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Medical Aid – Medical Peace-of-Mind for Expectant Mothers


Good Medical Aid Should Provide Peace-of-Mind for Expectant Mothers

There is no doubt that being a main or dependent member of a medical aid scheme can provide the peace-of-mind that is so important for expectant mothers, especially in South Africa where healthcare costs have steadily been rising. However, it should be borne in mind that this form of specialised cover is, in principle, not much different from an insurance policy and is subject to the same conditions as the one on your life or that covering accident damage to your motor car.

It is not possible to obtain a life insurance policy for a person who is already deceased, and neither can one insure a vehicle and hope to retrieve the cost of any damage incurred prior to purchasing cover. In the same way, although it is clearly not a disease but a physiological condition, a pre-existing pregnancy is governed by the same terms and conditions as an illness, and will be subject to a waiting period of twelve months.

Nevertheless, being a member of a medical aid scheme does provide some peace-of-mind for newly expectant mothers, as all conditions that are unrelated to their pregnancy will only be subject to a minimum statutory waiting period before a claim may be submitted, a condition that has long been applied to virtually all forms of insurance and which, in this case, amounts to just 3 months.

For a pre-existing member who may subsequently become pregnant, no such restrictions other than the usual 3 month waiting period will apply. However, the nature and the monetary value of the relevant benefits to which she will then be entitled are certain to vary according to the scheme in which she is enrolled, and any terms and conditions that may apply to the specific product that she has chosen.

Many women still express surprise or even shock upon learning of these constraints and, in fact, they were not always applicable. However, it was found that far too many expectant mothers in search of peace-of-mind, knowing that their medical expense would be covered, joined a scheme just long enough to cover the costs arising from their pregnancy and then cancelled their membership once they required no further care. It was this practice that, understandably, prompted the need for South Africa’s scheme managers to introduce more stringent rules.

Today, women can rest assured that as long as they have been members of a scheme for more than 3 months, should they then become pregnant, all the resulting expenses, from attendance at pre-natal clinics, to the delivery, recovery period, any paediatric needs that may arise and post-natal follow ups for mother and child will be covered to the full extent agreed upon by their scheme. In most cases, this should result in a relatively minor co-payment that will then need to be paid from the member’s own account.

KeyHealth offers affordable cover for women of all ages and, although the medical needs of expectant mothers are subject to these general conditions, those who have completed the appropriate waiting period can be assured of the peace of mind offered by comprehensive maternity cover plus valuable additional benefits, including a R1 000 gift voucher for baby items under our Smart Baby Programme – plus free emergency medical cover for your child with Easy-ER.