Pregnancy and childbirth can be both daunting and exciting for any woman and her partner. Naturally most couples will have concerns about the financial impact of having a child. But just as concerning these days is the costs associated with being pregnant and giving birth, especially if you are planning to use a private hospital in South Africa. Let’s face it – private health care in South Africa is not cheap.

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Pregnancy Medical Aid Costs

Without medical aid, most of us would not be able to afford to have a procedure done in a private hospital in South Africa. Pregnancy and childbirth is no less costly than many other in-hospital procedures. Should complications arise, you could be facing hundreds of thousands of Rand and medical aid is the only safety net.

If you have medical aid cover, and have been a member of your scheme for more than a year then you have little to worry about. Your childbirth costs will be covered by the scheme but you may have to fork out a little extra to the doctors, as many charge above medical aid rates.

Pre-existing pregnancy can be a problem if you do not have medical aid cover yet. Then you need to brace yourself for the financial impact of paying for the labour and delivery out of your own pocket. No medical aid in South Africa is going to cover your current pregnancy and childbirth costs, apart from certain exceptional circumstances.

Benefits for Pregnancy & Childbirth

Depending on your medical aid plan, your pregnancy costs like antenatal visits at your gynaecologist, scans at the radiologist and blood tests at the pathology laboratory may not be covered. These out-of-hospital services will only be paid for if you have a comprehensive medical aid (“full cover”). But if you are on a hospital plan then you will have to pay for these costs on your own.

However, the hospital costs for labour and delivery will be covered by your medical scheme even if you are only on a hospital plan. The extent of the benefits for pregnancy and childbirth can vary greatly between different medical aid plans. Some plans will only pay for these out-of-hospital costs from your medical savings and if that is exhausted then you will have to pay for it from your own pocket.

Other plans have separate benefits for day-to-day pregnancy costs, so you can rest assured of cover even if you have exhausted other day-to-day benefits on your cover. The hospital benefit will pay for the hospital stay, baby’s stay in nursery or other wards, the delivery procedure, theatre time in the event of a caesarean section, and the doctor’s fees (gynaecologist/obestetrician, anaesthetist, paediatrician).

Pregnant With No Medical Aid

If you are already pregnant before joining a medical aid then the pre-existing waiting period will apply to you. This means that the medical aid will not cover your existing pregnancy, irrespective of whether you knew or did not know that your in fact pregnant at the time. It is waiting period that not only applies to pregnancy but just about any pre-existing medical condition. Pregnancy is not a disease, but it is medical condition. Even though this pregnancy will not be covered, your medical aid will still cover you for other health services and future pregnancies.

Up until a few years ago, a handful of medical aids would still cover pregnant women who joined the scheme after falling pregnant. Some schemes would only pay for the pregnancy and childbirth costs if the woman was not more than the first month or first trimester along in her pregnancy at the time of joining. But now this has stopped. GEMS (Government Employee Medical Scheme) was one of the last medical schemes to allow pre-existing pregnancy to be covered in new members.

You need to make a decision to either have your baby in government hospital or pay the R30,000 to R40,000 for labour and delivery at a private hospital in cash. Private hospitals do not offer credit facilities. You will have to pay most of this bill upfront.

Labour & Delivery Costs at Private Hospital

It is always best to prepare for unforeseen circumstances and this would mean planning to pay for a caesarean section (C-section). You may have decided on natural birth but if an emergency arises, your gynaecologist/obestetrician will have to make the best decision for you at the time, and this may mean a C-section whether you like it or not.

These days the entire bill for having a C-section and the stay at a private hospital thereafter hovers around the R45,000 mark. Whether you are on medical aid or not makes little difference. Some doctors may be prepared to lower a slightly lower rate for paying the bill in cash before the actual procedure but this varies from one practitioner to another.

Private hospital care for the procedure and the stay for you and baby for 3 days after will cost you around R28,000 (2013 prices). Add in another R8,000 for a gynaecologist/obstetrician to perform a C-section, another R3,000 for an anaethetist and then R2,000 or more for the paediatrician and you will come close to R45,000 – give or take a few thousand rands depending on your individual case.

Most medical specialists charge above medical aid rates so you scheme will only pay around R3,000 to a gynaecologist/obstetrician to perform the C-section and you will have to pay the rest if you doctor’s fees are higher. The same applies to the anaesthetist and paediatrician.

Looking at these costs, it is obvious why most people need to financial safety net of a medical aid. In addition, medical gap cover is often necessary to make up for the short payment between what your doctor charges and what your medical aid reimburses. If you have the financial resources to pay for labour and delivery without medical aid, then make provision for additional bills should your baby have to stay in the neonatal high care ward or neonatal ICU. The costs for these wards is several thousand Rands per day.

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