Medical Aid Advice

[ghb7860]

Hi guys

So recently I've been surprised with the unexpected news that my wife is pregnant. We're a pretty young couple and have alot to learn so we're still relatively unaquanted with finance, medical aid, insurance and so on.
I've posted this thread seeking advice from all those knowledgeable about medical aid and the costs associated with having a child. Primarily, I'm on the fence as to whether I should look into taking out medical aid for her or not.

Some background:
I'm currently staying with my wife at my parents home and I am covered under my parents medical through medihelp.
I'm a recent Uni graduate and have a Junior Engineering Position earning a very basic salary. I'm still new to the company but I've got a very good opportunity to grow alot with the company after a year.
My expenses are relatively low (at this stage) and use side hussles as well to save up cash.
I understand that if I take out medical aid for her at this point, there are some penalties or certain things that are not covered from what I've been told.

I also just from listening to people and experiences with my family, hear about how many people have kak with their medical aid and end up forking out their own cash to pay for hospital bills and doctors appointments, medications etc.

Is it better that i save up (which im disciplined at) or take out some sort of medical aid plan for her?

Thank you In advance for your responses!

 

[Dom]

Hi guys

So recently I've been surprised with the unexpected news that my wife is pregnant. We're a pretty young couple and have alot to learn so we're still relatively unaquanted with finance, medical aid, insurance and so on.
I've posted this thread seeking advice from all those knowledgeable about medical aid and the costs associated with having a child. Primarily, I'm on the fence as to whether I should look into taking out medical aid for her or not.

Some background:
I'm currently staying with my wife at my parents home and I am covered under my parents medical through medihelp.
I'm a recent Uni graduate and have a Junior Engineering Position earning a very basic salary. I'm still new to the company but I've got a very good opportunity to grow alot with the company after a year.
My expenses are relatively low (at this stage) and use side hussles as well to save up cash.
I understand that if I take out medical aid for her at this point, there are some penalties or certain things that are not covered from what I've been told.

I also just from listening to people and experiences with my family, hear about how many people have kak with their medical aid and end up forking out their own cash to pay for hospital bills and doctors appointments, medications etc.

Is it better that i save up (which im disciplined at) or take out some sort of medical aid plan for her?

Thank you In advance for your responses!

My honest advice, look at the Discovery Classic Smart - 200% coverage & pretty good value for money.

Covers a lot of baby/mother check ups + is a good long term choice (don't skim on Medical Aid with a child (especially).

Has the wife not been on Medical Aid?

Regarding saving up or getting some MA - an MA is the way (risk adjusted costing that is made up of the overall risk pool of all insured members).

 

[Reegz]

Congrats on the soon-to-be-newbie. Fun times ahead! And save up, those small people cost money.

You would do well to speak to a broker about medical aid cover specific to you and your family's needs.

It's always a grudge purchase and most people don't make informed decisions - hence constant complaints about medical aid being kak etc. That's not to say that it's always rosy - but you gotta know what you're getting into.

Most Drs opt for cesarean section over natural birth these days. That procedure costs a ton of money. Most times the anesthetist want to be paid cash and they charge in excess of medical aid rates. Hospital bills and Drs bills add up quickly.

Should any further medical interventions be required you'll need to put down cold hard cash before the hospital will assist. The benefit of medical aid in this situation is that most in-hospital events are covered.

My R0.02 would be to get a basic hospital plan for yourself, the wife and newbie. Make sure to ask about cover for birth and the related costs. Try and negotiate with the Dr and the anesthetist for a better rate if you pay cash. You can claim it back from medical aid.

Essentially what you're buying is peace of mind that if - heaven forbid - there are complications you are covered almost in full for in-hospital treatment for both your wife and child.

 

[dazzy]

Congratulations!

Discuss with your gynae/obstetrician early on how much they charge - specifically if they charge medical aid rates or more. You also need this information for the various doctors who are in the room when you welcome your new addition (your gynae should be able to tell you the rotation of doctors on duty at the hospital) - the paediatrician and the anaesthetist.

One situation which adds alot of cost is if you plan to have a natural birth and end up needing an emergency C section.

If the situation above occurs or if the doctors charge more then medical aid rates - consider getting gap cover - it really helps not having to fork out from your pocket.

Theres a lot more to cover but already some good answers above and I'm sure to follow too.

All of the best! What an exciting time!

