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Health Insurance for Pregnancy

The Health Insurance for Pregnancy in South Africa revealed.

We tested and verified health insurance for pregnancy in South Africa.

This is a complete guide to the best health insurance for pregnancy in South Africa.

In this in-depth guide you’ll learn:

☑️ What is a health insurance?
☑️ Can you get health insurance if you are already pregnant?
☑️ What is the difference between medical aid and health insurance?
☑️ Is health insurance expensive?
☑️ Is it free to give birth in a government hospital in South Africa?

So if you’re ready to go “all in” with the best health insurance for pregnancy in South Africa, this guide is for you.

Let’s dive right in…

A guide to Health Insurance for Pregnancy

Introduction
Three best health insurance providers for pregnancy.
How the System of Medical Insurance Operates
Why Do Pregnant Women Need Health Insurance
The Vital Role of Health Insurance during Pregnancy
FAQ

Introduction of health insurance for maternity care

☑️ The healthcare system in South Africa is split into two categories: the public system and the private system. Unfortunately, South Africa’s public healthcare system has a relatively low standard of quality, which may be attributed to a shortage of medical professionals, ageing buildings, and lengthy wait periods.

☑️ It is imperative that you make the investment in a health insurance plan that actually pays out for what you believe it covers. Before choosing a health insurance plan, it is in your best interest to acquire knowledge concerning a number of key factors first.

☑️ The insurance coverage offered by local companies are dependable as well as reasonably priced.

☑️ This situation is made worse by the escalating cost of private insurance, which places it well out of reach for a significant number of people who live in South Africa.

The 3 best health insurance for Pregnancy – Summary

🔎 Provider	📝 Plan Name	🤰 Maternity / Pregnancy Cover Summary
Dis‑Chem Health	MyHealth Core	Includes 2 × 2D sonar scans per pregnancy via network provider. Requires pre‑authorisation. Adults ~R469 pm; children ~R329 pm
	MyHealth Plus	Same 2 × 2D scans as Core, plus broader day‑to‑day and accident cover. Adults ~R649 pm; children ~R439 pm
	Gap Base	Covers childbirth tariff shortfalls up to 500% of medical scheme rates. Adults ~R141–176 pm; children ~R20–29 pm
Oneplan Health	Blue Plan	Up to R610 per pre‑birth visit (max 3 visits; annual limit ~R1 830); Natural birth & emergency C‑section up to ~R50 000; Neonatal cover also ~R50 000;
	Professional Plan	Up to R615 per visit (3 visits, annual ~R1 845); Birth cover ~R60 000; Neonatal ~R60 000; standard waiting periods (~7– 12 months)
	Executive Plan	Up to R650 per visit (4 visits, annual ~R2 600); Natural/C‑section up to ~R70 000; Neonatal ~R70 000; maternity start after 12‑month wait
Affinity Health	Hospital Plan	Covers natural/home/water births up to R30 000; C‑section up to R40 000 per birth; hospitalisation benefits included
	Combined Medical Insurance Plan	Includes day‑to‑day + hospital cover. Same maternity limits: R30 000 (natural) and R40 000 (C‑section); Broader primary care and screening benefits; Premiums: ~R1 968 pm for main member, dependents ~R1 808 / child ~R688

Affinity Health

Affinity Health stands out as a premier option for individuals and couples in South Africa who are in search of affordable and adaptable health insurance that provides robust pregnancy-related benefits, all while avoiding the intricacies associated with traditional medical aid schemes.

With a diverse range of plans designed to meet various healthcare requirements, Affinity Health simplifies the process of securing coverage that facilitates a healthy pregnancy experience.

Below are several plans that deliver particularly advantageous benefits for expectant mothers:

Day-to-Day Plan

The Affinity Health Day-to-Day Plan represents an outstanding choice for those who need regular access to routine healthcare services during their pregnancy. It encompasses unlimited GP consultations, radiology, pathology, optometry, and basic dental care—many of which are crucial for prenatal health.

These outpatient benefits provide a practical and cost-effective solution for expectant mothers who require frequent check-ups, diagnostic assessments, and overall health monitoring throughout their pregnancy.

Hospital Plan

For individuals who are worried about maternity hospitalization, emergency treatment, and delivery, the Affinity Health Hospital Plan offers private hospital coverage that includes major illnesses, accidents, and maternity services. This plan is particularly advantageous for women who are preparing for childbirth or are considering pregnancy in the near future.

