Unlocking The Full Value Of Maternity Benefits On A Medical Scheme

I’m your host Lincoln and today we have a special focus on maternity benefits. Joining us today from Medihelp medical scheme, Charnette Steynvaardt, a business development officer, and Catherine Gay, who is a clinical risk specialist from FedHealth Medical Scheme. They will shed some light on how these benefits work and how you can make the most out of them. Welcome, ladies.

Thank you. Thank you very much.

Well, just to give you a bit of an introduction. Maternity benefits are an essential aspect of medical schemes ensuring that expectant mothers receive the necessary care during pregnancy and childbirth. However, understanding the intricacies of these benefits can be challenging for the average consumer. Today we aim to identify maternity benefits and provide you with the knowledge to navigate this important aspect of your medical scheme. Now, Charnette, in terms of question one, we all know that this can be a very exciting time for expectant moms. Also, a lot of reasons why particularly ladies want to join a medical scheme for the first time because of what maternity benefits can be offered by a medical scheme. Could you explain what maternity benefits are typically covered by a medical scheme? And what specific services and treatments members can expect to receive during their pregnancy journey?

Yes, what a beautiful time for a mom to have a new-born. With all medical schemes, it’s very important that you know there’s a benefit basket for mom and a benefit basket for baby. So, for mom, you look at antenatal and postnatal consultations and those might vary from scheme to scheme, but it’s an adequate amount that you can utilise for either your GP or if you prefer a gynaecologist, or then also a midwife.

So, these are nice things to consider, you have options. There’s alternatives and we want mom to be in a safe environment. Then other than that, we also offer two consultations after the birth of the baby where the baby can then either see a lactation specialist which makes it easy for mom. Remember for a new mom it’s always a challenge and we all know that the best way for baby is to be breastfed. So yes, that is important, or mom can see a dietician or attend an antenatal class. So yes, there’s various options for mom and then 2D sonars, which are very important so that they can track baby’s growth and development. That’s mom’s basket. And then looking into baby, the new-born at Medihelp, you register on a platform which is called our Health Print, it’s a Wellness Program. And via that platform, you will then be able to access all kinds of tips and healthy information that mom can use for baby, as well as a lovely baby book that will be sent to mom for some bedtime reading. Baby then will qualify for consultations to see the progress via a GP or a paediatrician, or ENT which is an ear, nose, and throat specialist. And remember now, new moms, these doctors can make a huge difference in your life if babies are well looked after. So, yes, very important. Secondly, is the vaccines that baby needs up till the age of six years. So, for baby, you can have consultations to see the development and growth as well as a vaccination program for baby. Thanks Lincoln.

Wow, that’s quite comprehensive and I think well answered. Thanks, Charnette. I think it’s important to know that medical scheme offers members the security to know that for mom and baby they’ll have the services they require to make the transition easier for them. But also, that emotional attachment, you want the best for yourself and for your baby, especially for a first-time mom. I’m sure for all your kids. I find it quite interesting. They say when you have more than one child, the first child, what you normally you sterilise everything, you put the dummy and you sterilise it. When it comes to the third child, you ask the dog to lick the dummy already. So, it’s nice to know that you have all these kinds of benefits, it’s available to members as well.
Coming to FedHealth, I just want to ask you Catherine, now many medical schemes offer prenatal consultations as part of their maternity benefits. Could you elaborate on the importance of these consultations and what members should expect during these visits? And then how can you make sure you get the most out of these appointments?

Thank you for the question, Lincoln, I’m going to take it right back and the English language is just about as miraculous as childbirth, but maybe we just need to define prenatal, antenatal, and postnatal because I think that’s an important place to start. So prenatal and antenatal is the same thing that is the pregnancy journey before your child is born, postnatal is after.

So, when we talk prenatal and antenatal, we’re talking the same thing so that we’re all on the same page. These are the prenatal consultations that are critical. Firstly, to understand and to meet your gynecologist, that person is walking a journey with you. And if you’re going to have multiple children, you’re going to know your gynae.

So, if you know that you’re going to be planning a family soon, make sure that your choice of gynecologist, your choice of hospital is somewhere that’s convenient, close to home and preferably understand your options with your medical scheme to make sure that there are no network restrictions. We don’t want anybody picking up any unwanted or surprising co-payments along the way.

