Joining a Medical Aid When You Are Pregnant

In general there is no medical scheme cover for women who join a medical aid after they have fallen pregnant.  This is because medical aids usually do not cover any treatment for a pre-existing condition in the first year of membership, and this includes pregnancy.

There are many people who say it is unfair that there is no pregnancy cover for women who join medical scheme while pregnant. They argue that pregnancy is a normal physiological process and not a disease.

But the medical schemes say they have to take into account the risk of paying for pregnancy procedures and treatment in the first year of membership. If every woman joined a scheme just to get cover when pregnant, this would be unaffordable to the medical scheme.

In fact, many women do just that. They join a scheme a year before falling pregnant, enjoy the benefits of a medical aid and resign shortly afterwards. This places enormous strain on the medical aids as the costs of pregnancy and childbirth might be more than the member’s total contributions. The medical aid then has to pay in from the fund pool to make up the difference. This is unfair to long-term members.

Some Exceptions to the Rule

pregnant womanSome of the so-called restricted schemes, which are not open to the general public and are designed for workers in selected industries or professionals with university degrees, accept pregnant women as members. These schemes may be partly subsidised by a professional body or a related organisation. Find information about the restricted (closed) schemes go here: List of Medical Aids.

No Medical Cover for Pregnancy

If you do not have medical cover for pregnancy you will have to pay an upfront fee at the private hospital when you arrive to deliver your baby. This can be an astronomical amount at some hospitals, in the order of R30 000 to R50 000. You then have to settle the entire bill once you are discharged. You face legal action if you don’t pay right away. If you don’t any kind of medical cover your baby will have to be delivered in a public hospital or at home. There are high risks associated with both of these options.

Clearly you need to sign up for a medical aid long before you aim to fall pregnant. Apart from covering you for all the costs associated with pregnancy and childbirth, the medical aid will automatically give your baby medical cover for the first 30 days of life, even if you have not officially added the baby to your medical aid.