PS. It sounds like you have great parents, you will be so grateful for their help when the baby comes!

 

[bionic187]

Get Gap cover. Medical aid may not cover the entire cost of the baby being delivered in hospital. For my first and second child, medical aid did not cover everything, and gap cover paid the remainder of about R25000 (iirc) per child.

If you do get gap cover, just make sure that since you are getting it after your wife is pregnant, that they will still cover on the expected due date. no waiting period etc

 

[Jaacques]

Congrats Guy,

My 2c, No Medical aid will cover her if she is already pregnant. By this I mean, They will insure her but there is a 12 or 18 month cool down before pregnancy can be covered. To have a Gynie do it its like 50k in a private hospital. I went through this exact experience.

 

[TheJudge]

Congrats Guy,

My 2c, No Medical aid will cover her if she is already pregnant. By this I mean, They will insure her but there is a 12 or 18 month cool down before pregnancy can be covered. To have a Gynie do it its like 50k in a private hospital. I went through this exact experience.

Was going to say the cover for pregnancy usually doesn't kick in straight away. May well be the same for gap.

 

[Billionairebum]

I agree with the above two comments, but speak to a broker ASAP so you know what your options are. You probably in for 60-100k depending.

 

[Obie]

Definitely worth it for now and the future.
I took medical aid out a while back (hospital plan) and it's come in more handy than I thought it would.

My son (2 year old) had conjunctivitis and needed to be booked in while they sorted that out.
He was in for 3 days and the total cost covered was around R28k.

Then my wife had an issue and after seeing a specialist we found she needed her gall bladder removed.
That was another roughly R55k they covered.

I'd say over the whole period I've still paid more on medical aid then I've gotten out from them but the peace of mind will always be there incase of a serious incident (car crash etc..) And that's worth it for me and my family.

P.s. get gap cover as it's only a couple hundred rand more each month but they'll cover you for any shortfalls when specialists/doctors charge above medical aid rates.

 

[🇹🇭🇪 🇩🇴🇳]

Congratulations bud...
My Combo for the broke 20 Yr Old (Coastal Saver + Good Gap Cover) so far on paper seems to be a solid cover, day-day I save in a vitality pocket (interest bearing) All in I am paying around 3K for myself.

Also could you not add like your kid and wife to parents one as dependants and pay? depending on how good their MA is it can workout

 

[TheJudge]

Congratulations bud...
My Combo for the broke 20 Yr Old (Coastal Saver + Good Gap Cover) so far on paper seems to be a solid cover, day-day I save in a vitality pocket (interest bearing) All in I am paying around 3K for myself.

Also could you not add like your kid and wife to parents one as dependants and pay? depending on how good their MA is it can workout

Coastal Saver isn't just for broke 20 yr olds, this 47 year old uses it for the family too and its done the job when combined with gap. That said as you can imagine I have to fork out substantially more per month given its a family of four.

 

[Confucius]

I’m on classic saver for the past 9 years. My savings is currently at 115k as I hardly use it. But my company does pay 80% so it’s not much for me with wife and kid.

They generally paid most of the stuff for the pregnancy at discovery rates. Opted for a natural water birth at genisis (when they still existed) and I think discovery didn’t pay like 3-4k which I claimed from gap cover.

So for me, it works.

Medical aid and insurance are grudge purchases but one should always have them if possible.

 

[el3venth]

I would outright call places like Discovery and Profmed (my preference after being at both) and ask them if they are prepared to waive some of the penalties if you join with them. You would be surprised what you can accomplish when you pit companies against each other.

 

[Divan85]

Didn't read all the above responses, however having just had our first born (born 3 weeks ago) I just went through all this.

Having medical aid is a must, which / what type of cover you get depends on your needs / wants and what you can afford. The medical aid will pay whatever is covered by them up to the "scheme rate", if a doctor (especially the anesthetists) charge more than the "scheme rate" then the medical aid won't cover it. Sometimes they will cover up to a certain percentage, ie. 150% or 200% or whatever.

In our case the anesthetist charged 400% scheme rate whereas the medical only covers up to 200%, so the additional 200% should be paid by me. For those reasons I have GAP cover. GAP cover covers everything that the medical does not cover in full (take note - DOES NOT COVER IN FULL), meaning they have to cover it to a certain extend. If the medical aid does not cover it at all, then GAP won't cover it either.

