While medical aids and hospital cash back cover offers maternity benefits, it does not apply to women who are already pregnant at the time of joining. Ideally people join a medical aid and sign up for cover before they actually need it. After all these types of cover are a means of financial protection to cover you in different circumstances. Joining a medical aid when you are already pregnant means that you cannot expect to be covered for your pre-existing pregnancy. The same applies to hospital cash back cover policies. You can still join but you will only enjoy maternity benefits and childbirth cover for your next pregnancy.

Do medical aids accept pregnant women?

Yes, medical aids accept pregnant women on the scheme. You can join at any age irrespective of your health status. However, medical aids do not cover the costs of the current pregnancy and upcoming childbirth. Your current pregnancy if you have already fallen pregnant at the time of joining is excluded from cover. Future pregnancy and childbirth costs will be covered. Up until a few years back, some medical aids that were keen to increase its membership accepted women in their first month of pregnancy and even first trimester and paid for that pregnancy and childbirth costs. However, this no longer applies. Whether you opt for comprehensive plan or medical aid hospital plan only, pregnancy is excluded for a period after joining.

Why is pregnancy excluded?

Every day in South Africa, women who have already fallen pregnant are searching for medical aid plans that will cover them for the current pregnancy and upcoming childbirth costs. Unfortunately there is no such cover. Pregnancy is a pre-existing condition – not a disease but a physiological condition. Medical aids have a waiting period of 12 months for any pre-existing condition, whether it is a disease or physiological state. So pregnancy itself is not being excluded but all pre-existing conditions at the time of joining. It is the medical aid policy and is legitimate.

Is it unfair?

Every consumer feels that they are being prejudiced and treated unfairly when things do not go their way but this pre-existing policy on medical schemes is not unfair. While pre-existing diseases were never covered immediately, medical aids used to accept pregnant women up until a few years ago. However, there was widespread abuse of this leeway. Women would wait until they are pregnant to join a medical aid, stay on the scheme throughout their pregnancy and a short while after childbirth and the quit the medical aid. Their total premiums in the time came to less than the amount they claimed for pregnancy and childbirth.

This behaviour was unfair to the loyal existing members. Millions of South Africans are on medical aid and sign up for cover despite being young, healthy  and not needing cover anytime soon. They contribute to a pool of funds that is then used for payouts for those members who have legitimate medical needs. Medical aids do not take the money and invest it to make large profits. They have to balance the incoming funds with the outgoing payments. When a person signs up for cover only to benefit from the contributions of other loyal members and quit thereafter, it is unfair on the existing members. It is not just pregnancy, it applies to any pre-existing condition.

Do hospital cash back plans cover pregnancy?

Hospital cash back cover has maternity benefits but it does not apply to a woman who has already fallen pregnant at the time of joining. It is also important to be cautious about maternity benefit criteria with hospital cash back plans as the types of insurance policy have a 2 to 3 day deferred period. This means that you will not receive a cash payout if you are in hospital for less than 2 to 3 days. With pregnancy meaning a short stay in hospital, you may not benefit from these plans unless there is clear stipulations about the criteria for cover with regards to maternity benefits.

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