Additionally, it covers visits to the casualty room, which offers reassurance in the event of pregnancy-related emergencies or complications.

Combined Plans

The Combined Plans present a comprehensive solution by merging the benefits of both the Day-to-Day and Hospital Plans. This guarantees thorough care, ranging from routine prenatal appointments to hospital deliveries and emergency services. It is an ideal choice for those seeking complete coverage throughout the entire pregnancy journey and beyond.

What is the monthly premium for the Affinity Health insurance plans?

The range of monthly costs offered by Affinity Health plans is R869 to R1, 968.

What Is the Waiting Period for Affinity Health Insurance Benefits?

Signing up for health insurance with Affinity Health often involves a three-month waiting period. In addition, there is a 12-month waiting period for people with pre-existing conditions. Certain services or ailments may have waiting periods before new members are entitled to receive benefits.

How to Claim for Affinity Health Insurance Benefits

✅ Affinity Health has an online claim form that you can obtain and complete. Verify that the treatment, provider, and cost facts are complete and accurate.
✅ Your claim and any supplementary materials can be submitted in a number of ways:
Send your filled out claim form to the email address provided by Affinity Health, and be sure to attach scanned copies of any supporting papers.
The required documents can also be faxed to Affinity Health if that is more convenient for you.
Affinity Health also supplied a physical address where you can deliver the necessary papers.
If you have an account with Affinity Health’s online portal, you may be able to submit some claims electronically.
✅ If you would like to know where your claim stands after submitting it, you can reach out to Affinity Health’s customer care via phone or email. They can also provide you with updates if you need more information.
✅ After receiving your claim, Affinity Health will examine it for accuracy and determine how well your plan meets your needs. Claim complexity and data quality can affect how long it takes to process a claim.
✅ As soon as your claim is reviewed and approved, Affinity Health will notify you. Assuming all is well, they will arrange for your health insurance to cover the cost. If your claim is denied, they should explain what went wrong and how to appeal.

Affinity Health Insurance Contact Details

If you need to contact Affinity Health, you can do so through the following channels:

✅By calling their Call Centre at 0861 11 00 33.
✅Emailing customer support at [email protected]
✅Mailing Affinity Health at Postnet Suite 124, Private Bag x101, Farramere, Benoni 1518
✅Faxing Affinity Health at 086 607 9419
✅Adding Affinity Health as a contact and sending customer support a message at 079 479 3230

The final option is to visit the insurer’s office at 1 Dingler Street, Rynfield, Benoni 1501

OnePlan Health Insurance

OnePlan Health provides a diverse selection of health insurance plans that are particularly advantageous for individuals in South Africa seeking pregnancy benefits. Renowned for its adaptability and user-friendly nature, OnePlan offers coverage options that assist expectant mothers in effectively managing their healthcare needs—free from the complications associated with traditional medical aid schemes.

Core Plus Plan

The Core Plus Plan represents an excellent option for those in search of a balance between cost-effectiveness and essential pregnancy-related healthcare. This plan encompasses day-to-day benefits such as consultations with doctors, prescribed medications, and basic dental care, which are vital during prenatal care.

Additionally, it provides in-hospital benefits including accident coverage and hospitalization due to illness, offering reassurance in the event of unforeseen complications during pregnancy.

Blue Plan

The Blue Plan is designed for individuals who need more comprehensive pregnancy coverage. It incorporates all the benefits of the Core Plus Plan, along with increased coverage limits and significant additions such as maternity pre-birth coverage and neonatal care.

This plan also addresses dread diseases and provides substantial accident protection, making it suitable for those intending to embark on a safe and well-supported pregnancy journey.

Professional Plan

For those desiring the highest level of pregnancy-related health coverage, the Professional Plan presents a wide array of benefits. It includes elevated limits on both day-to-day and in-hospital care, as well as coverage for specialist consultations and advanced maternity services.

This plan is particularly advantageous for expectant mothers requiring comprehensive support, as it encompasses coverage for natural births, emergency caesarean sections, and neonatal care, ensuring that both mother and child receive exceptional care throughout the pregnancy and birthing process.

What is the monthly premium for the OnePlan Health insurance plans?

Prices from OnePlan range from R500 for the entry-level plan to R1975 for more extensive coverage, depending on the plan you choose.

What Is the Waiting Period for OnePlan Health Insurance Benefits?