Discussing your birth plan with your gynecologist is an important thing that you can expect to have in these consultations. Also, important to talk about, and maybe we can touch on it later, is the fact that a birth plan doesn’t always go according to plan. And antenatal classes, doula benefits FedHealth does offer a benefit for a doula which is like a wing woman. Those people need to be there to help you in the times when you have a firm plan that then goes a bit south. There are different options. Scans to check the position and the growth of the foetus. These are important and something you can expect during those consultations. Your gynae will take you through what to expect and discuss any issues or potential problems that they see along the way so that you can address them upfront in your pregnancy, making the most out of these appointments. Obviously, knowing your medical scheme is important.

If you don’t know your options, effectively, you have no options. So, understand your medical scheme, understand your options. Fed Health offers members the ability to buy up within 30 days of a life changing diagnosis. I think we’ll all agree, falling pregnant is a life changing diagnosis. So, if you do need to change medical schemes during the year FedHealth does offer you that opportunity. FlexiFed two and above is a great option if you are planning a family. There are enhanced maternity benefits where you get the peace of mind that private medical care will be there to support you through your journey. If you’re able to take your partner along with you to these appointments, let them be part of it because I think it’s important, they’re not carrying this child, but they are very much a part of the journey.

Share the special moments, let them see the scan, listen to the heartbeat, and see those kicks. It is something quite special. Keep a running list of the questions you have in your head on your fridge because I promise you when you sit down there, your gynae has a limited time with you. I promise you there going to be questions that you wish you’d asked. So, while you’re pregnant, keep that running list on your fridge, have a chat, take it along to your consultation to ensure that you leave your consultation with all the answers that you came for. Also arriving early at your gynae is important. Often or almost every consultation they will test your urine to see if there’s anything they need to pick up. Allow time for that and provide the sample so that so that everything can run on time. Thanks Lincoln. I think that’s all I can think of right now.
I think it’s comprehensive.

Nice to know that there. You were talking about taking your partner with recently been through that journey. I can say that it does add to the whole experience being involved. It’s also nice to know that there’s a human experience with medical schemes too you mentioned as well, Charnette, by the book that you provided. I’m sure that comes in handy for moms too. The additional benefits we don’t really consider that you get on a private medical scheme, like you mentioned, the doula and stuff as well, which is really, important. So, it’s nice to know that you have that peace of mind with your medical scheme and like you say, just follow the correct procedures to enable you to utilise those benefits to the value of what they actually worth on a medical scheme.

Charnette getting back to you regarding the next question. So, maternity benefits offered include coverage for prenatal screenings and diagnostic tests. What are some of the common tests that members should be aware of? And how can these tests contribute to the overall health and wellbeing of both the mother and the baby?

Lovely. Yes, very important mom will have two 2D scans during the pregnancy. Now, 2D scans throughout the nine-month period, they will then obviously monitor baby’s heartbeat, the muscle tone, movement, and overall development of baby. During those scans, they will then be able to predict any kind of abnormalities. At that point in time, you and your partner can take it from there onwards. But basically, within the 2D scan period, it’s the overall development of baby.

Then obviously they can also detect whether it’s twins, triplets, or more babies. Then they determine the position of baby so that they know to plan if it will be normal birth or C section. And then lastly, it’s very important for mom to know that during these sessions towards the end, they will examine the ovaries and the uterus so that mom is also in a safe space going out of hospital. I think that’s in short, the importance of the scans, Lincoln.

I think also just to mention, and I’m sure it’s something that’s obvious, is that if a medical scheme offers you, let’s say 2D scans as a base, that you could obviously opt for a 3D or 4D scan and they would pay the price for a 2D scan. But those options are available to members on a private medical scheme. I think that’s quite important. And remember there might be an add-on fee to that. But if mom and dad want peace of mind or they would like to know if it’s a boy or a girl or something more detailed, then obviously 3D and 4D is lovely to see your baby.

Ok, Catherine coming back to you. So, we often hear about antenatal classes being offered by medical schemes. How can attending these classes benefit expecting parents? And what type of information and support can they expect to receive from these classes.

Thanks Lincoln. So, antenatal classes are important but not essential. There are lots of women around the world who give birth to children without having had the privilege of an antenatal class. But it does help. If you have the resources and the availability to attend an antenatal class, there are numerous benefits. The main one for me personally was just the community that I was able to hook up with during my antenatal classes.

