If you are pregnant and do not yet being to a medical aid, the need for medical cover is likely to suddenly become very important you as your maternal instincts kick into gear. However, joining a medical aid scheme while pregnant has become almost impossible in South Africa.
Medical aids usually do not cover any procedure or treatment for a pre-existing condition within the first year of joining a scheme.
This applies to pregnancy as well. While it is clear that pregnancy is not a disease or illness, and should this not be lumped in the same bucket from a medical aid point of view, the fact remains that medical aid providers need to weigh up the costs to them relative to what the member has contributed towards her medical care.
Medical aid is not cheap, and many young mothers (especially those without stable partners or husbands) are unable to afford the monthly premiums. Due to the high cost of being on a medical aid, there has been a trend in South Africa whereby pregnant woman join the scheme, stay on it during pregnancy, and then cancel their contracts shortly after the baby is born. (www.vitacare.co.za).
Most South African medical aid providers have now stopped accepting new members if they are pregnant, to protect themselves against what was becoming a burgeoning trend. While there are still one or two that do, these usually have very strict criteria for the women who can join. For example, they may have to be for university lecturers only, or be wives of men in a particular industry.
It is understandable for young women to want to join medical aids when they are pregnant, especially given the cost of giving birth. Giving birth in a private hospital can cost between R7 000 – R12 000, depending on the type of birth. Should your baby have complications and need to be hospitalised or kept in an incubator, the costs can quickly and easily elevate to over R30 000.
However, is it fair to expect a medical aid to cover these costs for a member who has paid no premiums up until this point? The reality is that for medical aids who do accept pregnant women, it is ultimately the long-standing members who are paying for this medical care through their own exorbitant fees.
It is difficult o judge women who suddenly seek out this option – in South Africa the prevalence of rape and sexual violence is frighteningly high, and often women don’t have a choice as to when they are impregnated, not to mention how or by whom.
However, women in stable, loving relationships should be advised not to join a medical aid scheme only when they get pregnant, but rather years before they contemplate having children. This protects them against all eventualities, and also protects the schemes and its long-standing members against having to pay more for their premiums to cover other peoples’ “unexpected events”.