Pregnant or planning a family? 3 things you need to know about maternity benefits on your medical aid

Pregnant or planning a family? 3 things you need to know about maternity benefits on your medical aid

– Tanya Motlafe (Director, Cornerstone Healthcare Consulting Services)

May is Mother’s Month and most moms will agree that few things in life are as exciting as the adventure into motherhood. Unfortunately, the medical costs surrounding pregnancy and birth can be exorbitant and sometimes, maternity benefits on medical aid plans can be frightfully difficult to understand.

To help you out and ensure that you can focus on your health and your baby’s wellbeing, Cornerstone Healthcare Consulting Services has summarised some of the most important things to remember and lookout for when you need the maternity benefits on your medical aid. For in-depth advice and expert guidance on all things medical aid, be sure to contact us today and find out more about our bespoke services.

Does your medical aid or option plan cover antenatal consultation for full pregnancy term? Some medical scheme offers cover pregnancy benefits from risk not your day-to-day benefits. If your medical scheme offers the benefit, this is what you need to do.

You must register for pregnancy/maternity benefits, for your antenatal claims to processed from risk.

A big misconception among expecting mothers, is that maternity benefits are covered by default on their medical aid plans. In order to make use of maternity benefits, you must register for them. This is a very simple process and usually only requires you to fill in an online form or contact the scheme. The process differs from scheme to scheme so it’s best to contact your broker if you need help with registering for the benefits.

During pregnancy, the pregnancy benefit should cover of the following minimum:

  • Antenatal consultation – midwife/gynaecologist
  • Certain blood test
  • Scans – 2/3D scans

Don’t have a broker? You’re seriously missing out! Click here to contact us.

Preparing for Childbirth / delivery

A hospital authorisation must be requested by the member or through a broker as per the information from the gynaecologist. The following information must be provided in order to obtain authorisation.

  • Hospital name or practice number
  • Doctors practice number
  • ICD 10 code and procedure codes
  • Date of delivery

The authorisation must be request as early as possible after the second trimester. Requesting the authorisation early doesn’t only give you peace of mind; but preparing you of any shortfalls and confirmation of cover.

After birth, your new-born must be added as a dependant on your medical aid

Although many post-natal treatments and procedures will be covered from your maternity benefit, your baby won’t be added onto your medical aid as a dependant automatically. In order for your baby to receive the most appropriate cover, you will need to register him or her as a dependant as soon as you can.

In order to do this, you will need to contact your healthcare broker or your scheme directly and request a new dependant to be added. You will have to fill in an application form and send it to the scheme along with your baby’s birth certificate.

Your maternity benefits and the level of cover depends on your chosen plan

This is vitally important. Make sure you know what maternity procedures, treatments, medication etc. you are covered for and what limits apply to these levels of maternity cover. Each medical scheme is different, and each benefit option is different, so in order to avoid unexpected bills, make sure you understand your maternity benefits. Some of the most important things to look out for:

  • Network hospitals

If your current benefit option makes use of network hospitals only, it’s imperative that you check whether the hospital you are going to deliver your baby at, is on the list. If not, you will have to pay a large co- payment before you are admitted. Therefore, always try to make use of hospitals within your current plan’s network where possible.

  • Cover for specialists

During and after pregnancy, you will most likely need to visit a variety of medical specialists. Specialists often charge private rates and can be very expensive. Therefore, check if you have cover for specialists and if not, consider taking out Gap Cover to recover some of the shortfalls.

Click here to read more about Gap Cover and why it’s a no-brainer

  • Waiting periods

If you join a medical aid after falling pregnant, your pregnancy will count as a pre-existing condition and you will not be covered for anything relating to your pregnancy. Unless you are joining through an employer group that has a free underwriting status. That is why it’s so important that you join a medical aid long before you fall pregnant to ensure you are fully covered.

Did you find our article helpful? Please let us know of our Facebook page by clicking here. You can also find us in LinkedIn and Twitter. To get more great content like this delivered directly to your inbox, be sure to subscribe to our newsletter. If you need assistance with maternity benefits or any if you have any other questions relating to your medical aid, be sure to contact Cornerstone Healthcare Consulting Services today for expert advice and qualified guidance.

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