Medical aid and gap cover are a must when planning to start or expand your family. With maternity costs in South Africa rising significantly, having the right financial protection ensures your focus stays on welcoming your new baby into the world.
Gap cover acts as a safety net, bridging the difference between what medical aid schemes pay (medical aid rate or scheme tariff) and the actual costs charged by specialists. For expectant families, this protection can save them from overwhelming medical costs.
Understanding Gap Cover
Gap cover is supplementary insurance designed to cover medical expense shortfalls that arise when healthcare providers charge more than your medical aid option reimburses. This protection is especially needed during pregnancy, when specialist consultations, procedures, and unexpected complications can quickly exceed what your medical aid pays.
Note that gap cover is not the same as medical aid cover, nor is it a replacement for your medical aid. Instead, it’s additional protection that works alongside your existing medical scheme. To qualify for gap cover, you must have an active membership with a registered South African medical aid.
Why Gap Cover Matters to Moms
South African healthcare costs continue rising, with specialists now charging above the medical scheme rates. For pregnant women, this reality means:
- Obstetricians typically charge above medical aid tariff rates.
- Anaesthetists and paediatricians often exceed medical aid reimbursements.
- In hospital procedures related to pregnancy can result in significant expense shortfalls.
- Emergency C-sections and complications lead to additional medical expenses.
| View our 2025 Coverage Brochure
Pregnancy Cover, Essential for Growing Families
Regular prenatal check-ups, specialist consultations, ultrasounds, and delivery costs can quickly overwhelm your medical aid benefits, leaving you liable for substantial co-payments and shortfalls.
What Pregnancy Gap Cover Typically Includes
Some gap cover policies provide comprehensive pregnancy cover that typically includes:
- In hospital specialist consultations with obstetricians
- C-section surgery and related hospital procedures
- Emergency interventions during delivery
- Shortfalls for anaesthetist fees
- Paediatrician consultations for newborns
- Private ward accommodation differences
These maternity benefits ensure that pregnant women receive the best care, without worrying about their financial repercussions.
How TRA’s Policies Cover Pregnancy and Postnatal Care
Total Risk Administrators (TRA) stands out amongst other gap cover providers, offering policies that support expecting families.
TRA’s Maternity Private Ward Benefit
TRA’s signature Maternity Ward Benefit covers the cost difference between general and private ward rates during childbirth. This benefit provides:
- Coverage for up to three consecutive days
- Daily limits that ensure comfortable accommodation
- Peace of mind during your hospital stay
Multiple Coverage Levels
TRA offers several comprehensive plan options to suit different needs and budgets:
- Basic Cover 300: Essential protection starting from only R99 per month
- Vital Cover Plus: Additional benefits for growing families
- Super Cover Plus: Protection with higher sub-limits
- Absolute Cover Plus: Ultimate coverage including extensive benefits
| View our 2025 Coverage Brochure
Understanding Waiting Periods and Planning Ahead
TRA’s Waiting Period Structure
While TRA eliminates general waiting period requirements, pregnancy and childbirth claims are subject to a 10-month condition-specific waiting period. This is industry-standard practice.
No gap cover claims can be submitted for pregnancy and childbirth within the first 10 months of membership. This highlights the importance of securing gap cover before beginning your pregnancy.
Already Pregnant? You Still Have Options
If you’re already expecting, you can still join TRA and benefit from coverage for your baby’s in-hospital care from the moment of birth. While your current pregnancy may not be covered due to waiting periods, you can ensure your newborn receives immediate protection for any required medical treatment.
Plan Your Coverage
- Join TRA before conception to avoid waiting periods
- Review your medical aid plan to understand your coverage
- Consider upgrading as your family grows
- Maintain continuous coverage for ongoing protection
Protection from Baby’s First Breath
Immediate Newborn Protection
TRA’s policies typically cover newborns from birth, provided they’re registered within the specified timeframe. This coverage proves invaluable when infants require:
- Extended hospital stays
- Specialist paediatrician consultations
- Emergency medical treatment
- NICU care if complications arise
Postnatal Care for Mothers
Recovery doesn’t end at delivery. TRA recognises that new mothers may require:
- Follow-up medical practitioner consultations
- Additional in-hospital treatments
- Physical therapy while hospitalised
- Specialist care for pregnancy-related complications
- The TRA Assist app offers trauma counselling and assistance for postnatal depression
TRA’s Extended Benefits: Beyond Standard Maternity Cover
Oncology Treatment Support
TRA provides extensive benefits for members facing serious health challenges, including extended oncology treatment benefits. This cancer treatment shortfall cover ensures that mothers receive the necessary care during already challenging times.
Emergency Medical Assistance
Unexpected situations require immediate response. TRA’s emergency medical assistance provides peace of mind when urgent medical treatment becomes necessary, regardless of whether you are pregnant or not.
TRA’s Simple & Effective Claims Process
When submitting claims with TRA, ensure you have:
- Completed claim form with all required details
- Original invoices from healthcare providers
- Medical aid statements
- Supporting documentation for in-hospital stays
TRA’s streamlined approach ensures quick resolution of legitimate claims. Our dedicated team understands the urgency of medical expenses and works efficiently to process payments without unnecessary delays.
Making the Right Choice For The Whole Family
TRA’s gap cover for pregnancy offers the perfect combination of comprehensive coverage, competitive pricing, and excellent service.
Pregnancy and childbirth should be times of joy and excitement, not financial anxiety. With TRA’s gap cover, you can focus on preparing for your bundle of joy while knowing you’re protected against unexpected medical expense shortfalls.
Choose TRA
The best time to secure gap cover is before you need it. Contact TRA today to explore your options and ensure your growing family receives the protection and peace of mind you deserve.
Ready to get started? Contact TRA’s expert team to discuss your gap cover options and secure trusted gap cover for your pregnancy.
