Pregnancy is one of the times when a person reassesses their medical aid cover as the costs associated with childbirth can be expensive. Considering the high costs of private health care, it is only natural for mothers to be concerned about the extent of cover for their pregnancy and childbirth, as well as cover for any complications that may arise, especially those that can affect the baby. Proper cover is essential and ideally you should have comprehensive medical aid cover before you fall pregnant (refer to Medical Aid for Pregnant Women).
Medical Aid Costs for Expectant Mothers
The medical costs associated with having a baby can be divided into :
This includes the costs of monthly appointments with your gynaecologist, scans, blood tests and any other investigations that may need to be done as part of the pregnancy. Most comprehensive medical aid plans with out-of-hospital benefit will cover these costs but if your doctor charges rates higher than the NHRPL, you will have to pay the difference in cash.
If you are on a medical aid hospital plan, you will not be covered for these out-of-hospital costs and you will have to pay your doctor and the pathology lab in cash. Pregnancy medical costs can be expensive since you will need to see your gynaecologist on a monthly basis, and more frequently as your approach your due date. Routine screening tests will need to be conducted to exclude any possible birth defects and should there be any complications like a threatened abortion, you will need to be on medication and possibly consult with a fetal specialist as well.
Delivery costs include the gynaecologist’s fees, hospital costs including materials, drugs and theatre time in the event of a caesarean section. All medical aids, even hospital plans, cover these costs but some medical aids may only allow you to attend certain hospitals in their network. Natural vaginal childbirth usually costs the least but if your decide to have an epidural or C-section, you should be aware of the additional costs especially if your do not have medical aid cover. Speak to the hospital and gynaecologist about their rates and verify that your medical aid will cover these costs within the labour and delivery benefit.
If your gynaecologist charges rates that are higher than the NHRPL (National Health Reference Price List), you may have to pay for the difference in cash. Some medical aid plans do cover in-hospital fees that are 300% of NHRPL and this includes the gynaecologist’s fees. Additional fees for the anaesthetist or paediatrician will also be covered by your medical aid but it is best to discuss this with your provider. If you are having an elective C-section, you should speak to both your doctor and medical aid about the cost. Some medical aids will not pay for an elective C-section.
This includes the cost for your hospital stay after giving birth, usually 2 to 3 days, as well as for the baby’s stay and care in the nursery. In the event of a premature delivery, breathing difficulties or other medical problems that your baby may experience, a stay in the neonatal ICU will be necessary.
It is important to note that even if your baby has to stay for more than 2 to 3 days in the neonatal ICU or pediatric ward, the medical aid will not cover the costs for the mother to continue staying in hospital. Most private hospitals do allows mothers to occupy a hospital bed but this has to be paid for in cash and can cost around R300 per day.
Medical Aid for Newborn Baby
Most medical aids will cover your baby for 30 days after birth at no additional cost. However, it is the parent’s responsibility to inform the medical aid of the baby’s inclusion on the cover as soon as possible.
Failure to do so can mean that you baby has no medical aid cover after 30 days and any additional costs will have to be paid for in cash. There are many medical conditions that can arise in a newborns and ensuring adequate medical cover for your baby is essential if your want to avoid unforeseen costs.
Most private hospitals will require a small cash deposit upfront even if you are on medical aid. This refundable deposit is for the cost of nappies and other miscellaneous items that your medical aid may not cover. If your baby is confined to the neonatal ICU for a long period of time, it may be worthwhile to consider supplying the nurses with your own diapers to prevent unnecessary costs.