This question can be a real head-scratcher for all parties involved. Imagine an overaged child-dependant, for example a student, who is still on her parent’s medical aid, falling pregnant – what cover does the mom-to-be and baby enjoy?
Firstly, Fedhealth is legally bound to cover a baby ‘born into the scheme’ if the baby belongs to the principal member, their spouse or minor child (under 18 years of age) and provided that there is no paternal support given to the baby. ‘Born into the scheme’ simply means underwriting free, with no imposed waiting periods and the baby has been registered with Fedhealth within 30 days of being born.
Should the scenario of a pregnant overage child dependant take place, the baby will not automatically be ‘born into the scheme’. The baby will therefore be subject to underwriting and waiting periods will apply.
The parent member is now faced with the following choices before the baby is born:
- Keep their overaged child (the new mother) on their medical aid. The pregnancy and delivery will be covered, but the baby will be subject to a three month general waiting period and may be subject to 12 month condition specific-waiting periods for pre-existing conditions
- Choose to move the overaged child dependant to their own option as a principal member and not an overaged child dependant. In this case, the pregnancy and delivery will be covered from the date of the new membership with no new underwriting being imposed and the new-born baby will be covered from the day one of birth, with no underwriting being imposed. The pregnancy and delivery will be covered by Fedhealth if the overage child dependant was a Fedhealth dependant at the time of becoming pregnant and there was no break in membership between moving to her own benefit option.
This is a difficult decision for members to face and could have far-reaching consequences. Therefore, members need to be made aware of and fully understand the implications their choice will have.
As always, Fedhealth believes that family should take care of family, and we will do everything in our power to answer any questions and explain the implications where possible. Please contact the Fedhealth Customer Contact Centre on 0860 002 153 if you have any questions.