MATERNITY PROGRAMME
Our maternity benefits are designed to give your little ones the best possible start. These benefits are paid from Risk, so they will not affect your savings or day-to-day benefits. To get even more value, make sure you use a provider on our network.
WHO IS ELIGIBLE TO ACCESS THE MATERNITY BENEFITS?
The maternity benefits are available to all eligible pregnant Polmed members
WHEN SHOULD YOU REGISTER FOR THE MATERNITY PROGRAMME?
You should register for the maternity programme as early as possible, i.e. as soon as your pregnancy is confirmed and before 32 weeks gestation. This will ensure that you can access the Maternity programme benefits, which will be funded from the Risk benefit pool from the date of enrollment and receive educational material and health education on pregnancy.
WHAT BENEFITS ARE AVAILABLE AS PART OF THE MATERNITY PROGRAMME?
You can be enrolled on the Maternity programme via the following ways:
You can call the Maternity programme team on 0860 765 633
Monday to Friday (08:30- 17:00)
Disease management programme
(Follow the voice prompts)
Polmed Maternity team can contact you for enrolment once you have been identified through claims for your pregnancy
Your treating provider can contact the Disease Management call centre
WHAT BENEFITS ARE AVAILABLE AS PART OF THE MATERNITY PROGRAMME?
MATERNITY TREATMENT CARE PLAN
- A list of additional services available to you during your pregnancy covered from your annual overall in-hospital benefit. These services include doctor visits, pathology tests, ultrasounds and 2D scan
Important to note:
A motivation is required for amniocentesis/noninvasive prenatal test (NIPT) and any scans needed after 32 weeks of pregnancy. Please ask your doctor to email the motivation to Polmedmaternity@medscheme.co.za
ANTENATAL VITAMINS
- Certain pregnancy vitamins and minerals as approved by the Scheme for a duration of six (6) months.
A valid prescription is required from the treating provider
FROM WHICH BENEFIT POOL WILL THE MATERNITY CLAIMS BE PAID ONCE YOU ARE REGISTERED ON THE MATERNITY PROGRAMME?
The Maternity related claims for services included on the care plan will be paid from the Risk-benefit pool from the date of enrolment on the Programme and not from your overall out-of-hospital (day-to-day) limit.
WHO IS ELIGIBLE TO ACCESS THE MATERNITY BENEFITS?
- Polmed has a Hospital Network in place for Aquarium. You must make use of a hospital that is listed on the Hospital DSP Network. Using a non-Network hospital may result in an R15 000 co-payment.
- All admissions must be pre-authorised – a penalty of R5 000 will apply if no pre-authorisation is obtained.
- The authorisation will cover admission in a general ward.
- This benefit also provides cover for hospital-related costs for you and your baby whilst in hospital.
- The cover is at 100% of the Polmed rate/agreed tariffs.
Please note:
You must obtain pre-authorisation for delivery from 32 weeks of pregnancy. Contact Polmed for a pre-authorisation number by calling the Client Service Call Centre on 0860 765 633 or emailing Polmedauths@medscheme.co.za. To speed up the process, please ensure you have the following information handy:
- Polmed membership number
- Healthcare provider’s practice number
- Hospital practice number
- Date of admission and possible discharge date
- Diagnosis (ICD-10) codes and procedure codes
ELECTIVE CAESAREAN SECTIONS
In terms of the Polmed Scheme rules, Elective (voluntary) Caesarean Sections (C/section) will, subject to the PMBs, be considered in line with managed care and funding protocols. Pre-authorisation is mandatory.
A co-payment of R10 000 will be applied should you have a planned caesarean section. Polmed will consider waiving the co-payment where the C/section is an emergency and a clear clinical motivation and evidence is provided that shows there was a clinical need for the caesarean section.
This evidence will be reviewed and vetted before co-payment is waived.
Should you have any queries, please contact the Polmed Client Service Department on 0860 765 633 or send an email to: polmed@medscheme.co.za
REGISTRATION OF BABY:
It is essential to register your newborn as a dependent within 90 days of birth.
When submitting your Application for Registration of Dependents Form, please attach a copy of your baby’s birth certificate and send it to Polmedmembership@medscheme.co.za
This does not apply to third-generation children.
3RD GENERATION (GRANDCHILDREN)
Polmed will cover the delivery of a dependent’s child. If the newborn (grandchild) need hospitalisation, they will NOT be covered by the Scheme. The newborn (3rd generation baby) registration as a dependent to the principal member is not automatic and shall not be covered as outlined in the Polmed Scheme Rules (Rule no: 4.11). Should the newborn baby require medical treatment immediately after birth, kindly note that the Scheme Rules do not allow Polmed to fund any further treatment.
CONTINUATION OF MEMBERSHIP IN CASE OF MAIN MEMBER’S DEATH
According to Polmed scheme rules 4.28.4, if the main member passes away, the continuation member (Widow) will not be able to register any new dependent on Polmed, i.e. children born after the main member passed away unless the widow was pregnant at the time of the main member death.
MIDWIFERY SERVICES
Polmed will cover antenatal care, delivery, and postnatal care services from risk benefits subject to registration on the Midwife Led Care Programme and using providers on the network.
DELIVERY BY THE MIDWIFE WILL BE FULLY COVERED IF DONE AT:
- Midwife facility
- Your home
- The hospital in the network
Authorisation of Midwife services can be done as early as ten weeks of pregnancy.
You must obtain pre-authorisation for delivery from 32 weeks of pregnancy.
POLMED HEALTHCLOUD
The HealthCloud is a site that you can access via the member zone on the Polmed website that provides you with information on your pregnancy
MIDWIFERY SERVICES
Polmed will cover antenatal care, delivery, and postnatal care services from risk benefits subject to registration on the Midwife Led Care Programme and using providers on the network.
DELIVERY BY THE MIDWIFE WILL BE FULLY COVERED IF DONE AT:
- Midwife facility
- Your home
- The hospital in the network
Authorisation of Midwife services can be done as early as ten weeks of pregnancy.
You must obtain pre-authorisation for delivery from 32 weeks of pregnancy.
POLMED HEALTHCLOUD
The HealthCloud is a site that you can access via the member zone on the Polmed website that provides you with information on your pregnancy.
CHILDHOOD IMMUNISATION BENEFITS
DOES POLMED COVER IMMUNISATIONS FOR THE NEWBORN BABY?
Polmed pays for the immunisations for the baby as per the Expanded Programme on Immunisation in South Africa for children up to the age of 12 Years.
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