Our Benefit Plans and how they cover pregnancy and childbirth

Good healthcare can help expecting members and their newborns to be in the best possible health. We offer additional benefits to expecting members who register on the Maternity Benefit to ensure good healthcare for the unborn up to birth. Within 30 days from birth, you need to complete an application form to add the baby to your membership to ensure they receive continued medical coverage.

No matter the Benefit Plan, members who register for the Maternity Benefit have cover for

certain blood tests;
specific ultrasounds;
visits to a gynaecologist, GP or midwife up to a limit.

We also pay for the birth in a private hospital.

HOW DO I FIND A NEW GYNAECOLOGIST OR GP

We always suggest that you use doctors, pharmacies, and hospitals in our networks to limit the deductible you may need to pay. This is because we’ve negotiated with healthcare providers in our networks to provide quality care at an affordable rate.

Log on to www.tfgmedicalaidscheme.co.za and use our MaPS tool to find a service provider in our network.

TFG Health

TFG Health is a network Benefit Plan. You need to use healthcare providers in our network. You might have to pay for a healthcare service yourself if you visit a doctor, pharmacy, hospital, or radiologist outside of the network.

Benefits are activated when

the member registers for the maternity benefit and creates a baby profile online
the delivery is pre-authorised or
when you register your baby onto the Scheme

Once the limits are exhausted, we pay for out-of-hospital healthcare expenses related to your pregnancy from the relevant and available day-to-day benefits.

The benefits listed below will be funded per Scheme benefit rules:

You are covered for up to eight consultations at your (network) gynaecologist, chosen network general practitioner (GP) or midwife which is covered from the Maternity Benefit at the Scheme Rate. (check with Gerda about the gynaecologist having to be in the network – don’t think this is a requirement)
You have cover for up to five prenatal or postnatal classes up until two years after birth with a registered nurse. You are also covered for one lactation consultation with a registered nurse or lactation specialist from the Maternity Benefit at the Scheme Rate. One nuchal translucency and Non-invasive Prenatal Testing (NIPT) screening is provided, subject to clinical entry criteria from the Maternity Benefit at the Scheme Rate. Your baby under the age of two years is covered for two visits at your chosen network GP, paediatrician or an ear, nose and throat specialist (ENT).
You are covered for up to two 2D ultrasound scans from the Maternity Benefit at the Scheme Rate. 3D and 4D scans are paid up to the rate we pay for 2D scans.

One flu vaccination during your pregnancy is also paid for. You also have access to postnatal care, which includes a postnatal consultation, a nutritional assessment with a dietitian and two mental healthcare consultations with a counsellor or psychologist. Cover for a defined basket of blood tests per pregnancy are available from the Maternity Benefit at the Scheme Rate

Please note that cover for medication is subject to medicine on the TFG Health formulary (medicine list). If you use medicine that is not on the formulary, you will be responsible for paying these costs.
In addition to the above benefits, being a member of TFG Medical Aid Scheme also allows you access to (and you can claim up to 25% discount on umbilical cord blood and tissue storage with) Netcells® Biosciences.

TFG Health Plus

The TFG Health Plus benefit plan gives you the flexibility to make use of a gynaecologist of your choosing. Please be aware though that if you do use a gynaecologist outside of our network, you may be liable for a deductible, as funding will be up to Scheme Rate and you will be liable for any amount charged in excess of the Scheme Rate.

TFG Health Plus Benefit Plan cover during pregnancy

We pay specific healthcare services related to the member's pregnancy from the available day-to-day benefits. This includes scans, blood tests and antenatal consultations with a GP, midwife or gynaecologist.

The below benefits will be funded as per Scheme benefit rules:

We pay for four GP or gynaecologist consultations without accumulating to your sub-limit for consultations and visits. Once you have used these limits, consultations will be paid from your day-to-day benefits subject to the sub-limit for doctors’ consultations. GPs and specialists who are part of a direct payment arrangement for your Benefit Plan will be covered in full, subject to the sub-limit for doctor’s consultations. GPs and specialists, who do not take part in a direct payment arrangement, are covered at up to 80% of the Scheme Rate, subject to the sub-limits for doctors’ consultations. Blood tests (including NIPT) are covered at 100% of the Scheme Rate and scans are covered at 80% of the Scheme Rate. Cover is subject to sub-limits for radiology and pathology.
We pay for two 2D pregnancy scans from available day-to-day benefits, subject to funds available in the Primary Care Benefit. Any 3D and 4D scans will add up to this limit and will be paid up to the rate of a 2D scan only. Scans are covered at up to 80% of the Scheme Rate, subject to the sub-limits for radiology. Antenatal and postnatal exercise classes, as well as breast feeding instructions are not covered.
In addition to the above benefits, being a member of TFG Medical Aid Scheme also allows you access to and you can claim up to 25% discount on umbilical cord blood and tissue storage with Netcells® Biosciences.

Finding a network provider

You can find a healthcare provider in our network by logging in to http://www.tfgmedicalaidscheme.co.za. Click on the TFGMAS tab and choose Find a healthcare professional.

Alternatively, call us on 0860 123 077.

How to register for the Maternity Benefit

Call us on 0860 123 077 to inform us of your pregnancy.

We will advise you on what you need to do, as well as what we will pay for.