Medical aid for pregnant women

Medical aid schemes pay the medical expenses for their members, whose monthly payments, known as premiums, are pooled into a collective pot for this purpose. There are around 124 different medical schemes available in South Africa, which work as a kind of insurance to protect their members from the risk of facing medical expenses too great to be paid out of pocket. Regulated in South Africa by the Medical Schemes Act (1998), they are effectively non-profit organisations, each with an elected board of trustees.

It's vital to investigate the coverage your medical aid provides at the start of your pregnancy, to find out exactly what you're entitled to under your current plan.

If you're not enrolled in a medical aid scheme when you become pregnant, the pregnancy and birth would most likely not be covered by joining a new scheme, due to the waiting period most plans have for new members. However, once born, your baby would be covered by this new plan.

Some schemes have a dedicated pregnancy programme, offering things like round-the-clock medical advice from a doctor via your mobile device, a pregnancy health record, a cost calculator, and a useful digital card to keep track of your baby's vaccinations. It'll usually include a baby bag with some useful items in as well.

If you are already a member of a medical aid scheme when you become pregnant, you'll have access to the out-of-hospital maternity benefits even before you've advised your medical aid provider of your pregnancy.

Just make sure your doctor puts the right ICD-10 codes on your claim so it's processed correctly. There may be some maternity benefits available, on top of savings and day-to-day benefits, and this can help you get all the support you need during your pregnancy while reducing your upfront costs.

You'll need to contact your medical aid scheme to pre-authorise the delivery of your baby, which you can usually do from 20 weeks. It can help you get to know exactly what benefits your scheme offers to take advantage of everything that's covered. You'll also likely receive a baby bag at this time, to help you to prepare for the arrival of your baby.

When your baby is born, you should register them with your provider, usually within 30 days of the birth, to ensure they are covered from the start and there is no break in coverage.

It's recommended that you use a Designated Service Providers (DSPs) for your appointments and birthing hospital, as these are arranged with special rates by your scheme, and will get you maximum value from your coverage and help you avoid co-payments.

Different schemes offer varying benefits, but you should expect to have the following appointments and tests covered:

Antenatal consultations - Up to 12 consultations with your gynaecologist, midwife or GP.

Ultrasound scans and prenatal screening - Up to two 2D ultrasound scans and one nuchal translucency or Non-Invasive Prenatal Testing (NIPT) screening (subject to meeting the clinical entry criteria).

Blood tests - A number of blood tests during each pregnancy.

Pre-and postnatal care - Up to five pre- or postnatal consultations or classes with a registered nurse during the two years after birth.

There is a range of medical schemes in South Africa that offer differing levels of cover for varying costs. Many of the main providers have schemes that cost under R1000 per main member each month. With income-based schemes, the cost of membership is proportionate to your income, which means some cheaper levels of coverage are not available to higher earners.

By choosing to compare medical aid plans, you could save money on medical aid costs by finding the right plan for the coverage you personally need.