Hospital Plan for Pregnancy and Already Pregnant Women

Pregnancy is a special time in every woman’s life. While there is often some degree of worry about the upcoming delivery but excitement about the new member in the family, there are many considerations that a pregnant woman has to bear in mind. Probably the most important of these is financial protection. Hospital plans are not affordable for every South African but can make a massive difference in easing the financial stress and accessing quality medical care. Women should ideally have a hospital cover before falling pregnant – both a medical aid, either full cover or hospital plan only, and a hospital cash plan. These are different products and one cannot replace the other. However, this is not always possible or affordable and it is then important to carefully consider your individual needs.

Medical Aid for Pregnant Women

Medical aid pays for the health-related expenses. If you have a full comprehensive medical aid, then your antenatal bills, medication and delivery costs will be covered. This includes the cost of doctor’s fees, scans, delivery room or operating theatre in the case of caesarean section, and the hospital stay thereafter for both you and your newborn. A medical aid hospital plan only will just cover the delivery, surgery in the event of a C-section and the hospital stay for both mother and child. Out-of-hospital bills like antenatal visits at the gynaecologist and scans will have to be paid in cash if you have only a hospital plan.

Cash Plan for Pregnant Women

Hospital cash plans pay for each day that you are in hospital. It puts cash in your hand at a pre-determined rate decided at the time that you signed up for the insurance. These hospital cash plans do not pay specifically for your medical bills. While you can use the payout for settling the medical bills, doctors and hospitals do not see these plans as a form of security and will usually require you to pay upfront amounts if you do not have medical aid. Nevertheless the hospital cash plan is useful in putting money in your hand when you cannot work and probably need it the most. The maternity benefits on the hospital cash plans differ among policies and it is important to get clarity on that matter at the outset.

Hospital Plan If Already Pregnant

Both medical aids and insurance companies in South Africa face the question daily by women who are already pregnant – can I still join a hospital plan? Yes, you can join a hospital plan if you are already pregnant but this does not necessarily mean that your current pregnancy and upcoming childbirth will be covered. All too often women have waited to fall pregnant, join a hospital plan, enjoy the benefits in pregnancy and during childbirth, only to leave the plan after having the baby. This negatively impacts on the finances of the medical aid or insurance company.

These financial products will therefore not pay out for pregnancy or childbirth within the first year of cover, or at least not if a woman is already pregnant at the time of joining. A person should sign up for medical aid hospital cover or a hospital cash plan when they are healthy and not necessarily have to use it. Unfortunately some people cannot afford cover or choose not to pay for it until they need it. This affects all the members of the medical aid or insurance policy.

So while you can join a hospital plan if you are already pregnant, you will not qualify for cover for your existing pregnancy.

Benefits for Future Pregnancy

Although a hospital plan may not cover a women who is already pregnant, it makes more sense to join the plan immediately rather than wait till later.

The first benefit for doing so is that a medical aid hospital plan will pay for the baby’s stay in hospital in the event of a complication. If you happen to have a preterm birth, then a premature baby will need to stay in neonatal ICU which is very expensive. Furthermore newborns are prone to a host of health problems and will be covered immediately by the medical aid upon their birth.

Family hospital cash plans will also benefit you after childbirth as it will pay you in the event that you get hospitalised for some reason or the other, and will also pay you a small travel allowance to visit your baby in hospital should your newborn be admitted for whatever reason.

Even without these immediate benefits, signing up for cover as soon as possible just makes sense. Just as you did not qualify for cover for this current pregnancy, by waiting any longer you may find that will be subjected to other exclusions apart from just pregnancy.