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Insurance and Pregnancy Complications: What you need to know

29 July 2019 Motshabi Nomvethe, Head of Technical Marketing at PPS
Motshabi Nomvethe, Head of Technical Marketing at PPS

Motshabi Nomvethe, Head of Technical Marketing at PPS

The birth of a child signifies a new beginning, hope, and endless possibilities. But not all pregnancies go according to plan. As a mother, you may experience medical complications related to your pregnancy which can involve your health, your baby’s health, or both.

Pregnancy complications can result in you being booked off work by your doctor. If you are a salaried employee with paid sick leave and maternity leave, this downtime shouldn’t pose a worry to you financially. But if you are self-employed, or a professional in private practice, where no work means no pay, this unforeseen downtime can be really stressful.

Sickness & Permanent Incapacity Benefit can ease financial burden
Under these circumstances, a monthly pregnancy-related sick pay benefit can provide invaluable peace of mind. Like medical aid, life insurance, or any other kind of insurance product, every short-term disability insurance policy with a pregnancy-related sick pay benefit will differ. You need to discuss all available options with your financial adviser to find the one which suits you best, and make sure you read the fine print before signing on the dotted line.

Current delivery trends in SA and their impact on the insurance industry
The World Health Statistics 2018 report by the World Health Organisation shows that South Africa has one of the highest rates of universal health coverage on the continent, with 97% of births attended by skilled health personnel.[i]

According to an article in Business Insider SA, published 20 April 2019, more than 70% of babies born at private hospitals to medical scheme members are delivered via elective or medically indicated C-sections.[ii] A former president of the SA Society of Obstetricians and Gynaecologists says that the overwhelming majority of malpractice litigation related to obstetrics involves vaginal deliveries. So given the threat of legal claims and the financial risk, many obstetricians appear hesitant to do vaginal deliveries where there is a reasonable chance of complication.[iii]

Stats published in an article by the Bhekisisa Centre for Health Journalism on 9 January 2019 reveal that a quarter to a third of babies at government hospitals are delivered via medically indicated C-sections.[iv] Elective C-sections are not offered at public healthcare facilities.

PPS responds to market issues
In response to these market issues, PPS has made enhancements to their Pregnancy-related Sick Pay Benefit, effective 1 June 2019.

The PPS Pregnancy-related Sick Pay Benefit is not a stand-alone benefit, and cannot be purchased as a separate or add-on benefit. It forms part of the Sickness & Permanent Incapacity Benefit for all their female members.

The Pregnancy-related Sick Pay Benefit is no longer focused on a list of specific pregnancy complications. And there is no requirement for hospitalisation. If a member is booked off work by her doctor for any pregnancy complication, the benefit pays for the full recovery period in line with normal Sick Pay claims criteria.

All C-sections are covered by the Pregnancy-related Sick Pay Benefit. If a member has a C-section, either medically indicated or elective, she will be paid for the duration of the recovery of the surgical wound which, like all major surgeries, is six weeks.

If, however, a member had a C-section before purchasing new or additional cover from PPS, she will receive a C-section exclusion to the new or increased amount of Sickness & Permanent Incapacity cover. Existing Sickness & Permanent Incapacity policyholders’ cover as at 1 June 2019 is free from this exclusion, even if the member has had a C-section before.

Vaginal deliveries with no complications to the mother are excluded from cover. As are costs associated with assisted reproductive treatment.

Any pregnancy-related sick pay claim with an event date after 1 June 2019 will be considered under the enhanced Pregnancy-related Sick Pay Benefit, provided the member has an active Sickness & Permanent Incapacity product with PPS at the time. All existing policies have been endorsed with the enhancements to this Pregnancy-related Sick Pay Benefit, and premium rates for the Sickness & Permanent Incapacity Benefit remain unaffected.

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