Yes, you can take out medical aid (as an individual medical aid member) if you’re already pregnant, although any costs associated with your antenatal care and the birth of your baby will not be covered by your new medical aid.
The only exception in this case could be if you are employed by a company that offers a group medical aid. The scheme may decide to cover your antenatal care and birth (if you sign up while pregnant), based on the claims experience of that company, and the associated risks.
Why won’t the birth be covered by my medical aid?
Many women (and their partners) only think about signing up for medical aid once they become pregnant – after all, having a baby can be expensive, and those medical bills soon add up. But if everyone did this, medical aid schemes would not have enough funds to pay out for all the procedures associated with pregnancy and birth at private hospitals (which can add up to hundreds of thousands of rands). Schemes call this anti-selection, where you’re only taking out medical aid because you need it. It’s the same concept as only taking out car insurance once you have an accident and need someone else to pay for the repairs.
That’s why medical aids have certain waiting periods (of up to 12 months) that are associated with pre-existing conditions, like pregnancy. This means that for a certain time period (known as the waiting period), they will not pay out any costs associated with that specific existing condition. So, if you sign up for medical aid while you’re pregnant, your baby would be born during this waiting period, and you wouldn’t be covered for expenses relating to your pregnancy or the birth. There is also another waiting period called a three-month general waiting period, during which time no expenses will be covered at all, except emergencies where the emergency is a Prescribed Minimum Benefit.
Is it still worth taking out medical aid?
Definitely. Because once your baby is born, they will require medical services at some point, and therefore they need to be signed up for medical aid. If they require urgent medical attention at any time after they are born, a scheme like Fedhealth will pay for it, regardless of the stipulated waiting period.
Should I tell the medical aid company that I’m pregnant when I sign up?
It’s vital that you tell the medical aid company about any pre-existing condition you may have – for example, that you’re pregnant – when you sign up. If you don’t tell them this and they subsequently find out, it’s very likely that your membership will be terminated, which could impact your own health and the health of your baby.
