If you are already pregnant and need medical aid that will cover your existing pregnancy then you need to be aware of some of the facts. First let us look at a common practice among South African consumers. We all buy insurance before we need it. Car insurance before an accident. Life insurance before we die. But when it comes to medical aid, we seem to wait till the need arises. In this regard, medical aid is no different from other insurance products. If you do not have cover by the time an event arises, the said event will not be covered. The same applies to pregnancy.
Does medical aid cover pregnant women?
Yes, South African medical aids do cover pregnant women. They cover any person of any age irrespective of their health status. However, they will not cover any pre-existing condition at the time of signing up. The operative word here is ‘condition’ which means a disease (pregnancy is not a disease) or physiological condition requiring medical care soon (pregnancy is a physiological condition). But this does not mean that a pregnant woman cannot sign up for medical aid.
If you sign up for medical aid while you are pregnant you can rest assured that you and your newborn child will be covered for medical care. Not for the current pregnancy and labour costs but for all other costs that may arise which are unrelated to the pregnancy. And future pregnancies will also be covered because the waiting period that is initially instituted would have been completed by the time you fall pregnant again.
Why do medical aids discriminate against pregnancy?
Medical aids do not discriminate against pregnancy. The history of pregnant women signing up for cover, paying the premiums for a few months, enjoying full cover for childbirth and labour, and then leaving the medical scheme thereafter had grown to almost epidemic proportions in South Africa. Pregnancy was then listed as one of the pre-existing conditions that would not be covered immediately upon signing up for a medical aid. There is a 12 month waiting period for all pre-existing conditions.
A medical scheme works by pooling the money of all the members together and then paying out for the sick. The rationale is that at any one time there should be more healthy members who do not need medical care than sick members requiring medical aid cover. When a person claims excessively from medical aid, they start to drain the resources of the scheme. But they are entitled to this cover if they have been contributing to the scheme pool. This means that they were established members loyally paying their premiums for months or years when they never needed medical care. So the scheme covers them completely when it is needed.
If every person only signed up for medical aid when they needed it, used the benefits and then left once they were better, the pool would quickly become depleted. So medical aids have rules in place to protect their members. You can only claim after 3 months of joining a medical aid and the scheme will only cover you for pre-existing conditions after 12 months.
Should I tell my medical aid that I am pregnant?
If you opt to lie on your disclosure form at the time of joining a medical aid, you will not be able to get away with cover for your pregnancy. Joining a medical aid after falling pregnant means that you are already one or two months into your pregnancy, if not more. Even if it is only a week, the fact is that you will be giving birth within 9 months or so.
Medical aids automatically exclude pregnancy cover for a minimum of 10 months but usually a 12 month waiting period is in place.
What this means is that women who lie about not being pregnant will still not be covered unless they are able to give birth after the waiting period ends. This is not possible for humans where gestation is roughly 9 months. There is no way of delaying childbirth beyond this although some women do give birth later than others. The fact of the matter is that you will be liable to pay for your pregnancy and childbirth costs in cash if you are already pregnant at the time of joining a medical aid.