Medical Aid If Already Pregnant

What South African Mothers Need to Know

If you are already pregnant and do not yet have a medical aid plan, joining a scheme is still possible—but there are important limitations to understand. In South Africa, pregnancy is considered a pre-existing condition, which means most medical schemes will exclude pregnancy-related benefits such as antenatal consultations and delivery costs. Knowing these rules can help you plan for out-of-pocket expenses while ensuring your newborn is covered after birth.

Can You Join Medical Aid While Pregnant?

Yes, you can join a medical aid while already pregnant, even if you have never had a plan before. However, because pregnancy is a pre-existing condition, schemes typically apply a condition-specific waiting period, often up to 12 months, during which pregnancy-related costs are excluded. General waiting periods of up to three months may also apply for other medical expenses.

While pregnancy-related costs like antenatal consultations, ultrasounds, and delivery fees are usually excluded, medical schemes are legally required to cover emergency care and Prescribed Minimum Benefits (PMBs). This ensures that life-threatening complications during pregnancy are covered even if you join late. Additionally, in most schemes, your baby will be covered immediately after birth, giving you peace of mind for neonatal care and early medical needs.

What Coverage Can You Expect?

Even as a new member who is already pregnant, you may receive coverage for:

• Emergency medical situations: Life-threatening pregnancy complications such as preeclampsia, severe bleeding, or infections.
• PMB-related treatments: Certain complications linked to pregnancy that qualify under Prescribed Minimum Benefits.
• Baby’s coverage: Most schemes automatically cover the newborn immediately after birth, including hospital care and any necessary medical treatment.
• Other non-pregnancy-related care: General hospital visits, chronic disease management, and routine medical care unrelated to your pregnancy.

It is important to understand that all routine maternity costs, including antenatal consultations, scans, and normal or caesarean deliveries, are typically excluded for members who join while already pregnant. However, emergency situations and the baby’s immediate postnatal coverage remain protected.

Tips for Joining Medical Aid While Pregnant

• Join as soon as possible: Early enrollment maximizes coverage for emergencies and PMBs before delivery.
• Understand waiting periods: Ask the scheme specifically about pregnancy exclusions and waiting periods for pre-existing conditions.
• Check emergency and newborn coverage: Ensure that complications and your baby’s immediate medical needs are fully covered.
• Budget for excluded costs: Routine antenatal care and delivery are excluded, so plan for these out-of-pocket expenses.
• Compare schemes: Some plans offer better emergency and newborn coverage for pregnant members.

What to Avoid

Do not assume full maternity coverage will be available if you join mid-pregnancy. Exclusions for antenatal care and delivery can lead to significant out-of-pocket expenses. Always confirm the scheme’s maternity rules, waiting periods, and coverage for emergencies and your newborn before joining.

Frequently Asked Questions

Can I join a medical aid if I’m already pregnant?

Yes, but pregnancy is considered a pre-existing condition. Most schemes exclude antenatal consultations and delivery costs for members who join while already pregnant.

Will delivery costs be covered?

No. Routine delivery costs and antenatal care are typically excluded for new members who are already pregnant. Only emergencies and Prescribed Minimum Benefits (PMBs) are covered.

Is my baby covered after birth?

Yes. In most schemes, the newborn is automatically covered immediately after birth, including hospital care and any necessary medical treatment.

Are emergencies during pregnancy covered?

Yes. Life-threatening complications are generally covered immediately, even if you are still within the condition-specific waiting period.

How long are waiting periods for pregnancy?

Condition-specific waiting periods for pregnancy can last up to 12 months. General waiting periods for other benefits usually last up to three months.

What can I do to minimize risks?

Join as early as possible, understand which emergencies are covered, and budget for out-of-pocket costs for antenatal care and delivery while ensuring your newborn is protected.