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Hospital Plan Medical Aid for Pregnancy and Childbirth

There is no medical aid in South Africa, whether full comprehensive cover or just a hospital plan, that covers a women who is already pregnant for the upcoming pregnancy and childbirth costs. Right up until 2007 and 2008, a few restricted medical aids would consider waiving this policy in certain instances. Unfortunately this is no longer the case and unless there is mitigating circumstances, pregnant women have to pay cash for their pregnancy and childbirth bills. Hospital plans may be cheaper and offer lesser cover but this does not mean that standard medical aid policies will change for these plans.

Already Pregnant Women

The biggest costs of any pregnancy is childbirth. Labour and delivery means spending time in hospital and requiring the services of specialists like a gynaecologist and obstetrician as well as a paediatrician for the baby. Even after giving birth, both mother and baby will need to remain in hospital for at least a few days. Private hospitals in South Africa are expensive and generally unaffordable for most citizens. This is where the hospital cover is most appreciated in medical aid cover. However, a hospital plan will not pay for the childbirth costs for a woman who is already pregnant at the time of joining and there is no way to work around this scheme policy.

No Waiting Period

There is a general 3 month waiting period for all new members of a medical aid. This applies to hospital plans as well. In this time, the scheme will not cover any medical bill except in certain emergency cases. Pregnancy-related complications are not covered if the member joined while she was pregnant. The other waiting period, more correctly known as an exclusion period, is for one year during which the costs of any pre-existing ailment from the time of joining is not covered. Essentially pregnancy is considered to be a pre-existing condition, although it is not a disease, and is therefore subject to the one year waiting period. The only time a no waiting period applies is when a medical aid member switches from one scheme to another, without terminating their membership in between.

Childbirth and Delivery Costs

Some women opt for home deliveries or in clinics with midwives where they may be able to have a water birth. These bills are also not covered by a hospital plan medical aid if a woman joins when already pregnant. Therefore women who think that their medical aid will consider pregnancy and childbirth cover by opting for facilities that are technically not a hospital are mistaken.

Opting for a home delivery may be cheaper but it is important for mothers to realise that should complications arise, then hospitalisation for both mother and baby will be necessary. Once again, these hospital costs will not be borne by any medical aid hospital plans. However, the baby can still benefit from hospital plan cover upon birth even if the mother joins when already pregnant.

Immediate Cover

There is sometimes a misunderstanding about medical aid policy. Firstly there is no immediate cover for pregnancy and childbirth costs if the member is already pregnant. But this does not mean that a pregnant woman cannot join a medical aid and opt for a hospital plan. In fact women are encouraged to do so. Firstly, he hospital plan does cover the pregnant women but just not for the pregnancy and childbirth costs for that pregnancy only.

Secondly, the newborn baby will be covered instantly upon birth thereby providing protection for the parents should there be costly bills like neonatal ICU hospitalisation. Therefore pregnant women should not be short sighted and shun medial aid cover simply because it is not covering their pregnancy and childbirth hospital costs immediately. Ultimately they disadvantage themselves and their newborn baby in the future.