Enrollment in OnePlan Health Insurance is available in a variety of forms, each with its own set of waiting periods and coverage options:

📣 There is usually a three-month waiting period before most medical services are covered by the daily benefits. Consequently, during the first three months of coverage, you will not have access to many of your usual benefits.
📣 All pre-existing conditions are subject to a 12-month waiting period. If you want coverage for costs related to conditions that were there before you joined OnePlan, you’ll have to wait twelve months from the policy start date.
📣 There is usually no waiting time for accidental injury claims; in fact, you can start making them the moment your coverage starts.

How to Claim for OnePlan Health Insurance Benefits

✅ Check to see if the OnePlan app is already installed on your cellphone. The app is essential for managing your coverage and filing claims.
✅ Simply launch the app, enter your information, and you’ll have access to all of your policy details and claims alternatives.
✅ Make sure you have all the necessary papers to back up your claim before you submit it. This may include relevant medical reports, invoices, and receipts.
✅ Use the app to submit a claim. You have the option to use the app to submit your claim details along with any necessary supporting papers. With step-by-step instructions and helpful prompts, this method is designed to be user-friendly.
✅ The OneCard is a unique feature offered by OnePlan. Once your claim is approved, the funds will be credited into this card. By paying for medical services directly with the OneCard, you can avoid paying out of pocket.
✅ Once you’ve submitted your claim, you may use the app to track its progress. It is the intention of OnePlan’s claims processing app to provide users with real-time updates regarding the progress of their claims.
✅ Please contact OnePlan’s customer care staff via the app in the event that you encounter any issues or concerns during the claim submission process. They are eager to help and will try their best to resolve any issues you may have.

OnePlan Health Insurance Contact Details

🟧 Phone:

General Inquiries: 010 0010 141
- Monday to Friday: 8:00 AM – 5:00 PM
- Saturday: 8:00 AM – 12:00 PM
Pet & Health Hospital Authorisation, Admission & Emergency: 24/7 (same number: 010 0010 141)

🟧 WhatsApp:

083 794 5452 (Available during business hours)

🟧 Email Addresses:

Customer Care (Health): [email protected]
Maternity Pre-birth & Specialist Authorisation: [email protected]
Hospital Claims: [email protected]
Hospital Authorisation & Admission: [email protected]
Day-to-Day Claims: [email protected]a
General Complaints: [email protected]

Dis-Chem Health

Dis-Chem Health provides a variety of health insurance plans that cater to individuals in South Africa who are looking for pregnancy benefits. These plans strike a balance between affordability and extensive coverage, making them an excellent option for those in need of dependable maternity-related healthcare without the exorbitant costs associated with traditional medical aid schemes.

MyHealth Core Plan

📌 The MyHealth Core Plan serves as an excellent choice for individuals seeking essential pregnancy-related healthcare services at a reasonable price.

This plan encompasses coverage for:

Day-to-day medical requirements such as GP visits Basic dentistry and optometry Chronic medication for a limited selection of conditions Although it does not constitute a complete maternity package, this plan is well-suited for expectant mothers who need routine healthcare and support throughout their pregnancy, without the necessity for extensive specialist services.

MyHealth Plus Plan

📌 The MyHealth Plus Plan provides a more all-encompassing solution for those in search of broader pregnancy benefits.

In addition to all the features included in the Core Plan, it offers:

Unlimited access to doctors Specialist consultations (including obstetricians and gynaecologists) Chronic medication for a wider array of conditions Virtual consultations for enhanced convenience and accessibility.

This plan is especially advantageous for individuals requiring ongoing support during pregnancy and access to a wider range of healthcare services, thereby offering greater peace of mind throughout the maternity experience.

What is the monthly premium for the Dis-Chem Health insurance plans?

With a number of options available, the plans’ prices start at R120 and go up to R705 a month.

What Is the Waiting Period for Dis-Chem Health Insurance Benefits?

The waiting periods for Dis-Chem Health insurance policies typically vary by plan type and level of coverage. But in any case, here are some general guidelines for common advantages:

📣 Claims arising from accidents are immediately covered, thus there is no waiting time.
📣 There is normally only a one- to three-month waiting period for common benefits like basic dental treatment, prescription medications, and doctor’s checkups.
📣 There could be lengthier waiting periods of 6 to 12 months for hospitalization benefits and coverage for serious diseases or procedures.

