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Thread: Anyone have experience with a pregnancy coverage on Discovery Coastal core plan?

  1. #1

    Default Anyone have experience with a pregnancy coverage on Discovery Coastal core plan?

    Hello, we are looking at having a child in the next year and are trying to decide if our current coverage is the best way to go on the discovery coastal core plan. it covers 100% of the health rates, but I know the hospitals will charge 3-4 times that. I will likely be going to Constantia or one of the other nicer hospitals in the southern capetown area. We will also likely pay out of pocket for a midwife as well.

    Does anyone have actual experience with how much they ended up having to pay out of pocket for a normal pregnancy or for a cesarean in case it comes to it? I would love a breakdown of the cost and total amount paid out of pocket. I am going to add the gap coverage which I don't currently have. Did discovery come through? And how complicated is it to get the gap coverage to cover the difference?

    Thank you for any help you can provide.

    james

  2. #2
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    My neighbour had a baby. Her(read their) medical aid paid for all as they had a good medical plan. Her baby was born early due to complications. Besides Baby's stay in hospital the bills were over R30k. Baby's stay was a further 1.5k per day ( excluding meds & Doctors visits) until he was strong enough to go home......

    I was rather surprised at the numbers & I get a feeling se did not mention all the bills.

  3. #3
    Senior Member philthom's Avatar
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    Quote Originally Posted by jamezjunk View Post
    Hello, we are looking at having a child in the next year and are trying to decide if our current coverage is the best way to go on the discovery coastal core plan. it covers 100% of the health rates, but I know the hospitals will charge 3-4 times that. I will likely be going to Constantia or one of the other nicer hospitals in the southern capetown area. We will also likely pay out of pocket for a midwife as well.

    Does anyone have actual experience with how much they ended up having to pay out of pocket for a normal pregnancy or for a cesarean in case it comes to it? I would love a breakdown of the cost and total amount paid out of pocket. I am going to add the gap coverage which I don't currently have. Did discovery come through? And how complicated is it to get the gap coverage to cover the difference?

    Thank you for any help you can provide.

    james
    Good question. And I was wondering the same thing, but more in general with which medical aid would suit the best for pregnancies.
    So I'm also looking forward to the answers and responses to the questions.

  4. #4

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    My med aid also says it covers 100%. But sometimes they have agreements with hospitals...
    In our case, we did not have to pay a cent (actually except prv room).
    Maybe check with them.

  5. #5

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    well, can't help with guys in Cape Town, but we are having a baby in 5 weeks, we are on discovery key care... We are having the baby at Genesis midwife clinic in Saxonwold, and Discovery are covering everything. The only stuff we have had to pay for is Midwife visits (@R150 per time, I can live with that ) and for the scans NOT done by the Gyane. They are paying for the whole stay at genesis (2 days for mom and baby) , covering the delivery by midwife, all the Gynae costs, as well as any medication that will be needed (if she wants an epidural, or other pain relief) also will pay for 3 nights if she has to have a caesar, as well as covering all the costs for that.
    As far as I (and my wife) are concerned if you are in the Joburg area, do yourselves a favor and check out Genesis clinic. Its more like a hotel than a hospital.
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  6. #6

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    According to my knowledge....

    The minimum that medical aid pays for (irrespective of plan):
    1. Full hospital stay (as long as you get preauthorisation).
    2. 100% of specialist fees (gynae/midwife/anaestologist/paeditrician)
    3. All meds used during the hospital stay.
    4. The actual delivery or emergency c-sec depending on circumstances.

    IF you have a cheaper option, expect to pay extra for the following in cash:
    1. Co-payment - if the specialist (gynae/midwife/anaestologist/paeditrician)
    charges above 100% (all of them do anyway)
    2. Private ward


    If finances are a problem, I would suggest you rather get get gap cover policy that covers [co-payment, specialist shortfall, sub-limits & hospital limits]... and pay that extra R100-R200 per month.

    But if you dont mind spending extra R400 upwards per month just for that 12 month period, then upgrade to a comprehansive plan (that also has a savings facility) of your medical aid.

