Welcoming a new baby into the world is the ultimate life event.
It can also be an expensive occasion, particularly if you’ve failed to plan properly and well in advance.
How much it costs to deliver a baby in South Africa depends on a number of factors.
Natural birth or Caesarean section
According to data from medical aid schemes, the average cost of a natural birth in a private hospital is around R25,000, including two to three days spent in hospital.
If your baby is delivered by Caesarean section, the cost jumps to between R38,000 and R44,000. That’s excluding the costs of an average hospital stay of three to four days.
If complications arise and your baby needs specialised care in a neonatal intensive care unit, you can add another R16,000 to the hospital bill – per day.
Costs after baby is born
Once your baby is born, there are further expenses that have to be covered, such as:
- newborn screening tests
- the services of a doula
- lactation and nutrition consultations
- post-natal follow-up visits to a paediatrician.
Medical aid for pregnancy: what is and isn’t covered
As an enrolled member of a medical aid scheme in South Africa, you can expect some help when it comes to paying the hospital bill and the specialists involved in the delivery.
Whether all the medical expenses are covered in full is option-dependent.
Most schemes will pay, in full, for a private or public ward in a network hospital.
Funds are extracted from the major medical benefit and cover is usually limited to a prescribed number of days.
Your choices impact the cost
Should you choose to give birth in a hospital that’s not part of the scheme network, a co-payment is usually levied for your account.
Some schemes don’t offer any benefits for elective Caesarean sections, particularly in the low-cost, entry-level options.
How medical schemes cover in-hospital specialists
Costs become more complicated when it comes to covering the rates charged by the obstetrician, anaesthetist and paediatrician for services rendered in-hospital.
Most medical aid providers only cover specialist rates in full when they’re part of the scheme network.
Thereafter, specialist fees are paid up to a defined percentage of the scheme rate, usually between 100 and 300%. Payments are made from the major medical benefit.
As specialists can charge up to seven times that amount, there may be a significant shortfall for you to cover – either out of your own pocket or by submitting a claim to your gap cover provider.
Gap cover for pregnancy: why it’s essential
Gap cover is a low-cost, short-term insurance product that complements existing medical aid benefits.
It’s designed to cover the funding deficit between what specialists charge in-hospital and what the medical aid scheme pays.
For just a few hundred rand a month, you’ll have the benefit of a policy that plugs the so-called specialist gap by up to 500% of the scheme rate.
Schemes that offer extra maternity benefits
There are medical aid schemes that offer that little bit extra when it comes to covering the cost of pre- and post-natal care.
Discovery Health has a dedicated maternity benefit that covers pre-natal healthcare services at the scheme rate – up to 12 antenatal consultations, ultrasounds, chromosome tests and blood tests.
Maternity cover varies across Discovery Health medical aid options.
Typically, birth-related benefits are paid from the hospital benefit. The services of a doula may be covered by medical savings and newborn screening may be paid from day-to-day benefits.
Cover is activated on registration of the My Pregnancy programme.
Bonitas has a standalone maternity benefit that doesn’t impact medical savings or day-to-day benefits.
Bonitas maternity cover depends on the medical aid option you choose.
Depending on the option, cover may be provided for a private ward stay, antenatal consults and classes, ultrasounds, amniocentesis and newborn hearing screening.
Delivery costs are paid from the hospital benefit.
Fedhealth has an option-dependent Foundation benefit that provides health screening and maternity benefits, such as doula cover, newborn hearing screening and post-natal midwife consultations, both in and out of hospital.
In addition, the Fedhealth Baby programme provides 24/7 support and advice during and after pregnancy, together with a selection of store vouchers and discounts.
Joining a medical aid scheme when pregnant
How much it costs – and how much you’ll have to pay – to deliver a baby in South Africa depends on when you join a medical aid scheme.
Costs relating to your pregnancy and the birth are not covered if you’re already pregnant when you join the scheme.
Pregnancy is deemed a pre-existing condition and excluded from cover for the first 12 months.
However, your newborn’s medical needs are covered, provided you register your little one with the medical aid scheme within 30 days of delivery.
Ask IFC for objective advice
If you want to know more about medical aid cover during pregnancy, contact IFC medical aid brokers on 021 593 3012. We will give you objective advice about the best possible medical aid and gap coverage for your needs.