How to Claim for Dis-Chem Health Insurance Benefits

✅ You must complete Dis-Chem Health’s claim form. You can usually find this form online or at any Dis-Chem Health store. Please ensure that all the details are correct in order to avoid any unnecessary delays.
✅ Include any necessary supporting documents with your completed claim form when submitting it. Email, postal mail, or visiting any of Dis-Chem Health’s branch locations are the usual ways for customers to make claims.
✅ Dis-Chem Health will handle the claim processing according to your insurance policy when you submit it. Checking the claim data and supporting paperwork for accuracy is what this entails.
✅ You will be notified of Dis-Chem Health’s decision on the claim. After reviewing your claim, they will either pay the healthcare provider right away or return any money you paid out of pocket.

Dis-Chem Health Insurance Contact Details

✅ Call:

Sales: 0861 029 892
Customer Support and General Enquiries: 0861 029 892
Family, Legal or Financial Counselling: 0861 635 766
Emergency (Netcare911): 082 911

✅ Email:

Sales: [email protected]
Customer Support and General Enquiries: [email protected]
Family, Legal or Financial Counselling: None
Emergency (Netcare911): None

❌ WhatsApp: None

❌ Fax: None

✅ Mobile App: Available on Apple Store, Google Play and AppGallery

✅ Website enquiry: https://dischemhealth.co.za/contact/

☑️READ also about Hospital Plans below R1500 in South Africa

☑️READ also about Medical Aid Plans below R1500 in South Africa

How the System of Medical Insurance Operates

☑️ Health insurance plans include hospital bills as well as routine medical charges. For each day the client is hospitalized, a daily cash-back or payment per covered event is made to the client at a predetermined set amount.

☑️ Both the maximum limit amount that may be paid out annually and the maximum amount that may be paid out for each incident are specified.

☑️ Health insurance’s hospital coverage will cover a range of life-threatening situations, such as severe illnesses, accidents, and treatment in an intensive care unit.

☑️ Additionally, health insurance frequently covers a wide range of illnesses, including hernias, appendectomies, gall bladder issues, kidney stones, among other conditions.

☑️ The predefined benefit will be paid out by these plans upon hospital admission. The benefit that is specified has no relation to the actual cost of the medical services being supplied because it is meant to offset ancillary costs like lost income.

☑️ This shows that health insurance companies pay the hospital a set sum, which is decided by the kind of insurance coverage you choose to acquire, rather than according to the degree of care you required.

READ more about: Best health insurance for a Family

☑️ This is because businesses that sell medical insurance policies do so to turn a profit, and these businesses rely on underwriting and actuarial data to predict anticipated future claims over a long period of time.

☑️ They are free to permanently exclude anyone with certain medical conditions, and they are not compelled to accept any of the applications. In spite of the fact that the actual cost may be far greater, they are likewise excused from paying the insured amount.

☑️ Depending on a variety of factors, like the client’s age, the size of their family, any pre-existing chronic ailments, etc., the monthly premiums people pay for their health insurance coverage can vary greatly.

☑️ In addition, health insurance offers less coverage than medical policies, protecting customers with either a Rand value per day or a total dollar amount per hospital incident and per year. This might either be a daily maximum or a yearly maximum, depending on the policy.

☑️ If you have medical insurance, you will be compensated in the event that you are hospitalized and unable to work or make a livelihood. It will also cover any further expenses that could be incurred as a result of your hospitalization. In the same way as with any other sort of insurance, you cross your fingers and hope you never need it, but having it might be quite helpful if you do.

☑️ If you are already pregnant, it is just too late to get medical aid coverage or insurance for the birth, let alone for the pregnancy itself at this point. However, this does not negate the significance of taking the necessary steps to ensure that both you and the upcoming addition to your family have access to adequate medical coverage.

☑️ Pregnancy is a pre-existing ailment that is not covered by medical insurance and is thus not covered.

☑️ Because pregnancy is regarded as a pre-existing condition, members of the scheme will not be eligible for any benefits related to it during the first year of their membership.

☑️ This practically implies that there is no medical coverage for the time leading up to the birth, as well as the actual labour and delivery of the baby.

☑️ When it comes down to it, if you are already pregnant when you sign up for a medical aid programme, you and your spouse will have to come up with the money to cover the costs of prenatal care and pay for the delivery of the baby out of your own personal savings. This is the unfortunate reality of the situation.

You should budget anywhere from R60,000 and above for a routine delivery.

👉🏾 Discover the best hospital plans for babies.

☑️ If you give birth in a private setting, you should plan on spending at least R60,000 (and probably more) on the experience. When there is no medical aid coverage, healthcare providers and hospitals will typically request payment in full or in part prior to providing any services.

