Maternity benefit
You may have many questions about your pregnancy, one of them being “How does my medical aid cover my maternity benefits?”.
You can read this page to find out more about how we cover pregnancy and childbirth.
Day-to-day benefits
Scans
These will be covered as per the out-of-hospital radiology benefit.
Other benefits
Consultations will be paid from your normal out-of-hospital benefits for general practitioners and specialists. Blood tests, non stress tests and amniocentesis, will pay from your day-to-day benefits subject to funds and available limits.
Hospital cover
Cover for having a baby
Before you go to hospital for any planned procedure, you must:
- See your doctor
- Authorise your hospital admission with us beforehand as hospital cover is not automatic. You must authorise your admission to hospital at least 48 hours before you go in (we advise that this should be done as early as possible in your pregnancy).
We need to know so we can manage your costs in the best way and give you information that is relevant to how we will cover your hospital stay.
Costs related to childbirth
We cover childbirth from your Hospital Benefit. Your Hospital Benefit covers your hospital account, internal medical devices and emergency medical services.
Hospital cover includes home births done by midwives with valid practice numbers and who are registered with the Board of Healthcare Funders. You must let us know 48 hours before your hospital stay.
Caesarean sections
We cover a stay of four days and three nights in hospital.
Normal vaginal deliveries
We cover a stay of three days and two nights in hospital.
Make sure your baby is covered
Your baby gets cover for the calendar month of his or her birth. To make sure there is continued cover, you must pay contributions for the baby from the first month after the baby's birth. Newborn application form.
- Example: A baby is born on 3 March. The mother is registered on the Fund. The baby gets cover until 31 March. If the baby needs cover from 1 April onwards, he or she must be registered on the Fund.
The Medical Schemes Act allows 30 days from the date of birth for the parents to register the baby with the Medical Scheme.
The baby may be subject to underwriting, if he or she is not registered within the 30-day period and may therefore not enjoy uninterrupted cover.
The baby may be subject to underwriting, if he or she is not registered within the 30-day period.
We may not pay for your treatment in full
Cover is subject to our rules
Once we authorise your hospital admission, we may not pay for the treatment in full. Your cover is according to the Fund rules, funding guidelines and clinical rules. There are some expenses you may incur while you are in hospital that the Hospital Benefit does not cover, for example private wards. Certain procedures, medicines or new technologies need extra authorisation while you are in hospital.
The following in-hospital expenses are not covered by the maternity programme:
- Mother and baby packs supplied by the hospital.
- Lodger or border fees.
- Home nursing related to this procedure will not be covered.