Benefit enhancements for 2019

  1. Most benefit limits for 2019 will increase to accommodate yearly inflation or cost increases.
  2. Introducing a comprehensive maternity benefit that includes cover for care for the expecting mother before the birth and, after the birth, care for up to two years for the mother and the newborn baby.

The background

Quality healthcare is important during pregnancy for prenatal care and screening for both the expectant mother and her unborn baby. For the average healthy pregnancy and birth, the estimated medical costs can be as high as R120 000. Expectant parents should be able to depend on comprehensive healthcare cover during the pregnancy.

Raising a healthy child requires optimal health, nutritional and physical wellbeing. Average medical costs for the first two years of a child’s life, including GP and specialist visits, can be as much as R80 000. Complete cover for the health of a young family should provide access to comprehensive healthcare, alongside access to vital clinical support and knowledge.

The Maternity Benefit

In 2019 LA Health is introducing a comprehensive basket of risk-funded benefits for expecting mothers and children under the age of 2 years, paid for by the Scheme from the Major Medical Benefit.

A defined basket of both pre-and post-natal care will become available after the expecting mother is registered on the Maternity Programme:

  • Eight midwife, GP or gynaecologist ante-natal consultations during pregnancy, paid at the Scheme Rate
  • One Nuchal Translucency or Non-invasive Prenatal Test (NIPT). For women with an intermediate or high-risk pregnancy, the test screens the DNA of an unborn baby, found in the mothers’ blood, to detect certain conditions in pregnancy, such as Down Syndrome. Specific clinical criteria apply
  • A routine and defined basket of antenatal pregnancy blood tests;
  • Two 2D ultrasound scans either from a GP, gynaecologist or radiographer. 3D or 4D scans will only be paid up to the cost of a 2D scan
  • Five ante-natal classes, or pre and postnatal consultations, with a registered nurse at the Scheme Rate, or agreed rate for HomeCare
  • One lactation consultation with a registered nurse or lactation specialist, paid at the Scheme Rate
  • One nutrition assessment with a dietician post the delivery, paid at the Scheme Rate;
  • Two consultations with a GP, gynaecologist or psychologist for postnatal mental healthcare services
  • One GP or gynaecologist consultation for post-natal complications.

For the newborn baby:

  • Two GP, paediatrician or ENT visits for children under the age of 2 years registered on the Scheme.

The defined basket of maternity and infant benefits will be paid up to 100% of the Scheme Rate, or agreed rate, from the Major Medical Benefit. As these benefits were previously paid from your day-to-day benefits, this means you will have more benefits available for other types of care. To help members for whom we are currently paying Medical Savings Account claims at cost, any GP or Specialists costs that are charged above the Scheme Rate for these services, will automatically be paid from the Medical Savings Account only.

Benefits will be activated by pre-authorising the delivery, done via the call centre or via online application on www.lahealth.co.za.

  1. Introducing cover for Doulas

Background

Prior to the modern trend of hospitalising women to give birth, women usually gave birth at home with the aid of their mothers, aunts or an experienced woman. The labouring mother was constantly surrounded by other women and was helped through all the various stages of labour to the birth itself. A Doula is a “woman caregiver” during birth, and in this sense a labour coach, childbirth companion or labour assistant.

Benefit for Doulas

In 2019, LA Health will pay for services rendered by Doulas during a childbirth from the Medical Savings Account only, with no accumulation to the Above Threshold Benefit.

  1. Introducing cover for Unani-Tibb therapy

Unani-Tibb therapy targets the underlying causes of the person’s disorder, rather than concentrating mainly on symptoms. It focuses on making lifestyle changes, uses massage, acupressure and aromatherapy and natural approaches to deal with the immediate clinical disorder, and to prevent it from happening again.

Benefit for Unani-Tibb therapy

In 2019, LA Health will pay for Unani-Tibb therapy from the Medical Savings Account only, with no accumulation to the Above Threshold Benefit.