Maternity Cover & Health Insurance: What You Need To Know (Oneplan Guide)


Jade Poole from I Write Words


Having a baby is both exciting and a little scary, which is why it helps to know what to expect from your health insurance when expecting…

If you are thinking about having a baby and starting a family soon, then the first thing you need to do is make sure you have medical cover that gives you access to private healthcare.

Have a look at this article on the costs of having a baby in South Africa (you’ll start to get a good idea of how expensive it really is and why you need medical cover).

In many cases, women think that medical aid is their only option. Although medical aid is a wonderful form of health cover and gives you the best care you can get, it can be very expensive as a monthly premium.

This is where health insurance comes in.

What is health insurance?

Health insurance is basically an affordable alternative to medical aid. It gives you the same access to private doctors and hospitals, but your monthly premium is substantially less.

With health insurance, it will help pay for hospital stays, doctor visits, prescription medications, important routine and preventive care.

The difference between health insurance and medical aid is that health insurance has set limits to your claims.

Medical aid, on the other hand, cannot place exact limits or amounts to their claim payouts. But with health insurance you know exactly how much cover you have and for what.

If you want to know more about health insurance, then read all about it in our blog on how it works.

Health insurance as gap cover

Health insurance can also work as gap cover to help cover the shortfall between your medical aid payments and the costs of hospital and doctor fees.

If you have both health insurance and medical aid, this is a great way to ensure you are covered for the majority of your hospital and private healthcare fees.

How does maternity cover work with health insurance?

If you want health cover for private hospitals and doctors, you will need a health insurance plan BEFORE you fall pregnant. The same conditions apply for medical aid.

With health insurance, you can access the best private hospitals and doctors, ensuring your health and your baby’s health are in good hands.

You can choose which hospital you want to give birth, choose your doctor and specialists.

What happens if I don’t have health insurance?

Without health insurance, you will have to pay for hospital fees out of your own pocket or you will have to give birth in a government hospital.

At a government hospital, you will not have a choice as to who your health care provider is during the birth of your child. You will not know the midwives or doctors attending the birth and you also run the risk of complications associated with public healthcare facilities.

The truth is that many of our public hospitals are sadly understaffed and lack the funding needed to tend to and treat the hundreds of patients in need of medical attention on a daily basis.

Maternity benefits and health insurance

At Oneplan, we have 4 different health insurance plans for you to choose from.

Each one offers different benefits and cover at a different price.

The more comprehensive plans are always a better option for expecting parents.

Each of our plans includes maternity pre-birth cover (all your visits leading up to giving birth), but only the top 3 plans include cover for Natural Birth and Emergency Caesareans.

Let’s break down our maternity cover to give you a good understanding…



These are appointments and medical care that take place before your baby is born.

What you are covered for:

●     Gynaecologist or midwife visits

●     Sonars done in the practitioner’s rooms

When cover is seen as health cover and not maternity:

●     Consultations without confirmation of pregnancy

●     Consultations after this limit is reached

What you are NOT covered for:

●     If one of your children fall pregnant (pre-birth only not covered)

●     3D and 4D scans




What you are covered for:

●     Home and or midwife deliveries, water birth

●     Emergency or clinically indicated caesarean section

●     Mother and newborn covered under the same cover (one limit)

What you are NOT covered for:


What you are NOT covered for as a MOTHER:

●     Complications of birth that occurred within the waiting period

●     More than 1 delivery for child dependants

●     Sterilisation

●     PCA pumps for pain control

●     Dietician consultations

What your NEWBORN is NOT covered for:

●     3rd generation babies (the child of your child)

●     Babies not registered within 30 days with Oneplan

●     Complications with birth that occurred within the waiting period

●     Hearing tests

What health insurance plan is right for me and my baby?

It’s a good idea to choose a plan that includes a range of benefits. Preparing for a baby is expensive as it is with clothes, the nursery and other childcare items.

Which is why you should choose a plan that gives you great cover for doctor visits, specialist visits and pregnancy check-ups.

Our Executive Plan is a great option for expecting parents as this includes our highest level of cover.

The great thing about Oneplan is that we even pay you BEFORE you see your doctor and let you go to any doctor of your choice.

Yours in hassle-free health insurance,


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