Questions to Ask Your Medical Aid When You fall Pregnant

Questions to Ask Your Medical Aid When You fall Pregnant

After having 3 kids, I can now tell you how extremely important it is to question your medical aid at the beginning of your pregnancy about your current plan and what it covers from time to time.

Sometimes we don’t realise how our medical aid plan could affect us in the long run – especially if we don’t have a gap cover or savings to assist during an emergency.

Gap cover has been extremely important for my family. It wasn’t an option – it was compulsory especially considering how poor the cover for dental costs is on my current medical aid.

Note: If you join a medical aid in South Africa after you fall pregnant, your birth would most probably not be covered but your baby will be covered when he or she arrives.

Medical aids have something called a “waiting period” for new clients. I am sure that you are already familiar with this.

Questions to Ask Your Medical Aid When You fall Pregnant

1. Do you have a pregnancy programme, if so, what exactly does it offer?

For example:

Discovery Medical aid has one and offers the following:

  • 24/7 doctor advice on your device
  • A maternity cost estimator
  • A pregnancy health record
  • A digital vaccination card

You can also preauthorise your hospital admission for the birth of your baby on the My Pregnancy

programme. You will most probably qualify for a diaper bag with a few goodies inside as well.

2. Do I have to use a specific hospital for my birth?

3. Antenatal consultations

How many visits (yes, some medical aids don’t cover them all) are covered and does that include urine tests, scans, etc?

Gynae visits are expensive especially if you choose one outside the medical aid network so it is important that you budget ahead and know what to expect.

4. Ultrasound scans and prenatal screening

Questions to Ask Your Medical Aid When You fall Pregnant

If you need a Non-Invasive Prenatal Test (NIPT), amniocentesis or Chorionic Villus Sampling (CVS), will it be covered? And if so, how much?

What types of ultrasounds will be covered? 2D, 3D, 4D?

5. Blood tests

Sometimes you are required to do a few blood tests and trust me, blood tests are not exactly cheap.

6. Antenatal classes

How many classes will be covered?

7. Reimbursement for breast pumps and thermometers

I know this comes out from your savings plan so be careful and budget wisely.

8. Midwives, Doulas, Waterbirth and Homebirth

What is the procedure like?

9. How many nights in hospital is the medical aid prepared to pay for?

10. Mental health and Lactation consultations after birth

How many sessions will be covered?

11. What percentage would you cover if I chose a doctor outside your network?

Many private doctor’s charge between 200 – 300% and sometimes medical aid only covers 100% so you would need to cover the difference.

12. What happens if my out-of-hospital benefits run out before my pregnancy is over?

13. Do you cover circumcisions, or does it come out of my savings?

14. What benefits are there for my baby’s first year?

15. What percentage is covered if I choose private vaccinations?

It is also important to know the number of days you have in order to add your newborn baby to your medical aid. The medical aid will not automatically do this and if you miss the deadline then you are responsible for any medical expenses for your baby during that time.

Don’t be fooled and think everything will be covered because it most probably wouldn’t be even though you are paying a huge amount monthly. Look at different options and compare pricing before you make that final decision.


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