s network. If you visit one outside the network, you will likely be charged a co-payment penalty.

Length of your stay in hospital

Vaginal births and caesarean sections affect your body in different ways. A c-section will tend to cost more because the hospital stay is a day or two longer than a vaginal birth. Be sure to check how many days in the hospital or birth centre your plan will cover, especially if you’re considering an elective c-section. If you’re opting for a vaginal birth, become familiar with the costs associated with a c-section anyway in case of an emergency.

Post-natal benefits

In addition to prenatal care, many plans offer post-natal benefits for you and your baby, such as paediatrician appointments, nutrition assessments, and lactation consultations, sometimes for up to two years after the birth.

After your baby is born

It’s important to register your baby on your medical aid as soon as possible after their birth, usually within 30 days. If you don’t do this, a waiting period may apply. You’ll need to fill out a form and provide the scheme with a copy of the baby’s birth certificate.

For those individuals not on a medical aid

Bear in mind that when you apply for medical aid, pregnancy cover and benefits are not automatic. If you are planning to have a baby, apply for medical aid or change medical schemes before falling pregnant so that you get the necessary cover. If you were on a medical aid but changed service providers recently and are currently pregnant, you might not be covered for this pregnancy or birth. However, you should be covered for future pregnancies and births, and be able to add children on your medical aid in future.

Once you have sorted out the administrative issues of your pregnancy and are looking forward to that new little addition to your family, it is imperative to take care of yourself and your health.

Whether you are pregnant or are planning on having a baby, decorating the nursery, choosing a name, and buying cute outfits are all part of the fun. But pregnancy is a serious business and preparing for this event properly includes other important aspects. Taking care of your health and ensuring you have a pleasant, fuss-free birth experience without any financial concerns is crucial.

Many South Africans now rely on their medical aid to cover them for major expenses like these, but you need to ensure that your paperwork is in order. Take care of your health and you will be able to better enjoy this precious time in your life. Producing a new addition to the family is a miracle; so enjoy those special nine months of pregnancy.

Sources: W24Financial Mail 

This post and content is sponsored, written and provided by Hippo.

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