Pregnancy is a joyous time for most women but it can also be a financial strain. The cost of private pre-natal care in South Africa is high and often unaffordable for many soon-to-be mothers. Medical aid for pregnant women offers a financial reprieve in that maternity benefits will cover the cost of childbirth. Pre-natal care may also be covered for members on a comprehensive medical aid plan.

Pregnancy Cover and Maternity Benefits

Being a pregnant mother and eventually delivering the baby can be a costly period in life from all perspectives. Medical care during this period if often the main concern for most expectant mothers. Private healthcare can be expensive as repeated gynaecologist/obstetrician (OBGYN) visits are necessary along with a slew of blood tests, scans, nutritional supplementation and sometimes even medication or other medical/surgical treatments.

Initially the expenses are mainly for out-of-hospital care. Pregnant women on a medical aid hospital plan will not be able to claim for OBGYN visits and related out-of-hospital pre-natal services. This is where a comprehensive medical aid is needed unless pregnant mothers can self-fund the relevant expenses. However, once hospitalisation is required even for care before childbirth, then both a comprehensive an hospital plan medical aid will cover the relevant expenses.

Medical Aid for Pregnant Mothers

Many women who are not already on medical aid start searching for cover when pregnancy is being planned for the near future. There are various factors that should be considered in order to make an informed decision. It is important to note that there is no specific medical aid for pregnant women. All medical schemes cover childbirth costs but it is important to understand the extent of these benefits.

Here are some of the questions that soon-to-pregnant women need to ask themselves.

How much can I afford with/without baby included?

Affordability is a major consideration for any person deciding on medical aid cover. Any medical aid plan that is chosen should be affordable for the main member and be sustainable for the long term. Many South Africans only join a medical aid when they need cover, like when a woman is pregnant, and terminate the membership thereafter.

However, this is an impractical approach and will eventually have adverse consequences. With waiting periods applicable to all new members, medical aid cover should be ongoing and preferably without any breaks or pauses. Pregnant mothers must also consider whether medical aid cover is affordable once baby is added to the plan.

Can pregnant women self-fund the out-of-hospital antenatal costs?

This is another very important question for women planning on conceiving. Pregnancy is  costly but so is comprehensive medical aid. It is therefore important to find the balance between self-funding out-of-hospital costs and affording cover with out-of hospital benefits.

Remember that the self-funding has to be considered for both during pregnancy and even after childbirth. Furthermore baby’s out-of-hospital costs also need to be considered, such a regular paediatrician visits and immunization apart from any other health problems that baby may have in early life.

Do pregnant women need comprehensive or hospital only cover?

Comprehensive or full medical aid includes both out-of-hospital and in-hospital benefits. It is the more sought after option for most South Africans but it is also more expensive than a hospital plan. If comprehensive cover can be afforded then it is usually the better choice for pregnant women.

Remember that OBGYN visits, blood tests, scans and medication/nutritional supplements are necessary in pregnancy. There may be even more expenses if there are any complications with the pregnancy. Any pregnant woman who is opting for a hospital plan only has to therefore ensure that she can fund the antenatal care.

Will medical gap cover be necessary?

Medical gap cover is often necessary these days for medical aid members. In most major South African cities, doctors, specialists and other medical services providers charge rates that are higher than medical aid tariffs. This means that members have to pay the shortfall from what the medical aid pays and what the service provider charges.

Fortunately medical gap cover is an insurance that protects medical aid members from these shortfalls for in-hospital treatment. Without understanding what medical aid is and how it works, pregnant women without gap cover may have a financial shock at the time of childbirth.

Pre-Existing Pregnancy Waiting Period

There is no medical aid for pregnant women who are already pregnant at the time of joining the scheme. In this case, most medical schemes consider the pregnancy to be a pre-existing condition and it is therefore not covered. However, schemes can make an exception at their discretion for women who are pregnant for less than 60 days but this is rare. Most medical schemes will not cover the pre-existing pregnancy.

Technically there is a waiting period applicable to conditions like pregnancy. The pre-existing condition waiting period is 12 months. However, pregnant women should not be discouraged from joining a medical scheme even if the current pregnancy is not covered. The fact is that other medical conditions may arise and will probably be covered if it does not fall within the general waiting period or pre-existing condition waiting period.

Furthermore, medical aid for a newborn baby is an extension of the mother’s cover. Therefore baby will be covered immediately upon birth. However, it is important to speak to the medical schemes to whether baby born from the pre-existing pregnancy will also be covered for neonatal costs such as the hospital stay and any relevant medical treatment. Some of these neonatal costs can be exorbitant and unaffordable without medical aid.


  1. Can you afford to have a baby?