Having a baby is one of the most exciting and important times in a woman’s life. It can also be one of the most expensive.
When one of our TRA policyholders gave birth to her son earlier this year, the total medical bill came to over R90,000. Her medical aid paid just over half. That left a shortfall of more than R38,000 that she would have had to pay out of her own pocket.
Instead, she paid nothing. Her TRA gap cover took care of it.
This is her story.
The Reality of Giving Birth in a Private Hospital
Like most pregnant women, she chose to deliver at a private hospital because she wanted the best care for herself and her baby. She assumed her medical aid cover would handle most of the costs.
She was wrong.
She is on a Discovery Coastal Saver plan, a more affordable medical aid plan, which she moved to when she took out gap cover. This meant her scheme would only pay up to 100% of the medical aid tariff. Her gynaecologist, like many healthcare professionals in South Africa, charges well above the medical aid rate.
The numbers looked like this:
- Total medical bill: R90,562.55
- Medical aid paid: R51,514.23
- Shortfall: R38,309.30
Without gap cover, that R38,309 would have come straight from her own pocket. After months of buying car seats, cots and endless baby essentials, a surprise bill of that size would have been devastating for any family.
How TRA Gap Cover Made the Difference
She is on TRA’s Absolute Cover Plus plan, which costs R620 per month. Here is what it meant for her.
TRA paid the full shortfall. The R38,309 gap between what Discovery covered and what her doctors charged was paid in full.
She got a private room. TRA’s maternity benefit covers the shortfall between general and private ward rates for up to three consecutive days. She stayed for three days in her own private room, which made all the difference to her recovery and peace of mind.
She did not have to pay anything up front. Some bills were paid directly to the suppliers by TRA. For the doctor’s bill, TRA paid her so she could pay him, but she never had to cover the cost out of her own pocket first.
A Seamless Claims Process
One of her biggest concerns was the admin. New baby, no sleep, hormones everywhere. The last thing any new mom wants is to chase paperwork.
Her broker handled everything. She did not have to do a thing. The claims were submitted, processed and paid without her lifting a finger.
TRA runs payments three times a week, so there was no long wait. The money came through quickly, and she could focus on what mattered most: her baby.
Why the Private Room Mattered
She emphasised how invaluable having her own private room was during those first few days.
Every mother would want this, but the reality is that not everyone can afford it. Even families in a strong financial position often choose not to spend on it because by that stage, they have already invested heavily in preparing for the baby. It becomes one of those things you have to sacrifice.
With TRA’s maternity benefit covering the ward upgrade, she did not have to make that sacrifice. She had space to rest, recover and spend those precious first days with her son in peace.
Peace of Mind During a Very Important Time
The financial peace of mind was tremendous.
By the time her baby arrived, she had already spent thousands preparing for him. Nursery furniture, baby clothes, nappies, and a car seat. It adds up fast.
The last thing any new parent wants after spending thousands preparing for a baby is an unexpected medical bill, especially when emotions are running high and income is reduced.
Instead, she left the hospital knowing everything was covered. She could focus on recovering, bonding with her newborn and adjusting to life as a new mom without worrying about money.
The Numbers Speak for Themselves
- Monthly gap cover premium: R620
- Premiums paid over 10 months: R6,200
- TRA payout for childbirth: R38,309
- Return on investment: More than 6 times what she paid in
That is from a single claim. Her gap cover continues to protect her family for any future hospital stays, procedures or medical emergencies.
Planning Ahead: The 10 Month Waiting Period
One important thing to understand about gap cover and pregnancy is that there is a waiting period.
TRA has no general waiting period, but pregnancy and childbirth are subject to a 10-month condition-specific waiting period. This means you need to have your gap cover in place for at least 10 months before your baby is born for the maternity benefit to apply.
If you are already pregnant when you join, your pregnancy will not be covered. However, your newborn will be covered from the moment of birth for any in-hospital procedures they may need.
The takeaway is simple. Get gap cover before you start trying for a baby. It is one of the best planning decisions you can make for your family.
What About Medical Aid Alone?
Some people assume that a good medical aid plan is enough. That is a risky assumption.
Even extensive benefits from medical aid schemes have limits. They pay up to a set tariff for each procedure, but healthcare professionals in South Africa can charge whatever they like. Obstetricians, anaesthetists and paediatricians regularly charge anywhere from 200% to 700% above the medical aid rate.
In this case, Discovery paid just over half of the total bill. The rest would have been hers to pay if she did not have gap cover.
TRA’s Maternity Benefits
TRA offers pregnancy cover across our gap cover options, in terms of covering tariff shortfalls etc.
Super Cover Plus and Absolute Cover Plus offer the most extensive benefits, including the maternity follow-up consultations and the maternity private ward benefit.
If you are planning a pregnancy, the higher-tier plans offer benefits that make a real difference when the bills arrive.
For 2026, TRA has also added a Premature Birth Benefit. See the 2026 brochure with all of the latest benefits and premiums here – https://totalrisksa.co.za/tra-gap-cover-2026/
Protect Your Growing Family with TRA Pregnancy Cover
TRA gap cover starts from R99 per month. No general waiting period. Fast claims. Maternity benefits included.
Contact us to speak with a consultant.
For more information, read our complete guide:Gap Cover for Pregnancy: All You Need to Know.
