Understanding Maternity Insurance
Late November 2013, Sharon, 25 and recently engaged at the time, learned she was expecting her first child.
The pregnancy was unplanned. Sharon also learned that her workplace medical cover did not include a maternity insurance. “I approached another insurance company but they told me they couldn’t just take me up on the cover. I should have been paying premiums ten months prior,” she says. This was a standard waiting period for most insurance companies. Pregnant women couldn’t just get get immediate cover. Something Sharon had no idea about.
She and her fiancé were left to their own.
Nonetheless, Sharon wanted a private doctor. One she would maintain for the duration of my pregnancy. Consultation fees for each pre-natal visit cost Shs2, 000. There was an extra charge for scans, physical exams and prenatal supplements like iron and folic acid. Non-negotiable costs in Sharon’s books. She had to be smart about it: “I explained the tight finances to my doctor, and she told me we could work around the insurance company. She changed the description of these extra costs and fixed them as regular hospital expenses under my medical cover. That way, insurance would take care of some of the prenatal care charges. I know it wasn’t right. But I had to do it. If she hadn’t, my fiancé and I would have paid over Shs30, 000 in doctor’s visits only. Money we already did not have.”
Sharon, like all new moms, wanted a natural birth.
But her baby was way overdue (at 42 weeks) and was not engaging properly. She resorted to an emergency Caesarean Section (CS). “The bill came to just over Shs160, 000,” says Sharon. “We paid my doctor Shs75, 000 and the paediatrician Shs50, 000.” Other costs like bed charge, use of delivery room and nursery cost took up the balance. NHIF covered Shs4, 800 for the three days she was in hospital.
A scheduled CS would have cost us between Shs80, 000 and Shs100, 000, says Sharon.
Sharon presented her baby’s birth certificate to her workplace’s insurance company, two weeks later. They added him as her dependent.
Mercy, 28 and married, also went through her pregnancy without any maternity cover.
How did she work around it? “I limited my prenatal visits,” says Mercy. “The first visit cost a one-off Shs10, 000. This covered consultancy of Shs1, 200 and other mandatory tests to monitor fetal development. The tests came back clean. And my pregnancy was pretty smooth after that.
I had only two scans in those 9 months. The first scan was at 3 months, to check for EDD. The other was at 5 months, to check for abnormalities. Each scan cost Shs2, 500.”
Mercy went to a mission hospital in Kericho to deliver. “I paid Shs12, 000 in total for the delivery – Shs5, 000 for my private room and Shs7, 000 for all other hospital charges. NHIF covered the hospital charges. I was in hospital for one and a half days.”
Justus Aoko, an insurance agent with PanAfrica Life, explains the nitty-gritty of the maternity cover.
“Maternity cover is one of the benefits under the medical cover. It comes alongside dental and optical cover,” he says.
Most insurance companies have a minimum benefit limit of Shs100, 000. Operate as you wish within this limit, he says. You can even have a private doctor. However, any costs above the limit are yours to settle. Emergency and scheduled CSs fall within this limit.
Maternity cover is not a walk-in-and-buy sort of cover, says Justus. There is a waiting period of between 10 and 12 months from when you first apply for it.
Regarding the newborns cover, Justus says, “If the baby is born with no congenital conditions, he is immediately put in as your dependant. If he has conditions, he is included as your dependant and enjoys cover for free for one full year. After one year, he is an independent person although with much higher premiums.”
There is also a fine print to CSs. “You are allowed the minimum benefit limit of, say, Shs100, 000 for the first CS. This limit is reduced by half for the second CS. And by the third CS, there is no benefit at all.”
No insurance company covers any cost relating to postnatal hospital visits, says Justus.
NO MATERNITY COVER? HERE’S WHAT TO EXPECT
Prenatal visits: You need to have at least one visit every trimester
Consultation: Between Shs 1, 000 and Shs 2, 000
Scans: Between Shs 1, 000 and Shs 3, 000
Supplements: At most Shs 1, 000
Natural birth: Between Shs 8, 000 to Shs 50, 000
Scheduled CS: Between Shs 25, 000 and Shs 80, 000
Emergency CS: Between Shs 50, 000 and Shs 120, 000
Postnatal visits: Free at government hospitals
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