Pensive pregnant woman holding her pregnant stomach

Maternity Medical Aid

WE WILL FIND YOU THE BEST MATERNITY BENEFITS

Are you looking for maternity medical aid cover or health insurance plans for pregnancy? Or maybe you’re looking for something more specific, like what medical expenses will be covered immediately when already pregnant?

WE CAN HELP YOU TO FIND MATERNITY COVER THAT BEST SUITS YOUR NEEDS.

Are you looking for maternity medical aid cover or health insurance plans for pregnancy?

FREQUENTLY ASKED QUESTIONS

All medical schemes, even if you are just on a hospital plan, cover child birth. The actual birth of the child is one of the biggest expenses you will have during this process. The cover for birth is robust, meaning you will not normally need extensive out of hospital benefits to ensure the most important pregnancy medical expenses are covered. This will include medical expenses for the gynae visits, GP or midwife consultation expenses. The expense of 2D sonars to monitor baby’s growth is also covered by your medical scheme.

Medical schemes like Bonitas, Discovery, Medihelp and Momentum have benefit options that allow expectant mothers to choose their preferred gynaecologist and the hospital where they would like to give birth. The birth plan, antenatal classes, pregnancy check-ups and childbirth options can be discussed with the gynae. To ensure you make the most of the pregnancy expenses paid by your medical scheme, familiarise yourself with your medical scheme benefits as well as the contracted gynaecologists used by your medical aid. Need assistance?

Most medical scheme options will include 2-Dimensional (2D) ultrasound scans to monitor the baby’s health. Ultrasound scans during pregnancy provide information for best planning the baby’s birth and helps the doctor’s to:

  • Check the baby’s growth throughout the pregnancy.
  • Find out if there is more than one baby.
  • Check and confirm the due date.
  • Confirm the sex of the baby. This can also be left as a surprise for parents if they so choose.
  • Look at blood flow patterns and find out the position of the baby.

Some medical schemes may offer 3D and 4D scans at an additional cost.

Antenatal classes provide a sense of community, information on childbirth options, and access to knowledge shared by experts about pregnancy, based on studies and facts. These classes help parents-to-be understand their rights during childbirth and may cover topics such as nutrition, exercise, and hypotension. While not essential, antenatal classes offer valuable support and information.

Postnatal care includes routine clinical examinations and observations of both the mother and the baby. Medical schemes may offer postnatal consultations for lactating (breastfeeding) specialists. Some schemes provide 24-hour nurse lines, telephonic triage (medical advice to determine if the baby needs urgent medical attention), and support for postnatal depression. Understanding available benefits and support is crucial during the postpartum period.

Additional benefits may include a baby program. Timely registration to the baby program provides access to additional benefits like doula support, 24-hour nurse lines, telephonic medical advice, and support for postnatal depression. Some schemes offer baby bags, live healthy pregnancy workshops, and community support through apps. These benefits contribute to the overall health and well-being of both the mother and the baby.

Members can access maternity benefits by registering for specific programs offered by their medical scheme. It’s essential to understand the options, cover, and any potential co-payments. Members should contact their scheme for hospital authorisation and follow any registration processes to ensure seamless access to benefits.

Maternity benefits are designed to support and care for both the mother and the baby during this special time. It’s crucial for members to be informed, proactive, and aware of the available resources and support provided by their medical scheme. Medical schemes are there to assist during the entire pregnancy journey, and exceptions and support are available for unique circumstances.

Some medical schemes offer support for postnatal depression through mental health programs and apps. These may include access to support groups, counselling services, and 24-hour helplines. It’s important for new parents to be aware of these resources and seek help if needed to ensure their mental well-being during the postpartum period.

Pensive pregnant woman holding her pregnant stomach

We have helped thousands of South Africans to find the right medical aid or medical insurance cover at the right price.

useful articles and resources

Medical aid claims

WE WILL HELP YOU WITH YOUR CHRONIC COVER

WE WILL HELP YOU TO FOLLOW
UP ON UNRESOLVED CLAIMS

Whether it’s Discovery medical aid claims, Bonitas claims queries, or any other open medical aid claims, we can assist you with following up and finding out why your claim is taking so long or is not being approved.
Name:

Frequently asked questions

To claim back from medical aid, submit an itemised invoice with ICD-10 and tariff codes (and a valid script where required) via your scheme/app portal or email. Ensure the claim reflects the exact name and details on your scheme membership, and that bank details are for the main member unless otherwise approved. If you already paid the invoice at the practice, then you need to provide proof of payment to the medical aid so that they know to reimburse you directly rather than paying the provider.
Medical aid claim documents typically include an itemised invoice, ICD-10 and tariff codes, proof of payment (if reimbursing you), a valid script for medicines, and any pre-authorisation letter for hospital or specialised procedures.
Medical aid claims tracking is available in your scheme/app portal under Claims or Authorisations. Check status updates, remittance notes, and any requests for documents. Turn on notifications to respond quickly and avoid delays.
It is best to submit your claim as soon as possible, even if you might be missing some supporting documents. It’s not unheard of that situations arise where a member waits for all the relevant documents and information before submitting their claim, but by the time they’ve gotten everything, the window to submit claims has passed. It’s essential that you submit all claims within a four-month window after the date of service (the date that you went for your treatment). After that four-month window, your claims will be considered “stale” by the medical aid and they will reject payment for the claim. It is also recommended that you submit claims to the medical aid, even if you know that they won’t cover the cost (because your savings have run out or the benefit is depleted) because this will contribute towards the tax certificate you receive from your medical aid.
Medical claim types are usually provider claims (doctor/hospital submits directly) and member claims (you submit and are reimbursed). Plans also distinguish in-hospital vs out-of-hospital claims, each with different rules and limits.

JOIN AS A MEDXPERT USER FOR FREE AND UNLOCK SOLUTIONS TO ALL YOUR MEDICAL AID QUESTIONS ALONG WITH THE ABILITY TO COMPARE HEALTH COVER BENEFITS