Family planning – Gap cover helps beyond birth and every step of the way

“Pregnancy and childbirth are usually occasions of great joy, but the medical expense shortfalls that go along with it can add a lot of stress,” Tony Singleton, CEO at Turnberry Risk Management Solutions reminds parents-to-be. “The best solution is to plan your financial future carefully and have medical aid and gap cover in place well before falling pregnant, so that waiting periods are not an issue. However, life happens, and this isn’t always possible.”

According to Singleton, parents-to-be should know that it’s never too late to get gap cover, even though waiting periods may exclude the actual birthing process if they’re already pregnant. “Babies will be covered on their parents’ gap cover policy from the moment they are born, provided they are registered within 90 days of birth, which gives parents peace of mind in case of any complications. It’s also important to remember that giving birth is only the beginning of a lifelong journey, and gap cover supports parent and baby every step of the way,” he stresses.

Why do I need gap cover BEFORE I get pregnant?

Gap cover provides additional protection for medical expense shortfalls that are not covered by medical aid. These shortfalls include co-payments, making use of providers outside of the scheme’s network, and doctors charging more than the scheme rate. When it comes to having a baby, these additional expenses are common, and they add up to significant sums.

If you decide to give birth at a hospital that falls outside of the specified network, or your gynaecologist is not a network doctor, you will be left with out-of-pocket medical expense shortfalls. If you make the decision to have an out of hospital birth or have support from a doula, this may result in additional expenses. Should you be transferred to a hospital, the gynae may not be part of the network. The immediate emergency treatment will be covered, but the additional hospital stay may not be covered in full if you are out of network. There’s also the matter of the anaesthetist – should you decide to have an epidural or a caesarean section, even if your doctor and hospital are in network, you may not know who your anaesthetist is until the day of the procedure. In addition, most anaesthetists do not form part of medical scheme networks and charge above the medical aid rate.

Gap cover providers impose a 10-month exclusionary waiting period on pregnancy and childbirth, which means that these will not be covered by the policy until this period has elapsed. This is true even if you weren’t pregnant when you signed the policy but get pregnant shortly afterwards and give birth early. Planning is the best way to minimise financial strain, but even when this isn’t possible, it’s never too late for gap cover.

Why should I get gap cover if I’m already pregnant?

As much as pregnancy is a time of joy, childbirth can also be fraught with complications, from congenital defects to jaundice to the need for baby to stay in the Neonatal Intensive Care Unit (NICU). Some problems like cleft palates, club foot and heart defects require extensive surgery after birth, which may not be fully covered by medical schemes. The result? Medical expense shortfalls that you will be responsible for paying. When you’re on maternity leave with reduced income, how do you afford these unanticipated costs?

One example we have seen was a young family whose new-born baby was diagnosed with hyperostosis of the skull, a rare condition which causes thickening of the skull. The baby later on underwent extremely complex surgery, under the care of both a neurosurgeon and an Ear, Nose and Throat (ENT) surgeon, which attracted a shortfall in excess of R110,000. This amount was covered by their gap cover policy

“Parents-to-be need to speak to their financial advisors in order to make sure they start their new journey as parents on the right note,” Singleton advises.

We suggest that you rather speak to them first. Gap cover is becoming increasingly important as a result of the proposed changes in legislation around medical care and forms a critical part of the comprehensive cover you need to provide your clients with.

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