My husband met fellow fathers to be, I met moms to be and we’re still friends today. Our children, some of them are in the same class at school in our area. For a first child, antenatal classes are just important to give the mother to be and the father to be, I suppose, an idea of what to expect. Also, the birth plan, to discuss options in terms of the risks and benefits of a natural delivery, home births or a Caesarean section.

There is no correct way to give birth. A healthy baby and a healthy mother at the end of the day is the aim and medical schemes understand that. On FedHealth, for example, we do pay for the hire of a water bath if you do want to give birth at home. But then it’s important that you discuss your options clearly and that you understand the risks and benefits associated with the choice that you are making. One of the most important aspects of antenatal classes is pretty much just imparting evidence-based information so that the parents to be, can understand their rights during childbirth.

Antenatal classes are also not the only way to impart information. I mean, at FedHealth, we’ve got antenatal classes, maybe I should go back a step. We recommend that antenatal classes are taken before week 26. There’s a lot that can be done and FedHealth runs a live healthy pregnancy workshop that we invite our mothers in that pre-26-week period to attend. They talk about nutrition, they talk about optimal exercise, hypotension, which is low blood pressure, is the common thing that we see.

Just advising on diet and how to exercise correctly to ensure that your blood levels remain stable during your pregnancy. With a myriad of services available to members, I think you just realise the importance. I think you don’t know what you don’t know. How often have we found in the industry you’d ask someone is this benefit sufficient for you? And they’ll obviously definitely say yes, but they haven’t had to utilise a benefit.

We want benefits when you join a medical scheme. But also, some of the human aspects that go along with the pregnancy, which are quite important too. And maybe I can just add there as well. Many medical schemes including FedHealth have based their option design on a life stage model. So, if you’re young and healthy and not planning to have children, you’re on the bottom option.

It’s important that as you grow, as your family grows, as your needs grow, that you choose and move options accordingly. Because if you don’t, you are going to be the only one to lose out.

If I could maybe just ask this question, how does one go about ensuring that if I were to become a member, or if I am a member of a medical scheme, that I can get access to the benefits? Is there a protocol that we must follow? Do you have to register to access this basket of benefits generally on Fed health?

If you know that you are pregnant and phone us to get your hospital authorisation, we then have specific codes that we pick up and we run algorithms in the background for example we’ve seen that patient X has gone for a pregnancy ultrasound.

There’s a high chance she’s claiming for folic acid, which is used pre-pregnancy so that you reduce your neural tube defects. We then contact those members. We also look very carefully with age as well. We have had some scenarios where we pick up a 70-year-old who the doctor coded an ultrasound for pregnancy incorrectly. That’s a clear error, but we will then contact the patient, we get them registered on our baby program, get them their hospital pre-authorisation, or discuss their options as well because if they are on an option that has a Designated Service Providers for the hospital or a specialist, obviously we need them to be aware that there will be a co-payment. The choice of doctor and the choice of facility remains the prerogative of the member.
If they are willing to pay a co-payment, should they choose to go outside of a scheme’s standard rules. But the choice lies with the member.

Charnette, before I get to the next question, maybe I can just ask you just in short, in terms of what you heard FedHealth. Now, their process, I would assume, is a similar process for most medical schemes.

Yes, absolutely Lincoln. There might be an individual baby program in case, we call it the health print and it’s a wellness program. So, mom will register and then you get all the nice tips, and they will remind you about a scan, a consultation, and baby’s vaccination schedule but pretty much the same.

Coming back to our next question. So, postnatal care is an important aspect of maternity benefits. Could you explain what this care entails and how medical schemes support new mothers during the postpartum period? What types of services or systems can members access?
I think this is quite an important one because like you’re saying, things don’t always go as you expect at times, and you want to know what is available to you as a member. Postnatal care can be very crucial at the beginning stages of baby’s life and especially the period after the delivery of baby.

