Primary Option

Primary Option Benefits Maternity Benefits

Maternity Benefits

  • Effective 1 January 2024

  • Members and their dependants are entitled to the following benefits, subject to the provisions of the rules of the Scheme, and in particular the provisions of the statutory Prescribed Minimum Benefits (PMBs).

    This summary is for information purposes only and does not supersede the rules of the Scheme. In the event of any discrepancy, the rules will prevail.

Benefits Description
(i) In hospital

Natural birth		 Uncomplicated natural birth is subject to a limit of R35 100 per confinement

Complicated natural birth is subject to a limit of R51 200 per confinement		 100% of Agreed Rate, unless a PMB, in which case 100% of cost
Caesarean (excludes elective caesareans) Emergency caesareans only; subject to a limit of R51 200 per confinement 100% of Agreed Rate, unless a PMB, in which case 100% of cost
Neonatal intensive care Subject to a limit of R73 600 per year PMB admissions are
paid at 100% of cost and will accrue to this limit, but is not subject to the limit		 100% of Agreed Rate, unless a PMB, in which case 100% of cost
(ii) Out of hospital

General practitioner consultations		 Supervision of uncomplicated pregnancies at network GP up to week 12

Antenatal visits at gynaecologists after week 12

Gynaecologist visits are limited to 2 from insured benefits; thereafter subject to out of-hospital specialist limit and pre-authorisation required		 100% of Agreed Rate, unless a PMB, in which case 100% of cost
2-dimensional ultrasounds 1 scan during 1st trimester 100% of Agreed Rate unless a PMB, in which case 100% of cost
Routine blood tests for abnormalities As requested by the network GP and subject to the network formulary 100% of Agreed Rate unless a PMB, in which case 100% of cost
Refer to Annexure C for Out-of-hospital benefits covered under the Maternity Management programme