Best bet would be to chat with a broker who can explain all of this to you, the medical aid, pros and cons of different types of plans, GAP cover, etc. and then make an informed decision based on that.

Just be mindful, some medical aids will see your wife's pregnancy as a "pre-existing condition" and might not cover any medical expenses with regards to the pregnancy. So make sure the pregnancy will be covered.

 

[Divan85]

One situation which adds alot of cost is if you plan to have a natural birth and end up needing an emergency C section.

If this happened to you then you should definitely query it with your medical aid / doctor. This is exactly what happened with us, we were going natural and then because of pre-eclampsia my wife had to get an emergency c-section. The anesthetist actually told us that since it is an emergency procedure the medical aid will cover all the costs whereas if it was a selective procedure (c-section by choice) then the medical aid will not as it is deemed unnecessary and therefor you pay for it.

I must also add that the doctor provided us with revised authorization codes to update the medical aid on the fact that the procedure is changing from natural birth to emergency c-section. Without that I doubt they would have paid for it, I don't know.

 

[Oj0]

have alot to learn

my wife is pregnant

.

 

[CoolBreeze]

I thought I'd just add my 2c worth - as an obstetrician.

Firstly, congratulations!

Secondly, no medical aid will cover her now, unless she was covered by some medical aid and had to change because of her job. HOWEVER, and I can't stress this enough, the baby will be covered in full from birth. That is critically important, on the off chance you need ICU cover for baby. NICU runs at about R250k/week, so having that peace of mind is invaluable, in my opinion.

As others have said, the hospital bill alone is going to be between R25k and R50k. You can look at R7500 to R15000 for the anaesthetist, if needed, and somewhere between R10000 and R30k for the obstetrician. On average, female doctors are more expensive. Also, don't forget, everything in life is negiotiable.

My personal advice, especially if you're as disciplined as you claim - take a hospital plan. All medical aids are kak, but you have to pick one. I'm with Discovery. Coastal core. No savings, I do that on my own. We used to be on Classic saver, but after 3 years with money left over in our savings account, despite my wife and I both getting specs and contact lenses, I decided I'd rather have that money in my bond than in Discovery's pocket. The first year or two is a bit dicey, but if you look at the difference between something like Coastal core and Classic saver, and you put away the balance, you'll not only be fine, but you'll also have a nice emergency fund for whatever.

 

[Frana.mtb]

General question ( please remove if interfering )

Seeing a therapist ( should've started long ago ) X shit Medaid has my mental benefit at R 29 152.40 for the year

Therapist is R 4998 pm

When this runs out I need to cover it , which feels like BS considering I'm paying nearly 6k for healthy single 26 old with no dependents.

Is there a way to get a prescription for this type of thing to force them to pay it ?

It's definitely a good thing for me but I'm scraping by and another 5k bill monthly is so far out of the question its almost funny

 

[TheJudge]

General question ( please remove if interfering )

Seeing a therapist ( should've started long ago ) X shit Medaid has my mental benefit at R 29 152.40 for the year

Therapist is R 4998 pm

When this runs out I need to cover it , which feels like BS considering I'm paying nearly 6k for healthy single 26 old with no dependents.

Is there a way to get a prescription for this type of thing to force them to pay it ?

It's definitely a good thing for me but I'm scraping by and another 5k bill monthly is so far out of the question its almost funny

Really comes down to whether it is a PMB or not, if not they can't be forced unless your particular plan covers it (then its a requirement of the contract).

I know Discovery does have a system you can use to file a request even if it is not specifically covered.

 

[goldfritter]

General question ( please remove if interfering )

Seeing a therapist ( should've started long ago ) X shit Medaid has my mental benefit at R 29 152.40 for the year

Therapist is R 4998 pm

When this runs out I need to cover it , which feels like BS considering I'm paying nearly 6k for healthy single 26 old with no dependents.

Is there a way to get a prescription for this type of thing to force them to pay it ?

It's definitely a good thing for me but I'm scraping by and another 5k bill monthly is so far out of the question its almost funny

Firstly good job on seeing a therapist. It's never too late.

With Discovery your PMB cover for mental health admissions can be converted to psychologist sessions, up to 15 a year IIRC. However you must be diagnosed by a doctor with one of the PMB mental health conditions, and there is a bunch of paperwork for both your doctor and your psychologist to do.

I don't remember all the details, chat to your psychologist and doctor, they should know the ropes.