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What should I ask my medical aid before I fall pregnant?

Megan Woods
Navigating the ins and outs of your medical aid scheme benefits can be daunting. Here are my top thoughts and questions you should be asking before falling pregnant. 

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As well as working at Edison Way CrossFit (if you can call doing your passion daily “work”), not many people know that I also work at The Foschini Group. Yup, I am also a corporate gal. I manage the benefits space and one of those portfolios happens to be medical aid. Now, in the months leading up to Ethan’s birth, I was super organised in ensuring that we were fully prepared for our hospital visit. We didn’t (and couldn’t) afford any surprise bills when we were sent on our way.
Here are the top things you must double and triple check with your hospital:
  • Preauthorisation: For a scheduled birth (yes, even having a vaginal birth is scheduled), you need to preauthorise with your medical did and with your hospital. One thing I did not realise, is, if your baby is due in the first quarter of the year and you preauthorise the year before, you need to call again in the new year as the benefits may have changed.
  • What hospitals are covered by your plan? Some medical aids have network hospitals - double check your chosen hospital falls within this network. If it does not you, need to find out what will be covered by your Medical Aid.
  • What expenses are fully covered? Most don’t know that medical aids will cover up to a scheme rate and anything over and above is for your account. It is a good idea to take out a gap cover before you are thinking about getting pregnant.
  • Do I have to deliver in a hospital? What if I want to deliver at home? Different medical aids have different policies on a non-hospital birth. Double check the procedure and cover you have with your Medical Aid.
  • If I have preauthorised for a vaginal delivery but we have to do an emergency Caesar, do I need to inform my medical aid? You would need to check that with your medical aid, as each might have different qualifying criteria.
  • How many paediatrician or clinic visits does my medical aid cover? Once baby is born, you will need to go for many checkups to ensure that your babe is tracking nicely on their growth chart. Double check how many consultations your plan allows before you need to foot the bill yourself.
  • If I want a private room, does medical aid cover this? Most do not cover a private room and it is something you would need to pay for yourself.
  • I want my baby boy to be circumcised - does my medical aid pay? In most cases, not if it’s cosmetic. You would need to call in another doctor to perform the procedure and pay for it yourself.
  • What will my gap cover insure? Gap Cover is a short-term medical insurance, which covers in-hospital fees over and above the medical aid rate, up to the insurance tariff.
  • If I fall pregnant and I am not on a medical aid or gap cover, what can I do? You can still apply for medical aid and gap cover, but you may be subjected to underwriting and waiting periods.
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25 June 2017 06:52

My partner and I have been trying for a baby for over seven years, Finally i am now a mother now

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