Now, the postnatal care includes the routine clinical examination and observation of mom and baby. As we also mentioned in the beginning, it’s very important to look at mom and baby after pregnancy and we allow two postnatal consultations for mom. Now, the postnatal, most moms utilise this for the lactation specialist. Remember just for those of you who are new moms, it’s a private nurse who specialises in the care of baby lactation. So, it’s very important. First time moms do struggle with breastfeeding, and they don’t always know the tips and the tricks. So, to get baby latched from day one, the correct way, without hurting mom, and to get the most out of the feeding time, you need to know a little bit more.

So, it’s very important that both mom and baby be very comfortable during the specialist sessions. So, breastfeeding consultations do really help as specialists in this field, and they will assist moms with the guidance. And then as a more myself, I would like to say, trust your instinct, and just love your angel most of all. Then you can have a smooth experience going forward, enjoy your little one.

And I agree, and I can also add, being a father, I seem to know a lot more about lactation and breastfeeding and how to latch. So, like you’re saying, there’s a lot of other aspects that come along with it too. Thank you, Charnette for that answer there.

Now, some medical schemes offer additional benefits as you mentioned now, as breastfeeding support, lactation consultations, or even baby wellness programs. Could you elaborate on these additional benefits and how they contribute to the overall health and wellbeing of both the mother and baby Catherine?

Thanks Lincoln. Firstly, I just want to say that people generally consider a pregnancy to be three trimesters. It’s four trimesters. So, the three months after the baby is born is still considered part of the intimate pregnancy journey and we were learning a lot during that time. It’s not easy and I think there’s lots of celebration while someone’s pregnant. There’s excitement. There’s a baby shower, there’s the pictures, the tummy growing, everybody gets excited.

Then you have this baby, people will pop in hospital and then you get home and then it’s like “is there anybody out there?” and I think medical schemes want their patients to know that yes, your medical scheme is out there. We’ve got your back as FedHealth. We have a baby program where a professional will, in the prenatal stage, send you a baby bag when you register on the scheme. The Doula benefit, I’ve also alluded to earlier on where you’ve got your wing woman, and that doula benefit is important just to have someone who’s got your back.

Phone them up in the middle of the night, say I’m not coping I just need to sob because I don’t even know why I need to sob. But someone who’s there and a person to you, I feel like that’s been my job of recent. Some of the other things that certain medical schemes offer FedHealth included is we have a 24-hour nurse line. So, you can, if you’re in the middle of the night at 2 a.m. and you don’t want to get to the doctor, you can phone that line to give you some peace of mind or some guidance.

If you have any queries related to your child’s health, even your own health, maternal health as well, they will assist you. And then most importantly, and a topic that’s not touched on sufficiently in my mind, is postnatal depression and support for the patient and the mother and possibly even the father who is finding themselves in a very difficult space. FedHealth does offer support in the mental health space. We’ve got a lovely app via the Panda app where we connect you with other mothers in a support group in a community just to lift you up and pull you through.

So, I mean, if the message is one thing, we want our patients and clients to know that medical schemes are here when you need us. You phone, and we will find a solution to support you. Thank you.

I think it’s encouraging because I don’t always think members really see that. So, I think it’s important that you raise that, because many times members do see some of the benefits they are getting. I think by richly explaining the benefits that we can offer to members it gives them the reassurance to know that we are there to support them in their time of need as well.

So, is there anything more that you feel that you would like to add to the conversation that we may have necessarily missed? That wasn’t mentioned that you think could add value to anyone listening, whether it’s a prospective member or a member of a medical scheme.

Just maybe to summarise, we’ve covered a lot of information just in brief overview points, but I want to tell potential moms or parents’ medical scheme will look after you and your well-being and baby’s well-being. So, we’re going to be there for you.

It could be an uncertain period for couples, or life is busy and expensive, but pregnancy is the best miracle you can ever experience. So yes, from a medical point of view, medical schemes are there to look after you and baby during this very special time.

Agreed it is a special time. Thank you, Charnette. Catherine coming back to you, just as a final sort of point on this, is there anything you feel will be add value in terms of just ending the conversation you’d like to add to this?

I’d like to just add that that medical schemes have benefits. We have brochures, but we also know that there’s a family and a real person at the end of the line. There are exceptions that are made. There are exceptional circumstances. Often things don’t go the way that we had planned. Just know that medical schemes have a human heart as well and maybe also to mention, register your baby when they are born on the scheme.

Right ladies. Thank you so much. Thank you, Catherine. Thank you, Charnette, for your expertise today on this topic.