Maternity

We cover a variety of benefits when you are pregnant which include; healthcare professionals, hospital stays, home births and antenatal classes. This is dependent on your health plan type or option.

Being pregnant is a very important time in a woman’s life, and a time when you don’t want to worry about medical cover. With your Scheme you have peace of mind that we offer you the best care while you are pregnant, and your newborn once your baby is born.

For more information about how you are covered, refer to your benefit brochure.

Antiretroviral medicines to prevent mother-to-child transmission

We fund HIV medicines to prevent mother-to-child transmission of HIV. Please refer to the HIVCare brochure or call the HIVCare team on 0860 123 077

Your cover for your hospital stay depends on the type of delivery

We pay the hospital account from your hospital benefit. All related accounts such as the gynaecologist, midwife, anaesthetist and other healthcare services will be paid from your Hospital Benefit up to 100% of the Scheme Rate for your plan. You can benefit by using Healthcare Professionals participating in our direct payment arrangements relevant to your TFG Health Plus because we will cover their approved procedures in full.

You have cover for three (3) days and two (2) nights for a normal delivery and four (4) days and three (3) nights for a caesarean section, if approved. The day of the delivery is counted as day one.
Elective caesarean sections are not covered on TFG Health.

If you need to stay in hospital longer than the number of days we approved, your doctor will need to send a letter to motivate why you need to stay in hospital longer.

We will cover home nursing from your hospital benefit if you decide to leave the hospital earlier than the stay we normally cover. We will cover the days you received home nursing up to the stay we normally cover in hospital. Always confirm leaving hospital earlier with your Healthcare Professional.

We cover home births with a registered midwife

Home births are covered from your hospital benefit. We will cover the cost of a midwife who is registered with BHF and has a valid practice number up to the maximum rate that your plan covers, for up to three days after the delivery.

Treatment for neonatal jaundice

If your baby needs phototherapy for neonatal jaundice, we will cover the phototherapy lights from the hospital benefit as long as you confirm your benefits with us.

There are certain items we do not cover

We do not cover these items:

  • mother and baby packs that hospitals supply
  • the bed-booking fee that some hospitals may require you to pay
  • your lodger or border fees if your baby needs to stay in hospital for longer and you choose to stay on

If you choose to have a water birth in hospital, the cost of the birthing pool is included in the global fee for confinement. If you choose to hire a birthing pool outside of what is supplied, you will need to pay this yourself.

How to get the most out of your cover

Home births are covered from the overall annual limit. We will cover the cost of a midwife who is registered with BHF and has a valid practice number up to the maximum rate that your plan covers, for up to three days after the delivery.

Treatment for neonatal jaundice

If your baby needs phototherapy for neonatal jaundice, we will cover the phototherapy lights from the overall annual limit as long as you confirm your benefits with us.

There are certain items we do not cover

We do not cover these items:

  • mother and baby packs that hospitals supply
  • the bed-booking fee that some hospitals may require you to pay
  • your lodger or border fees if your baby needs to stay in hospital for longer and you choose to stay on

If you choose to have a water birth in hospital, the cost of the birthing pool is included in the global fee for confinement. If you choose to hire a birthing pool outside of what is supplied, you will need to pay this yourself.

How to get the most out of your cover

Tell us about your pregnancy as soon as possible

TFG Medical Aid Scheme covers the birth of your baby either in hospital or clinic with a doctor or a midwife or at home with the help of a midwife. It is important to call us as soon as possible to inform us of your pregnancy. Call us on 0860 123 077 between 12 and 24 weeks of pregnancy.

Understand your benefits

Pregnancy is one of the conditions covered under the Prescribed Minimum Benefits. Prescribed Minimum Benefits is a set of conditions which all medical schemes must provide a basic level of cover for. This basic level of cover includes funding of the actual delivery. Antenatal care is only funded as Prescribed Minimum Benefit where it is necessary to hospitalise the mother before she gives birth.

Pregnant mothers who need to be admitted during their pregnancy can apply to have their admission covered in full as a Prescribed Minimum Benefit

To access full cover for your hospitalisation as a Prescribed Minimum Benefit, you must use a doctor, specialist or other healthcare provider who is in the Schemes network. We will pay the account in full up to the agreed Scheme Rate. If you chose to use a hospital or healthcare provider who is not on our network, we will pay the hospital or healthcare provider up to 100% of the Scheme Rate and you will be responsible for any difference between what is charged and what we pay.

Register your baby within 30 days of the birth

We automatically cover newborns under the parent’s name up to the last day of the calendar month that he or she is born. For example, if your baby is born on 20 May, he or she will have automatic cover from 20 May until 31 May under your name.
To continue cover, the baby must be registered from the next calendar month and we must receive a contribution to TFG Medical Aid Scheme. Please note we may apply underwriting if you do not register your baby within 30 days of the date of birth.

To register your newborn on the Scheme, you must inform your employer.

Understand your benefits

Pregnancy is one of the conditions covered under the Prescribed Minimum Benefits. Prescribed Minimum Benefits is a set of conditions which all medical schemes must provide a basic level of cover for. This basic level of cover includes funding of the actual delivery. Antenatal care is only funded as Prescribed Minimum Benefit where it is necessary to hospitalise the mother before she gives birth.

Pregnant mothers who need to be admitted during their pregnancy can apply to have their admission covered in full as a Prescribed Minimum Benefit

To access full cover for your hospitalisation as a Prescribed Minimum Benefit, you must use a doctor, specialist or other healthcare provider who is in the Schemes network. We will pay the account in full up to the agreed Scheme Rate. If you chose to use a hospital or healthcare provider who is not on our network, we will pay the hospital or healthcare provider up to 100% of the Scheme Rate and you will be responsible for any difference between what is charged and what we pay.

Register your baby within 30 days of the birth

We automatically cover newborns under the parent’s name up to the last day of the calendar month that he or she is born. For example, if your baby is born on 20 May, he or she will have automatic cover from 20 May until 31 May under your name.

To continue cover, the baby must be registered from the next calendar month and we must receive a contribution to TFG Medical Aid Scheme. Please note we may apply underwriting if you do not register your baby within 30 days of the date of birth.

To register your newborn on the Scheme, you must inform your employer.