The maternity benefits on a hospital plan is a consideration and concern for family members looking at having a child in the near future. But what hospital plan are you looking at? The term ‘hospital plan” in South Africa is vague. Are you talking about a medical aid hospital plan or a hospital cash back plan? Both are very different financial products and the nature of the maternity benefits on each type of hospital plan differs. It is imperative that you understand the differences in the maternity benefits as pregnancy and childbirth in a private hospital in South African can be very expensive.
Medical Aid Maternity Benefits
A medical aid is a form of cover that pays for medical services either directly to the provider or patient. In terms of a hospital plan, the scheme will pay for the hospital and delivery costs including the fees for a gynaecologist and obstetrician. If you have a cesarean section then the theatre fees and anaesthetists charges are also covered. Medical aid hospital plans pay according to the NHRPL tariffs and sometimes more for doctors who charge higher rates in hospital. This is dependent on the medical aid and hospital plan in question.
Medical aid hospital plans do not cover pregnancy costs, such as antenatal checkups and scans, gynaecologist consultation fees, blood tests and so on. You will need a comprehensive medical aid with an out of hospital or day to day benefit for coverage of these bills. However, the more costly part of pregnancy is the in-hospital costs.
Hospital Cash Back Maternity Benefits
Hospital cash back plans have become a popular form of insurance in South Africa. These plans are not a medical aid. It simply pays cash to the insured person for each day in hospital. Neither doctors nor hospitals will accept these cash back plans as a form of security for the payment of bills like they do a medical aid. You can collect the cash after being hospitalised and settle your medical providers. However, all private hospitals in South Africa and most doctors will insist on upfront payment or at least a deposit if you do not have medical aid cover.
Pre-existing Pregnancy
Most hospital cash back plans will not cover the hospitalisation of a woman who is already pregnant at the time of signing up for the insurance. As with medical aid, only hospitalisation for a future pregnancy will be covered. It can be confusing but the bottom line is that both hospital plans protect themselves against members who may be trying to scalp the insurance or medical aid. Some women sign up for a hospital plan, make use of the maternity benefit and then terminate their membership shortly thereafter. Therefore these measures are in place to prevent women who are already pregnant from doing so.
It is important to note that no medical aid covers the pregnancy and childbirth costs if a woman is already pregnant at the time of joining the scheme. This is a standard policy across the board. Therefore it is imperative to join a medical aid before falling pregnant. It does not matter if it is full medical aid or hospital plan only. Some women who are already pregnant at the time of joining think that a hospital plan medical aid for pregnancy and childbirth will cover the costs in hospital only since they joined at the start or pregnancy or did not disclose that they were pregnant. To their surprise, they may be slapped with a massive bill after giving birth which they then have to pay for in cash.
Advantages of Maternity Benefits
Hospital plans are a form of protection. The cash back plan protects a person from expenses incurred and possible loss of income when hospitalised. A medical aid protects the member from the financial impact of medical bills. While bringing a new member of the family into this world is a time of joy and celebration, the financial implications of pregnancy and childbirth can be depressing. It may impact on a person’s finances for months and even years after childbirth.
Maternity benefits on both these type of plans are therefore an essential protection since childbirth can be costly and leave a woman unable to work for a period of time. There is no way to say one type of hospital plan is better than another as it depends on the needs of the individual. However, the staggering costs of private health care in South Africa does make a medical aid somewhat of a necessity if one wants to avoid the services of government hospitals.
Similarly hospital cash back plans can be of great assistance when you have to pay the medical bills to the doctor and hospital which are not covered by medical aid. In addition, the cash back plan puts money in your hand at a time when you need to invest in all the little niceties for your new bundle of joy.