☑️ When there are difficulties involved, the expense of medical care might quickly escalate. An otherwise happy event has the potential to become a financial nightmare if there is no safety net in the form of medical aid. The good news is that the infant will be insured.

☑️ Your child will be eligible for medical aid the minute they are born. The only stipulation is that you have to register the infant with the program within the allotted time frame, which is often thirty days.

☑️ Because of this, enrolling in a medical aid program is of the utmost significance, as it will guarantee that your infant will receive the highest standard of medical treatment from the very beginning of their life.

☑️ If you sign up for a plan before you find out you are expecting a child, you automatically become eligible for all of the maternity benefits the plan provides.

👉🏾 You might like to read more about the best medical Aids for Pregnancy

Why Do Pregnant Women Need Health Insurance

☑️ In South Africa, the public healthcare system is supposed to cover everyone, although in practise this is not the case. Both public and private hospitals are included in South Africa’s comprehensive healthcare system. Private health insurance is typically purchased for better conditions and shorter waiting periods.

☑️ There is a wide variety of businesses that provide health insurance policies, each of which makes available a plethora of alternative treatment choices. These operate in a manner that is comparable to traditional health insurance plans.

☑️ Medical costs in South Africa are covered by health insurance up to a certain yearly amount. However, each of these offers a very different level of coverage. Some health insurance policies may offer more coverage than you actually need. It is crucial that you shop around for the best health insurance quotes that are catered to your unique needs because of this.

☑️ You should not only check your coverage but also become familiar with the premium charges and excess fees that you would be liable for in the event that you become unwell. Even though premium payments are frequently made on a monthly, quarterly, or annual basis, some companies demand full payment for the entire year up front.

👉🏾 READ more about Health Insurance for Kids

The Vital Role of Health Insurance During Pregnancy: A Visual Breakdown

Understanding the Importance of Coverage

Pregnancy is a significant life event that often brings about a range of medical expenses. From prenatal check-ups and childbirth to potential complications, the costs can be substantial. That’s why having comprehensive health insurance is crucial for expecting mothers.

A Visual Representation

To better understand why health insurance is essential during pregnancy, let’s break down the key factors in a visual way:

Our Key Findings:

Prenatal Care (25%): Regular prenatal check-ups are essential for monitoring both the mother’s and baby’s health. Insurance covers these visits, as well as necessary tests and screenings.
Delivery and Postnatal Care (30%): The cost of childbirth, including hospital fees, doctor’s fees, and medications, can be significant. Health insurance helps cover these expenses.
Infant Care (20%): Newborn babies require medical care, including vaccinations, check-ups, and potential treatments. Insurance can help offset these costs.
Complications and Emergencies (15%): Unexpected complications can arise during pregnancy or childbirth, requiring specialized care and potentially expensive treatments. Insurance provides financial protection in such cases.
Medications and Treatments (10%): Certain medications or treatments may be necessary during pregnancy or for the newborn. Insurance can help cover these expenses.

Our Conclusion

As the pie chart illustrates, health insurance plays a vital role in ensuring a healthy pregnancy and a smooth delivery. By having adequate coverage, expecting mothers can focus on their well-being and the arrival of their baby without the added stress of financial burdens.

FAQ

Is pregnancy a pre-existing condition in South Africa?

Yes, pregnancy is a pre-existing condition excluded from medical aid cover. It is excluded from all benefits for the first 12 months of membership.

How much does it cost to give birth at a private hospital without medical aid?

Natural births at private hospitals can cost R60 000, assuming you stay for three days at the hospital without any complications.

What’s the difference between medical aid and medical insurance?

Medical aid ensures you are covered if you need to be hospitalised, have a chronic condition under prescribed minimum benefits or need day-to-day benefits while medical insurance ensures you receive a pay-out if you are hospitalised.

What will determine the cost of medical insurance?

The monthly premiums paid by individuals for their health insurance policies can vary according to a client’s age, the number of members in their family, any pre-existing chronic diseases, etc.

Is it free to give birth in a government hospital in South Africa?

Yes, South Africans have a right to free maternity treatment during pregnancy as well as postnatal care after baby is born, in a government hospital.

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Adriaan Schoeman

Adriaan holds an MBA and specializes in medical aid research. With his commitment to perfection, he ensures the accuracy of all data presented on medicalaid.com every three months. When he is not conducting research, Adriaan can be found indulging in his passion for trout fishing amidst nature.