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Maternity Medical Aid

WE WILL FIND YOU THE BEST MATERNITY BENEFITS

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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

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Maternity and your
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 if medical expenses might be covered immediately when already pregnant?

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

Medical aid and medical insurance offer very different levels of maternity protection. Medical aid, regulated by the Council for Medical Schemes, provides comprehensive maternity benefits that typically include antenatal consultations, ultrasounds, hospital births (including emergency C-sections), and neonatal care, all subject to pre-authorisation and scheme rules. Many of these benefits fall under Prescribed Minimum Benefits (PMBs), which schemes are legally required to cover. In contrast, medical insurance (or health insurance) is a short-term insurance product that pays fixed amounts, such as a daily hospital cash benefit or a lump sum for childbirth. These plans are not required to offer maternity cover, although some include limited benefits like a few doctor consultations or basic radiology and pathology services; however, they generally do not cover complications during delivery or neonatal care. Medical insurance also applies its own underwriting, which may vary in length but cannot exceed the Medical Schemes’ 12-month waiting period. While medical insurance can provide some financial relief, it does not cover the full cost of private hospital care and should not be seen as a substitute for medical aid.
All medical schemes, even if you are 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. For more detailed information on maternity cover you can depend on MedXpert to provide the clarity you need
Hospital plan cover for pregnancy generally includes the in-hospital part of birth (normal or caesarean), approved emergencies, theatre, and ward fees at network hospitals. Routine antenatal consultations, scans, and blood tests are usually not included unless the plan has day-to-day or a dedicated maternity benefit. Expect pre-authorisation, designated service provider rules, and possible co-payments if you use non-network facilities.
The best time to get cover is before conception because one type of waiting period that exists is a condition-specific waiting period (12 months), and this will apply to any condition that exists before you take out the medical aid including a pre-existing pregnancy. If you conceive after you join the medical scheme then no waiting period will apply to your pregnancy. Changing Schemes can also trigger waiting periods or pro-rated benefits. If no waiting periods apply to your pregnancy, you can register your pregnancy with your medical scheme after week 6 to activate your maternity programme – if your plan has one – so that you can be covered for delivery and benefits such as antenatal consultations and ultrasound scans. Registering your pregnancy will also allow you to determine which networks and designated service providers you should use to make the most of your benefits.
Getting maternity health cover when already pregnant is difficult because schemes apply waiting periods to pregnancy and birth-related claims. This is a rule that all medical aids adhere to and follows the regulations set forth by the Medical Schemes Act. You can still join for future needs, but maternity claims are excluded during the waiting period. If you do join after falling pregnant, your baby will be covered at birth for any unforeseen procedures.
Most medical schemes provide maternity benefits under both hospital (major medical) and out-of-hospital (day-to day or additional benefits). Many schemes also include postnatal check-ups and a new-baby registration process within a set timeframe. Certain schemes require your baby to be registered within 30 days while others allow for a longer period of 90 days. Be sure to familiarise yourself with your scheme’s ruling to ensure that you register your baby in time. For more detailed information on maternity cover, you can depend on MedXpert to provide you with the clarity you need.
Depending on your medical aid, your maternity registration process will differ, so be sure to consult MedXpert about the specific process you need to follow. You can, however, call the scheme and state that you would like to register your pregnancy. The consultant will ask you for your ID number or your membership number and then they will ask you a few questions to verify your identity. The medical aid will ask you for your pregnancy test results, be it a blood or urine test, as long as the confirmation comes from a doctor. Based on the results, the medical aid will be able to get an idea of period of conception as well as an estimated due date for the baby. The medical aid will usually request that you choose a specific GP/Gynae/Midwife to assist you throughout your pregnancy, and they will provide you with information concerning your designated service providers and your maternity benefits.
Prenatal consultations under maternity benefits usually include GP, midwife, or obstetrician visits according to a schedule in line with your trimesters (the frequency of visits typically increase as your due date approaches). Cover depends on your plan design: some pay from a maternity bundle, others from savings/day-to-day. Using network providers reduces out-of-pocket costs. Keep all invoices, scripts, and proof of payment (in the event that you paid upfront), and obtain pre-authorisation, for specialist consultations, where required by your scheme, and any planned procedures.
Most medical schemes include prenatal check-ups as part of their maternity benefits. Depending on your plan, this may cover a set number of doctor or midwife visits, standard scans, and routine pregnancy blood tests. During each visit, your provider will track your health and your baby’s development, check for any early warning signs, and answer questions about your pregnancy. Some schemes also require using specific network doctors to avoid extra costs, so it’s important to confirm how your plan works before booking your appointments.
Maternal mental health support within maternity benefits can include screening/s for perinatal and postnatal depression, a set number of counselling sessions, referral pathways to psychologists or psychiatrists, and 24/7 nurse or counselling helplines. If you experience persistent low mood, anxiety, or intrusive thoughts, contact your provider or emergency line and request an in-network mental-health referral.
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 in-person or online pregnancy workshops, and community support through apps. These benefits contribute to the overall health and well-being of both the mother and the baby.
Another valuable tool for your maternity journey is gap cover, as some plans offer maternity lump sum benefits as well as cover for private wards or extended hospital stays – this can be very helpful because most plans only cover a three day stay. Some medical aid options will also help you get your health back on track after birth by offering dietician and counselling consultations.
Medical schemes like Bonitas Medical Fund, Discovery Health Medical Scheme, Medihelp Medical Scheme, and Momentum Health Medical Scheme have various benefit options that give expectant mothers a variety of benefits for their maternity journey. These benefits include the number of antenatal/prenatal classes and consultations that are available, the range of pathology and radiology benefits, and childbirth options covered by your plan. Certain plans give midwife and doula benefits and allow for home and water births, while other plans specify that the birth should be in-hospital. Your plan might specify that a planned caesarean won’t be covered so be sure to familiarise yourself with the birthing options available to you. It’s also important to note that some plans only allow for birth in a general ward, whereas more comprehensive options will allow for private rooms.

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