  7. #7

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    Quote Originally Posted by ozziej View Post
    well, can't help with guys in Cape Town, but we are having a baby in 5 weeks, we are on discovery key care... We are having the baby at Genesis midwife clinic in Saxonwold, and Discovery are covering everything. The only stuff we have had to pay for is Midwife visits (@R150 per time, I can live with that ) and for the scans NOT done by the Gyane. They are paying for the whole stay at genesis (2 days for mom and baby) , covering the delivery by midwife, all the Gynae costs, as well as any medication that will be needed (if she wants an epidural, or other pain relief) also will pay for 3 nights if she has to have a caesar, as well as covering all the costs for that.
    As far as I (and my wife) are concerned if you are in the Joburg area, do yourselves a favor and check out Genesis clinic. Its more like a hotel than a hospital.
    I know a few ppl who had their babies there... apparently its so nice you dont even want to leave

  8. #8

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    Quote Originally Posted by ozziej View Post
    well, can't help with guys in Cape Town, but we are having a baby in 5 weeks, we are on discovery key care... We are having the baby at Genesis midwife clinic in Saxonwold, and Discovery are covering everything. The only stuff we have had to pay for is Midwife visits (@R150 per time, I can live with that ) and for the scans NOT done by the Gyane. They are paying for the whole stay at genesis (2 days for mom and baby) , covering the delivery by midwife, all the Gynae costs, as well as any medication that will be needed (if she wants an epidural, or other pain relief) also will pay for 3 nights if she has to have a caesar, as well as covering all the costs for that.
    As far as I (and my wife) are concerned if you are in the Joburg area, do yourselves a favor and check out Genesis clinic. Its more like a hotel than a hospital.
    Thanks for the input, do they cover any scans or visits before the actual hospitalization? I thought it only covered the actual day of the pregnancy? Have you had to contact the hopstial and arrange for everything to be covered ahead of time? Just wondering what we will need to do on our end. Thanks for the help.

  9. #9

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    We're on Coastal Core and if my memory serves me right, our first born cost about R2500 out of our pocket (3 years ago) and our youngest didn't cost anything extra (a year ago).

  10. #10
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    Quote Originally Posted by jamezjunk View Post
    Thanks for the input, do they cover any scans or visits before the actual hospitalization? I thought it only covered the actual day of the pregnancy? Have you had to contact the hopstial and arrange for everything to be covered ahead of time? Just wondering what we will need to do on our end. Thanks for the help.
    We had our second baby 7 weeks ago. Also Discovery Coastal Plan with the GAP option. It was a natural birth with no epi. Wife stayed in private room vor 2 nights. We had to eventually pay the following:

    1. Extra for private room
    2. R 80 for some ointment for my wife

    The GAP option covered a lot, especially the visit from the on-call ped that comes to visit baby twice...approx. R1100 (sharks)
    The gynea is extra, but ours allowed us to pay our 50% in installments over 3 mnths before baby is born and the rest they claim from Discovery. Total was approx. R 10 000 This is just for her to "catch the baby"...and do the other rather gross stuff afterwards...1 and half our tops...good money. But massive responsibilty so I guess worth it...
    Scans and gynea visits are not covered by Hospital Plan and believe me it becomes expensive and I think also a bit of a money making scam. You go for about 6 or 7 scans over your term and at R450 a pop it adds up.
    We had both babies at Louis Leipoldt MediClinic...fantastic place with awesome people.
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  11. #11

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    Quote Originally Posted by MightyQuin View Post
    We had our second baby 7 weeks ago. Also Discovery Coastal Plan with the GAP option. It was a natural birth with no epi. Wife stayed in private room vor 2 nights. We had to eventually pay the following:

