Medical Aid Cover for a Newborn Baby

Most medical aids cover newborn babies immediately upon birth at no additional cost for 30 days. Some medical aids may extend this to up to 60 days after the birth. Cover is dependent on at least one parent being a medical aid member and with the hospital birth certificate clearly indicating the parent’s details. However, delaying to register your baby on your medical aid can lead to a host of complications and additional costs.

Medical Aid for Babies

Newborn babies are covered from day one of their birth with no exclusions being imposed by the medical aid. Most schemes do not charge any additional premium for the first month of the baby’s life. However, this is dependent on the parent who is the main member, informing the scheme of the child’s birth and clearly indicating their wish to have the child covered. The newborn has to be the main member’s biological child or there has to be legal documentation confirming that the baby in question has been adopted by the medical aid member.

Most private hospitals will notify the mother’s medical aid of the child’s birth if the baby is born within their facility.  However, the onus lies on the parent to confirm this with the medical aid, complete the necessary documentation and submit it to the medical aid within 30 days of the birth of the child. Failure to do so will mean that your baby is not covered and the costs incurred in the first month of life will not be paid for by the medical aid. A hospital cannot be held liable for failing to inform the medical aid of the child’s birth as this is not within their duty.

Medical Aid Exclusion for Newborn Babies

Medical aids cannot impose any restrictions on a newborn baby if the parent, who is a medical aid member, registers the child under their plan within the first month of life. If a parent fails to do so, meaning that the parent attempts to register the child after the first month, the medical aid can impose certain exclusion clauses on the cover. Children born with any medical condition will therefore not be covered by the medical aid for these ailments usually within the first year from the date of registration.

If there have been medical expenses accrued within this first month, the medical aid may also refuse to pay these bills since the parent did not register the child within the specified period i.e. within first 30 days of birth. While most medical aids do provide the first month of cover free for children born to their members, any attempt to register the child after 30 days of their birth may mean that the medical aid will backdate the monthly contributions.

Medical Costs for Newborn Babies

Many parents only focus on the medical costs associated with childbirth and do not consider the expenses that may be incurred for the treatment of the newborn baby. A host of complications can arise, from a simple case of jaundice, to neonatal breathing problems, infections and so on. The baby will therefore require care in the hospital’s neonatal ICU, pediatrician costs, medicines and possibly even surgery in some cases.

As the parent, your medical aid will pay for these bills for your newborn’s treatment provided that you register your child on the medical aid within the first 30 days of birth. There is sometimes confusion whether a father with medical aid cover can register the baby on his plan although the mother is not covered by medical aid. This should be clarified with your medical scheme but in most cases, the newborn baby will be covered if he or she is the father’s biological or adopted child.

Covering Your Grandchild

Problems may arise, however, if grandparents attempt to register a baby from day one of the child’s life when the parent is not part of this medical aid cover. In this instance, the child will still be covered but the medical aid may not provide the cover free of charge for the first month of life and could even impose exclusions based on the baby’s medical history. This however can vary on a case by case assessment.

If adoption by the grandparent can be confirmed, then the medical aid may agree to full cover from day one without restrictions provided that the necessary documents can be handed in within 30 days. In a case where the mother is a member on the grandparent’s medical, most schemes will not impose any restriction. However, this has to be confirmed with your medical aid as policies in this area may vary and depend on a number of criteria due to the complexity of the issue.

Medical Aid Contributions for Newborns

The cost of adding a newborn baby to your medical aid is the same as for any child. It is advisable to clarify the cost with your medical aid. With some schemes, you will only have to pay for your first 2 or 3 children and any child added to the medical aid afterwards will be covered for free.

If you are on a company medical aid, you need to inform your employer about the birth of your child. Ideally your employer should be aware of this impending birth well ahead of time. Failure to do so could affect the cover as your employer may not notify the scheme in time or may erroneously fail to pay the employer’s portion of the total contribution.