Think | Claims assistance - Medical Aids and UIF

MommyREG Maternity Benefit Services was established in 2004. This service assists pregnant woman that have contributed to the Unemployment Insurance Fund to claim Maternity Benefits from the Department of Labour. We offer e-mail- & personal consultations, making it possible to make use of our services even if on bedrest or out-of-town.

E-mail: mommyreg@telkomsa.net for more detail.

What percentage of my salary can I expect from the UIF?
The UIF pays 38% - 58% of your gross salary, to a maximum ceiling salary of R12 478.00. If you earn above R12 478.00, the UIF will calculate the maternity benefit on the last mentioned salary. The UIF takes in consideration your last 6 months average salary. They also take in account your last 4 year’s of UIF contributions. Please note that for each six months you have worked entitles you 1 month of maternity benefits up to 4 months.

How long can I claim for?
The maximum benefit you can expect from the UIF depending on your credits is 121 days – 4 months

When should my forms be submitted to the UIF office?
At the start of your maternity leave. When you are not earning a full salary. Tums2Mums UIF prefer to have your paperwork 2-4 Weeks before the start of your maternity leave so that we can ensure that your paperwork is at the Labour Department at the start of your leave.

I am already on maternity leave, can I still claim?
Yes, you have to apply within 6 months from the birth of your baby. The Department of Labour will back pay your pmts from the start of your maternity leave to date of application.

How long will it take for approval of my UIF Maternity Claim?
It approximately takes 4-8 weeks for approval and first payment of your claim – that is why we prefer to get your paperwork in 2-4 Weeks before start of maternity leave. The Department of Labour will start processing your application on the first day of your Maternity Leave.

How soon will I receive my first payment?
Your first payment is available as soon as the UI.4 form (confirming the birth of your baby) has been submitted to the Department of Labour.

How will I be paid?
Benefit payments will be deposited directly into your personal bank account directly from the Department of Labour.

Will I be taxed?
No Tax is payable on the benefits

Who can claim?
Workers on maternity leave, who pay UIF every month can claim. (If you don’t receive your full salary while on maternity leave)

Workers who miscarry in the third trimester or have a stillborn child can claim for six weeks.

If you did claim Maternity benefits in the last four years you will be able to claim again now.

Who can not claim?
If you claimed any other type of benefits from the Department of Labour in the last four years for example because you got retrenched or were sick, we can check your status at the UIF office.

If UIF is not deducted from your salary every month, you can not claim. ( By law your employer is supposed to deduct UIF if you work more than 24 hours per month)

You must have a bar-coded ID book. ( If you are not a South African citizen you can not claim.)

If you are having problems with claims from your medical aid for your home birth, or for any claims on hiring our equipment - as a last resort - please contact the Council for Medical Schemes.

The Council for Medical Schemes is a statutory body, established by parliament to supervise medical schemes.  Let them know that you are not having any luck regarding your 100% claim, stating the financial benefits of a home birth for both you and your medical aid.  Include all communication that you have had with your medical aid.

The Registrar of Medical Schemes is
Patrick Masobe
Sharecall - 0861 123 267
Telephone - 012 431 0500
Fax - 021 430 7644
email - support@medicalschemes.com
Post - Privatebag X34 Hatfield 0028
Website - http://www.medicalschemes.com

To achieve this you need to have authorization for the full cost of your birth covered by your medical aid and for that, three things are required:

• Start as early as possible in your pregnancy – from 12 weeks ideally.
• Be tenacious – but polite! It will take commitment and time (weekly follow ups) – it makes it easier to dedicate some space in your diary for this or to keep a small note book.
• Don’t accept no for an answer

• Begin your request for full home birth cover from your medical aid as soon as you know you are pregnant (or the moment you see this information!) – start with their regular procedure for lodging an authorisation request. This usually means you make a request to a call center where they log your call and give you a reference number. Home birth is an utterly foreign concept to them, so your request is unusual – you need to respect that and be mindful of it when tensions rise.

• Take note of the call log reference number, the person you spoke to and when you called.

• Follow up within 1 week if you don’t get any feed back – be polite if they delay you again, but find out who will be responsible for making the ultimate decision (usually the fund manager).

• Politely follow up with the call center each week (or two days!) at least 2 more times

• Should no proper answer be received at this point, contact the fund manager or their assistant – and press them to tell you a date when their decision may be expected. Keep following up on this until you have an answer.

• If the decision continues to be delayed or it comes back as “no” or that they will only pay at NRPL rates (a quarter of the midwife’s fee), then log a complaint with the “Council for Medical Schemes” (independent umbrella body who watch over all schemes). This complaint is made in writing. When you prepare this, it helps to get a written quote from your local private hospital for a natural delivery – the comparative cost to home birth is reason on its own! (bear in mind, they quote you ward fees – not gynae/midwife or anesthetist fees – that’s extra!)

• A complaint logged with the Council is then sent to the Medical scheme – they get 30 days to respond. If their response is not favourable, you can complain to the Council, who will take it further. This is unusual however, because if your request is fair, the moment your medical aid know you have gone this route, they are more likely to accept it – but its important to go through the regular channels first (don’t try to short cut!!).

• Always follow up – check that the Council has the complaint logged (call a day or two after lodging your complaint medical aid have received the complaint from the council

• Once you have authorisation from you medical aid for a home birth, then birth products such as those supplied by Birthworks would become part of the expenses for birth aids (auxiliaries) covered by the midwife. This means that you could arrange for the costs to be included on your midwife’s invoice (for the claim to the medical aid), or you could submit the Birthworks invoice. You would most likely need to pay your midwife and Birthworks first and then claim from your medical aid afterwards, but this does depend on which company you are with and how they manage their claims.

Written for Birthworks by Claire Roy Mother of 3 , thanks Claire