In Australia, private health insurance is divided into two parts: extras and hospital cover. You can take them out separately as standalone policies or bundle them together into combined hospital and extras cover.
On the other hand, hospital cover can pay towards surgeries as a private patient, such as pregnancy and birth-related services, gynaecology and medically-necessary breast surgery.
Bear in mind that hospital insurance is categorised into four different tiers: Basic, Bronze, Silver and Gold. Both the procedures you’re covered for and your insurance premiums will differ depending on the level of cover you choose.
You also may have to hold your health insurance policy for a set amount of time, known as a waiting period, before you can claim on the services you’re covered for.
Gold hospital cover (and some lower tier ‘plus’ policies) can include benefits for pregnancy and birth-related services, like the cost of private care during your pregnancy, accommodation, labour ward costs and doctors’ fees. While hospital insurance doesn’t cover consultations before you’re admitted to hospital as a patient, you can claim a portion of these costs through Medicare.
When you give birth in a private hospital, you can choose your own obstetrician, see the same doctor throughout your pregnancy and recover in a private room (if available). Women treated in a private hospital also get to spend more time on average recovering in hospital before they have to go home.3
There is a 12-month waiting period before you can claim expenses for pregnancy and birth-related services on your hospital insurance, so it’s vital to take out cover before you start trying if you want to receive private care during your pregnancy.
You can also access many valuable out-of-hospital health services for your pregnancy through extras cover. This includes birthing and breastfeeding classes, pre- and postnatal midwife visits and sleep settling consultations. Physiotherapy is another helpful extras service for women who have experienced pregnancy complications resulting in back pain, pelvic pain or incontinence.
If you have a hospital insurance policy that covers assisted reproductive services, you may be able to receive treatment to help you fall pregnant such as in vitro fertilisation (IVF) and gamete intrafallopian tube transfer (GIFT).
If you have a genetic condition that you’re concerned about passing to your children, you may be able to receive genetic testing to assess the genetic makeup of your embryos before they’re implanted for conception.
There is also a 12-month waiting period you’ll have to serve before you can claim on these services, so make sure you take out cover well before you plan on trying for a child.
If you’re not planning on having a child, there are other benefits of private health insurance that you might be interested in. For example, certain extras policies cover you for some of the cost of prescribed contraceptives for a medical purpose from a pharmacy. This is handy if you require a more expensive contraceptive that isn’t on the government’s Pharmaceuticals Benefits Scheme (PBS).
Termination of pregnancy is also an option available to women through private health insurance. Abortion is legal in some form in every Australian state. However, the specific laws surrounding termination of pregnancy do differ between states, so you’ll want to discuss your specific circumstance with your general practitioner, as you may need the approval of a second doctor, depending on your circumstances.4
Yes, you can still get cover if you’ve been diagnosed with a pre-existing health condition, and your coverage will not cost more for it. However, you’ll typically have a 12-month waiting period before you can claim treatment relating to your pre-existing condition.
Waiting periods for hospital insurance are set by the Australian Government and vary depending on the treatment. These waiting periods are the same across all health insurance providers, regardless of sex.
|Waiting periods for specific hospital treatments are:||Waiting period|
|Psychiatric care in hospital||2 months|
|Palliative care||2 months|
|Pre-existing conditions||12 months|
|Pregnancy and birth-related service||12 months|
Waiting periods for extras cover vary between insurers and will generally be 2 months, 6 months or 12 months, depending on the treatment. Some services, like hearing aids, may attract even longer waiting periods, so read your policy document carefully.
The good news is that adding dependant children to your existing family policy doesn’t cost extra. Although, you may need to pay more for dependants over the age of 21 who aren’t studying.
Dependants can typically be insured up to 21 to 25, depending on the health fund and whether your child is studying, employed full-time or married. This is up to the insurer, who can implement their own age range from 18 to 31.
If you want to buy health insurance to help cover medical expenses, there are a few factors that might impact your decision on when you should take out cover:
These initiatives are designed to encourage Australians, whether they’re men or women, to take out health insurance earlier in life.
There are also other incentives for cover, such as:
1 OECD Statistics, Health status, Life expectancy for women born in 2020, Accessed July 2022
2 Australian Government Department of Health, National Women’s Health Strategy 2020-2030, Accessed July 2022
3 Australian Institute of Health and Welfare, Australia’s mothers and babies, Updated June 2022
4 Health Direct, Abortion, Last reviewed March 2021, Accessed June 2022
5 Australian Institute of Health and Welfare, The health of Australia’s females, Updated December 2019