Maternity

You may have lots of questions surrounding pregnancy, the information below details how BEMAS covers pregnancy and childbirth.

Below you will find a detailed explanation of how we cover for maternity benefits as well as information on what you need to do to register your baby on the Society so he or she is covered.

To have access to the benefit, you need to activate your Maternity and early childhood benefits, find out how you are covered and authorise your hospital admission, by calling 0860 002 107 or click here to read more about the maternity benefit.

Antenatal and postnatal care

• You have cover for up to 12 ante-natal consultations by a specialist, general practitioner or midwife per pregnancy, limited to your Maternity Benefit limit and included in the overall annual limit.
• You also have access to postnatal care which includes one postnatal consultation, one nutritional assessment with a dietitian and two mental healthcare consultations with a GP, gynaecologist or psychologist.
• You are also covered for one lactation consultation with a registered nurse or lactation specialist from the Maternity Benefit at the Society Rate.
• Your baby under the age of two years is covered for two visits to a GP, paediatrician or an ENT from the Maternity Benefit at the Society Rate.

Scans

• Pregnancy scans are limited to funds available in your Maternity Benefit limit
• Limited to two 2D scans per pregnancy, 3D and 4D scans will be covered up to the cost of a 2D scan

Cover for having a baby

If you are expecting a baby, we want to make sure the childbirth is a time of celebration.

Before you go to hospital for any planned procedure, you must:

• See your doctor
• Authorise your hospital admission with us beforehand as hospital cover is not automatic. You must authorise your admission to hospital at least 48 hours before you go in.

We need knowledge of your hospital admission so we can manage your costs in the best way and give you information that is relevant to how we will cover your hospital stay. If you do not authorise your admission, you will be responsible for the payment of all accounts.

Costs related to childbirth

We cover childbirth from your Hospital Benefit. Your Hospital Benefit covers your hospital account, internal medical devices and emergency medical services. Hospital cover includes home births done by midwives with valid practice numbers and who are registered with the Board of Healthcare Funders. You need to pre-authorise your delivery even if it is a home birth.

Caesarean section

We cover a stay of four days and three nights in hospital. You will have a co-payment of R3 100 for a caesarean section birth that is not medically necessary.

Normal vaginal deliveries

We cover a stay of three days and two nights.

Home births

We cover home births from the Hospital Benefit. The midwife attending the birth must have a valid practice number and be registered appropriately with the Board of Healthcare Funders. You must let us know if you choose to have a home birth. The midwife charges a global fee for the confinement (the birth of the baby) and this includes any follow-up care needed for three days after the delivery.

Make sure your baby is covered

The baby will be covered for the calendar month of his or her birth. To continue cover contributions for the baby must be paid from the first month following the baby's birth.

• Example: A baby is born on 3 March. The mother is registered on the Society. The baby is covered until 31 March. If the baby needs cover from 1 April onwards, the baby must be registered on the Society.

The Medical Schemes Act allows 90 days from the date of birth for the parents to register the baby with the Society.

The baby may be subject to underwriting, if he or she is not registered within the 90-day period.

We may not pay for your treatment in full

Cover is based on our rules

Once we authorise your hospital admission, we may not pay for the treatment in full. Your cover is according to the Society Rules, funding guidelines and clinical rules. There are some expenses you may be responsible for while you are in hospital that the Hospital Benefit does not cover, for example, private wards. Certain procedures, medicines or new technologies need additional authorisation and review while you are in hospital. Your pre-authorisation consultant will confirm your cover when you call us to pre-authorise.

The following in-hospital expenses are not covered by the Maternity Benefit:

• Mother and baby packs supplied by the hospital
• Your lodger or border fees if your baby needs to stay in hospital for longer and you choose to stay on
• Circumcisions are not covered unless medically necessary and home nursing related to this procedure will not be covered
• The bed-booking fee that some hospitals may require you to pay
• The cost of a birthing pool for water births if you choose to hire a birthing pool outside of what is supplied.