Planning to start a family? Before grabbing those prenatal vitamins or sorting through name books, one step that often tends to be neglected is ensuring you have sufficient cover for your maternity journey. In keeping with Women’s Month, we aim to empower women with information so that they may choose to control their own health journeys. Understanding how maternity benefits come into play, and why timing really matters, can save you much distress and expense down the road.
1. The hidden truth about maternity benefits
A lot of women assume that medical aid will automatically cover their pregnancy costs. The truth of the matter is, if you apply for medical aid while already pregnant schemes will not pay for any maternity expenses, including antenatal visits, scans, hospital stay, and your delivery, because you will be assigned a waiting period of 12 months.
This is to prevent people from taking out medical aid only when they need expensive treatment. Now is the perfect time to start making arrangements. MedXpert will help you understand your current maternity benefits and assist with requesting an upgrade, where possible.
Upgrade requests outside of the annual benefit review period can be made in the case of a “life-changing event”, however the approval of such requests is at the discretion of the scheme. While pregnancy is typically considered a life-changing event, most schemes will require a formal motivation for an upgrade request, which the scheme will review and approve or reject.
2. What to expect from a good maternity basket of care
Not all maternity benefits are designed the same. While reviewing your present medical aid or thinking of joining one, keep an eye out for the following attributes that go into a good maternity basket of care:
- Antenatal visits and routine scans
- Labour and Delivery (natural or caesarean delivery)
- Hospital accommodation and professional fees
- Midwife access, should you want a more natural or home-based birth
- Postnatal care and baby’s early check-ups
According to the scheme’s policy documents, or depending on the advice of a medical aid, one may get an exact idea of what is covered and the possible out-of-pocket cost involved.
3. Where does health insurance fit in?
Health insurance and medical aid are separate things, and it does make a difference when planning for pregnancy. Some health insurance policies may assist in covering certain maternity-related expenses (such as doctor visits or lump sum benefits); however, they usually do not cover hospitalisation or labour and delivery expenses the way medical aids do.
If your sole protection is health insurance, make sure to ask exactly what is covered and what is not before assuming that these big-ticket items are included in your coverage.
It is also important to keep in mind that a lot of insurance providers impose their own waiting periods when it comes to maternity benefits, and it isn’t necessarily subject specifically to pre-existing pregnancy.
4. Can I choose a hospital plan over a traditional medical aid plan?
You can. However, it does depend on what you need.
Hospital plans are designed to cover big events, like giving birth in hospital, and don’t always cover a comprehensive start-to-finish journey. Most medical scheme plans have a maternity programme built into its make-up and this programme defines what benefits you can expect throughout your pregnancy. While these benefits aren’t classified as day-to-day benefits (which are the kind of benefits that hospital plans typically don’t cover), your hospital plan’s maternity programme may not be as comprehensive as it could be on a different kind of plan.
That said, some options like Bonitas’ BonEssential Hospital Plan do include a few maternity and child benefits. The most important thing? Knowing what’s actually included before you commit.
5. How to choose or switch plans wisely
Already on medical aid? You might be able to upgrade your plan within the same scheme. That makes reviewing your current option a smart first step. If you’re not on medical aid at all, joining now means you’ll likely need to wait a full year before any maternity benefits kick in if you are already pregnant. That’s why early action is key. Planning ahead gives you time to research, compare plans, and avoid rushed decisions under pressure.
6. If you’re thinking about pregnancy, start now
There is no “perfect” time to have a child, but there is an ideal time to initiate cover preparations, and that time is prior to conception. Even if you are considering having a child within the next year or two, it would be worth looking at your medical aid options now. Pregnancy is not just about nine months of childbirth; it starts from the initiation of any act leading to parenthood.
7. Final message: Know your benefits before you need them
Maternity cover is not only about paperwork and policies, but also about peace of mind. Reducing surprises and stress ahead of time translates into a smoother ride as you embark upon parenthood. Take control today.
Review your current medical aid, speak to an expert, and find out what your options are, before you see those two pink lines. Alternatively, fill in the form via the link below and one of our MedXpert advisor will contact you.