Parenting - Budgeting - Medical Aid Parenting - Budgeting - Medical Aid

Medical aid for pregnancy

Not sure who and what you will need for the birth? Is there a possibility that you might prefer a home birth, or a private hospital even though you are not a member of a medical scheme? Don’t leave it too long to decide. Whatever you decide, you’ll probably need to be part of a medical aid to cover your pregnancy and birth – and you can’t make that decision at the last minute!

If you do not belong to a Medical Aid Scheme you have the option of having your antenatal care, delivery and postnatal care at a state hospital. The National Department of Health utilises the primary healthcare (PHC) approach in providing early and quality ante- and postnatal services. They also offer essential infant and child health services and nutritional advice. Antenatal service is free at local clinics, but public hospitals will charge a minimum fee.

Your other option is to go to a private hospital – but then you’ll have to foot the bill up front.

It is important to think of what you want in advance, and know what model of birth care you want – whether it is natural, caesarean, water birth or hospital birth. Check with your medical scheme or any existing medical policy you have to ensure you’re covered. Remember that there might be other expenses that your scheme will not cover.

In South Africa there are many clinics and hospitals available that you can use for the birth of your child even if you don’t belong to a medical aid scheme – provided that you have the cash on hand to pay in advance. And who has that!

What does your Medical Aid cover?

It’s also important to understand what you are covered for at a private hospital. Medical aids in South Africa do pay for childbirth delivery costs. However, your scheme may not cover the rates of private doctors or specialists, who charge significantly higher cash rates these days. While you can be assured that you and your baby will be covered for the hospital’s bills in full on your medical aid, you have to be cautious about the bills from all the doctors involved. 

Check that your private health cover includes any additional services that you or your baby may require in the event that something goes wrong. 

All in all, it can be an expensive business. Depending on which private hospital you choose to have your baby and the rates of your obstetrician/ gynaecologist, anaesthetist and paediatrician, you can expect the final bill to be as much as R45 000. 

Maternity support

Many medical schemes offer their pregnant members maternity support in the form of advice, guidance and information throughout their pregnancies. The best thing to do is to familiarise yourself with what is available to you through your medical scheme, and discuss these plans with a medical scheme consultant. This will help you to make the best choice when selecting a medical scheme plan for your mid- to long-term healthcare needs. 

Choosing a scheme for your pregnancy

  • Most South African medical schemes won’t cover you if you’re already pregnant when you join – thus you will be responsible for all your own pregnancy-related expenses.

  • Just as you planned your pregnancy, plan your medical cover – join a medical scheme well in advance – to minimise the costs associated with pregnancy and childbirth.

  • Assuming that you were already a member when you fell pregnant, your medical aid scheme will cover many of the basic costs associated with pregnancy and childbirth, such as hospitalisation, and – depending on the type of plan you have – maybe even certain antenatal benefits.

  • For more information visit Health24.com

Benefits offered by medical schemes:

Depending on whether you have a hospital plan or a day-to-day medical plan, the costs of your confinement will be covered (though some may be subject to co-payments):

  • Some medical schemes will contribute to the cost of foetal scans and certain antenatal blood tests even if you’re only on a hospital plan. Day-to-day plans may also cover antenatal visits, additional growth scans and, in some cases, a certain number of paediatrician visits following the birth.

  • Some medical schemes offer cover for antenatal classes up to a set amount, and may also provide cover for home births, provided that a registered midwife is present.

  • Regardless of whether or not your pregnancy was covered by your medical scheme, your baby will be covered from birth if you are a medical scheme member and have registered the baby’s birth. 

Before you become pregnant

  • Make sure your medical scheme includes obstetric-related services – if not, take out, or transfer to one that does.

  • Draw up your budget 

Once you are pregnant

  • Choose your hospital and obstetrician

  • Check that your chosen hospital is part of your medical scheme (although most hospitals accept all medical schemes – just check with your clinic if it is covered).

  • Ask your obstetrician or any specialists involved in your treatment for a written quote of any “out of pocket” expenses you might have. 

After your baby arrives

  • Add your new baby to your health cover after birth (you have 30 days to do so).

  • Check what post-birth support services are available to you and your baby through your medical aid scheme. 

The expensive reality
According to the cost breakdown provided by Mediclinic, a natural birth (for the first day) will cost you over R9 000. If you'd like an epidural with that, it'll cost you almost R2 000 extra. If you're planning to stay a little longer and need the nursery, the cost is just over R3 000 extra per day.

For C-section moms, the first day of confinement will have you forking out almost R13 000. You too will need to pay just over R3 000 for every extra day you need to stay at the hospital. 

For more information on public sector healthcare:

  • Department of Health: Antenatal care <link to external site- http://www.health.gov.za/pc.php>

  • Department of Health: Postnatal care <link to external site- http://www.health.gov.za/pac.php>

  • Department of Health: Caesarean Booklet <link to external site- www.health.gov.za/docs/Policies/CEASEREAN_BOOKLET.pdf> 

For more information on medical schemes available in South Africa:

For more information on hospitals or clinics in South Africa:

For more information on birthing options: