Health insurance for couples planning a family

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A guide to health insurance for family planning

Updated 19 March, 2024
Written by Joshua Malin
Reviewed by Steven Spicer

Expert tips for couples looking to start a family

Our health insurance expert, Steven Spicer, has some tips for couples who are starting a family and looking for the right cover for them.

Steven Spicer
Executive General Manager – Health, Life & Energy

Take out cover early

Consider taking out private health insurance for hospital admissions before trying to conceive. Not only will this give you more time to serve your 12-month waiting period for pregnancy and birth before the baby arrives, but you may also be able to claim a benefit for some other, non-pregnancy related medical conditions in the meantime.

Consider both hospital and extras

Hospital cover allows you to stay in a private hospital in a private room (if available). You can also choose your own available doctor (their fees and associated labour ward costs will be covered up to the Medicare Benefits Schedule). Through extras cover, you may be able to claim a benefit on birthing classes, remedial massage, physiotherapy and other support services before the baby’s arrival.

Confirm your child is included on your policy from birth

It’s important to familiarise yourself with your health fund’s rules on how they cover your newborn from birth. Even if you already have couples cover, you may want to consider taking out family health insurance before (or soon after) the baby is born depending on your health fund. Your health insurance premiums for a family policy will often be similar to or the same as what you will pay for a couples policy.

If you’re on a singles policy, it will most likely cost you more to move to a family or single-parent policy. Depending on your insurance provider, if you have a family policy with extras cover, your family policy may carry group or annual limits on extras benefits and include items such as orthodontics and major dental.

Which health insurance policies cover pregnancy?

Pregnancy and birth-related services are included on Gold hospital policies, and some select ‘plus’ policies. These services will pay a benefit towards any medically necessary private hospital inpatient care associated with your pregnancy and childbirth and assisted reproductive treatments. For more information on what’s included on each level of cover, visit our health insurance categories page.

It’s important to note that pregnancy-related hospital benefits have 12-month waiting periods. So, if you’re looking to start a family, you should consider taking out hospital insurance before trying to conceive.

You might also want to consider including ambulance cover on your policy if you’re not already covered by your state ambulance service. Cover for emergency ambulances could save you from a significant out-of-pocket fee if there are complications and you need to go to hospital unexpectedly.

Can I get private health insurance if I’m already pregnant?

Yes, you can still get private health insurance while you’re pregnant. However, health insurance won’t pay a benefit towards pregnancy-related procedures until you serve the 12-month waiting period. Therefore, if you’re pregnant and want to give birth in a private hospital without insurance, you’ll have to pay for it out of pocket.

While you won’t be able to claim a benefit from your health fund for birth in a private hospital if you take out hospital cover while pregnant, there is another type of cover that can benefit you during and after your pregnancy. An extras policy can provide expecting or post-partum mothers with several useful out-of-hospital treatments and therapies, such as physio and chiropractic.

It might still be worth taking out a hospital insurance policy too, even if you can’t claim on pregnancy and birth-related services. You may want to take advantage of some pregnancy-related hospital services with shorter waiting periods, provided the condition is not classified as pre-existing (many pre-existing conditions will require you to serve a 12-month waiting period). This could include gynaecology, diabetes management for gestational diabetes and treatment for miscarriage or termination of pregnancy.

Does health insurance cover newborns?

Every health fund has different rules on how they will go about including your newborn from birth. Some may not require your newborn to serve any waiting periods, while others may only require the newborn to serve waiting periods not already served by the principal member (provided the newborn is added within the allowable timeframe). In many cases, this will be shortly after the birth of the baby, while others may require you to upgrade to a family policy up to 12-months before the baby is born for them to be covered from birth.1 It’s important to speak to your insurance provider to understand exactly what you need to do if you want peace of mind knowing your baby will be able to access the benefits of private hospital insurance if there are any complications after the birth.

Meet our health insurance expert, Steven Spicer

Steven Spicer
Executive General Manager – Health, Life & Energy

As the Executive General Manager of Health, Life and Energy, Steven Spicer is a strong believer in the benefits of private cover and knows just how valuable the peace of mind that comes with cover can be. He is passionate about demystifying the health insurance industry and advocates for the benefits of comparison when it comes to saving money on your premiums.

1 Commonwealth Ombudsman: obstetrics and pregnancy fact sheet. Accessed November 2023.