What are Maternity Benefits?

Maternity Benefits are available for members and their dependants.

For the birth itself, benefits are paid from Hospital and Trauma Benefits.
Associated services such as antenatal classes and scans are paid from the Everyday Services Benefits under each Plan (except Hospital Network Plan, which does not offer any Everyday Services Benefits).

For ease of reference, the various benefits and procedures around maternity have been combined in this chapter.

While you are pregnant

	PLATINUM	COMPREHENSIVE	TRADITIONAL	SAVINGS
ANTENATAL CONSULTATIONS	R8 300 combined maternity benefit per family per year. Once the limit is exhausted, this benefit will be paid from the Routine Medical Benefit limit. 3 x 2D or 3D scans per family	R4 500 per family
SCANS		3 x 2D pregnancy scans per family per year
ANTENATAL CLASSES Normal delivery and labour Breathing exercises Caesarean section Pain relief Breastfeeding Post-delivery body changes Care of the baby during the first few weeks It is recommended that you attend antenatal classes between the 25th and 30th week of pregnancy. Most often there are about six to eight classes, each two hours long, presented by a nurse or midwife.		R1 660 per family
ANTENATAL VITAMINS (excluding calcium supplements and Omega preparations)	Payable from Routine Medical Benefit, at Medicine Price List.	Comprehensive Plan: Paid from available PMSA. Paid at Medicine Price or Medicine Price List, whichever is the lesser. Traditional Plan: Paid from Medicine sub-limit under Everyday Services Benefit. Paid at Medicine Price or Medicine Price List, whichever is the lesser. Member: R3 705 Member +1: R5 770 Member +2: R6 090 Member +3: R7 130 Savings Plan: Paid from available PMSA.

REMEMBER TO PRE-AUTHORISE YOUR HOSPITAL ADMISSION

by contacting Hospital Authorisations on 0860 100 080. This is usually done around 12-14 weeks; usually when you book your bed at the hospital.

The Scheme’s YourHealthPortal offers moms-to-be a very handy tool, offering weekly bite-sized emails with interesting information about:

what is happening in your body that week,
how your baby would be developing during that week, and
what you need to do (if anything)

There is also a wide range of more general articles around pregnancy and babies on the Portal – simply type an appropriate search term to access this information.

HOW TO REGISTER:

Visit the Scheme’s website and log in to the Member Zone. Go to the YourHealthPortal. View ‘Programmes’ and click on ‘Pregnancy Pogramme’ to access this tool. (You would need to deregister to stop these emails if you deliver before your due date or if your pregnancy comes to an unexpected end.)

Giving birth

CONFINEMENT IN HOSPITAL

Cost or Medical Scheme Rate, whichever is the lesser, subject to the overall annual limit.

As per clinical guidelines and protocols.

Further days will require motivation by the attending doctor and approval by a Case Manager.

MIDWIFE DELIVERY

Society for Private Nurse Practitioners’ tariffs, including pre-and-post confinement costs, if a gynaecologist is not used.

CONFINEMENT IN A REGISTERED BIRTHING UNIT

Cost or Medical Scheme Rate, whichever is the lesser, subject to the overall annual limit.

4 x post-natal midwife consultations per event are also covered.

UPDATE YOUR PRE-AUTHORISATION

On the day of your admission or within one working day, update your hospital authorisation by contacting Hospital Authorisations on 0860 100 080. Remember that if you do not pre-authorise your stay in hospital, you will have to pay a penalty on your hospital account.

Choosing your birth partners and setting

Whether you choose a gynaecologist, a general practitioner, or a registered midwife to help you with your birth will depend on a number of factors, including what kind of experience you want, where you plan to give birth, whether your pregnancy is normal or high risk, and what your medical scheme will pay for. Many women prefer the peace of mind of a gynaecologist, especially if they expect higher risk pregnancies and deliveries. For others, the personal touch of a midwife is more what they are looking for. Some combine these options, by opting for a midwife, but with a gynaecologist as a back-up. Some women also employ a doula – someone whose primary focus is on the physical and emotional comfort of the mother during the birth process. This can also be a close friend or sister who has already gone through the birth process herself and has the temperament needed for this role.

The case for natural birth

Emergency Caesarean sections have saved the lives of countless mothers and babies who would have died, had they not received this lifesaving intervention. However, is it really the best option for you and you baby if there is no emergency?

Since the 17th century, midwives and surgeons have experimented with Caesarean section in situations where the mother and/or child were in danger. The operation was risky back then and there was no guarantee of survival. But today the procedure is safer and immensely popular.

It’s become so prevalent in fact, that in South Africa, C-section rates in the private sector stand at over 70%, according to 2014 information by the South African Council for Medical Schemes. This is worrying as the World Health Organisation recommends an ideal 10-15% Caesarean section rate worldwide. The C-section rate exceeding the WHO recommendation is a worldwide trend.

WHY ARE SO MANY WOMEN CHOOSING C-SECTION?

A prospective mother’s anxiety is often a motivating factor when choosing C-section. The media and society in general feeds this fear of something that used to be normal: natural childbirth. In contrast, we have casual attitudes towards surgery and have lost our fear of medical procedures, even though surgery is also risky. We simply do not have enough education on the positives of natural childbirth.

In an environment where patients are increasingly suing their healthcare providers for malpractice, doctors may also err on the side of safety by encouraging a mother-to-be to choose a C-section.

WHAT ARE THE BENEFITS OF NATURAL BIRTH?

There are many benefits to choosing natural birth over C-section (if the mother’s and baby’s health permits this).

GOOD FOR BABY

Babies born via natural delivery have physiological advantages, say the experts. For example, babies’ digestive systems are colonised by their mother’s flora as they pass through the birth canal; they receive stimulation from being squeezed and having their lungs compressed, and emerge more enlivened, with fewer admissions for wet lungs, fewer respiratory problems, and a lower incidence of asthma.

GOOD FOR MOM

For the mother, recovery time is quicker and bonding is easier, and she can experience birth as empowering.

GOOD FOR THE BUDGET

A natural delivery’s costs are around half of that of a C-section. This means that you have smaller outof- pocket expenses with a natural childbirth. Your medical scheme also has lower delivery claims, which ultimately has a positive effect on your contributions and benefits.

After birth

REGISTERING YOUR BABY AS A DEPENDANT	You have to notify the Scheme of the birth of your baby, and arrange for him/her to be registered as a dependant on the Scheme. Your new-born baby can be registered telephonically by calling 0860 100 080. We will require the full name, surname and date of birth of your baby. Be sure to register the baby as a dependant within 30 days of birth, so that the Scheme can register your baby from date of birth and therefore cover any medical claims incurred for the baby during that time. PRINT REGISTERING YOUR BABY AS A DEPENDANT
AFTER-BIRTH CARE SERVICES	After-birth care services, for example home visits by a registered nurse and phototherapy treatment for your baby at home (if necessary) are subject to managed healthcare protocols and prior authorisation.
CHILD VACCINATIONS	The Platinum Plan covers child immunisations at a private clinic or doctor at the Medicine Price List, up to a limit of R5 940 per family per year. (This is for medication only – the facility fee or nursing consultation fee will not be covered from this amount.)