Abortion on Medical Aid, Termination of Pregnancy

The termination of a pregnancy is the right of every expectant mother in South Africa. However, many women experience difficulty in getting the appropriate advice on the costs and facilities associated with an abortion. There are many private abortion clinics in South Africa and while government hospitals should also offer this service, the strained public health care system does not always give priority to abortions. Medical aids may cover the cost of an abortion, however, some medical aids limit the number of times the procedure may be conducted or may not cover the procedure at all.

Private Abortions in South Africa

In the event that a woman decides that she wants to terminate her pregnancy, the cost implications are always a factor to consider. The cost of an abortion in South Africa can vary greatly, depending on whether you visit a private abortion clinic or a private gynaecologist and obstetrician who will conduct the procedure in a hospital.

An abortion by a private doctor is dependent on whether the practitioner does conduct these procedures. Many practitioners may refuse to conduct abortions unless the pregnancy is due to a case of incest or rape, or the pregnancy poses a threat to the mother’s health. The costs associated with an abortion in these cases will involve the cost of the hospital, theatre time, equipment and consumables as well as the doctor’s fees. Private abortion clinics offer this service at a reduced cost and the procedure is conducted by medical professionals usually on an out-patient basis.

A medical abortion is the use of the abortion pill to detach the placenta from the wall of the uterus. A second pill is administered to cause the uterus to contract and expel the contents. A surgical abortion involves a dilatation and curettage (D&C) which needs to be conducted within a hospital or suitable medical facility.

Medical Aid Cover for Termination of Pregnancy

Medical aids will always cover the procedure if the pregnancy is not viable or poses a threat to the mother’s health. This is considered as a medical issue and will be approved by your medical aid based on clinical guidelines. In the event that a woman opts to terminate the pregnancy with no indication of possible medical complications, some medical aids may still agree to pay for the procedure. This may be reviewed by the authorizations department and a decision will be made on each individual case.

Whether your doctor or the abortion clinic will accept medical aid payments need to be discussed before the procedure. If the practitioner or facility is contracted into medical aids and charges NHRPL rates, then medical aid will be accepted provided that you scheme pays for the procedure. Some medical aids will require the doctor to provide a motivation before authorizing the procedure.

If your medical aid does not cover the cost of an abortion on an elective basis, then the member will have to pay for the procedure in cash. Joining a medical after falling pregnant will not allow you to access cover for the abortion as the medical aid may impose a waiting period of up to one year on certain procedures like an elective abortion. However, if the termination is necessary for medical reasons, your medical aid is required to pay for the costs associated with a D&C (dilatation and curettage) and related procedures.

You should speak to the pre-authorization department of your medical aid to confirm whether the procedure will be covered in full.