    1. Extra for private room
    2. R 80 for some ointment for my wife

    The GAP option covered a lot, especially the visit from the on-call ped that comes to visit baby twice...approx. R1100 (sharks)
    The gynea is extra, but ours allowed us to pay our 50% in installments over 3 mnths before baby is born and the rest they claim from Discovery. Total was approx. R 10 000 This is just for her to "catch the baby"...and do the other rather gross stuff afterwards...1 and half our tops...good money. But massive responsibilty so I guess worth it...
    Scans and gynea visits are not covered by Hospital Plan and believe me it becomes expensive and I think also a bit of a money making scam. You go for about 6 or 7 scans over your term and at R450 a pop it adds up.
    We had both babies at Louis Leipoldt MediClinic...fantastic place with awesome people.
    Thank you so much for this info, this is what I am looking for. How much did they charge you for the private room? Do you have any guess as to total out of pocket expenses prior to the birth of scans and visits, etc?
    Also, did you guys use a midwife at all? Thanks.

  12. #12
    Super Grandmaster blunomore's Avatar
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    Quote Originally Posted by jamezjunk View Post
    Hello, we are looking at having a child in the next year and are trying to decide if our current coverage is the best way to go on the discovery coastal core plan. it covers 100% of the health rates, but I know the hospitals will charge 3-4 times that. I will likely be going to Constantia or one of the other nicer hospitals in the southern capetown area. We will also likely pay out of pocket for a midwife as well.

    Does anyone have actual experience with how much they ended up having to pay out of pocket for a normal pregnancy or for a cesarean in case it comes to it? I would love a breakdown of the cost and total amount paid out of pocket. I am going to add the gap coverage which I don't currently have. Did discovery come through? And how complicated is it to get the gap coverage to cover the difference?

    Thank you for any help you can provide.

    james
    We are on Discovery Classic Priority.

    My baby was born in May this year via c-section and the total bill (hospital/obstetrician/paediatrician/anaesthesist) was approx R 36 000 of which we ended up having to pay approx R5 000 out of our own pockets.

  13. #13

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    There's a simple answer to that. If you want to have a baby but you are not pregnant yet you need to go onto Liberty's Gold Saver option which is awesome value for money, the main member will pay R1282, the second member will pay R1051 and R471 per child(you will only start paying this once the baby is born). Besides free benefits like cholesterol checks and etc you get 3 x scans and 1 x 3D scan during the pregnancy free, you also get a private room in hospital. On this option you will be covered at 100% LMS rates but you can get an optional gap cover for R128 for the membership irrespective if you are one member or 6 members that R128 is for the whole family and it covers you up to 400% LMS rates in hospital, that is normally used for specialists that charge higher rates. Remember that you are also getting savings on this plan and you can go to any hospital you like. So just to sum it up, on Gold Saver with gap cover you won't pay anything extra specifically for pregnancy.

    Bear in mind that on Liberty medical aid you can keep your child on your membership until maximum age of 27 at child dependand rates provided that your child is studying, most medical aids stop that once the child is 21 years old.

    Just to add to that, there's a medical aid tax rebate of R720pm for the main member and second member and R450 for every child dependand. Basically it works out slightly cheaper than what you are actually paying.

    Liberty Health also introduced BurnJoules program which is similar to Discovery's Vitality that gives you free gym where you can gym as much or as little as you like there are no penalties, there is a free pair of Nike takkies once a year, 20% off Nike brands, discounts on flights, car hire, restaurants, health shops, spa's, golf and much more.

    I work in this industry so if you have any queries or would like more info please PM me and I will email you brochures, I can also give you a call and even meet up with you.

  14. #14
    Super Grandmaster cerebus's Avatar
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    Ok I have direct experience with this because our second child was born on Coastal Core through Caesarian, and had about 4 days in ICU.

    Covered: Everything in-hospital including pediatrician visits because our paed is under med aid rates. But the hospital stay and the ICU we didn't have to pay for.
    Not covered: Gynae visits both in and out of hospital above the cover amount including the operation. Anesthesiologist. We did not have a private room and we did not have a midwife.
    Total out of pocket expense: about r11000.
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  15. #15

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    how do you know what the 'actual rate' is for a procedure? do they hide it away somewhere secret, because i've trawled through every nook and cranny on their site.

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