Understanding private health insurance for pregnancy
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Pregnancy and birth cover explained
Pregnancy and birth cover explained by Dr Ginni Mansberg.
Dr. Ginni Mansberg
Health
Video Transcript
Hi, it’s Dr. Ginni Mansberg, GP and health commentator in the media.
I’m here to chat about what you need to know about pregnancy.
If you’re pregnant or planning on starting a family.
Congratulations! Welcoming your bub into the world and becoming a parent can be the most rewarding and the most challenging thing you will ever do.
Australia is lucky enough to have an excellent public health care system that allows every family to deliver a baby in a hospital.
If you’re interested in choosing a private hospital, having your own room, if one is available, choosing a specialist and obstetrician or fertility support.
Medicare might not provide access to the services you want.
Chat to the experts about whether private health insurance is a good option for you. And which one best suits your needs.
Do you need private health insurance for pregnancy?
Both public and private hospitals in Australia provide quality healthcare for mothers during pregnancy and birth. However, with a private health insurance hospital policy, you can:
- Choose your own obstetrician and get continuity of care when available
- Give birth in an agreement private hospital of your choosing
- Get a private room if there’s one available
- Receive in-patient assisted reproductive services (ARS) to treat infertility (if this is included in your policy).
Choosing maternity cover
Policies can be very different, even with the same provider. You should think about:
- What you want to be covered for
- Waiting periods and when to take out cover
- Whether there’s an excess or co-payment for your hospital stay
- Whether assisted reproductive services are included.
There are two types of health insurance that may pay a benefit towards pregnancy:
- Hospital – This will pay a benefit towards costs relating to your hospital admission such as the hospital room, labour ward and some doctors’ fees
- Extras – This can pay a benefit towards out-of-hospital services such as lactation consultation, postnatal care and more.
You can choose to have one or both types of cover if you are planning on starting a family.
Expert tips for finding the right private health insurance for pregnancy for you
Our health insurance expert, Steven Spicer, has some helpful tips for finding the right private health insurance for pregnancy for you.
Steven Spicer
Executive General Manager – Health, Life & Energy
Pregnancy waiting periods
When considering whether the benefits of private health insurance are right for your pregnancy, remember to factor in the waiting periods that apply. You’ll need to have pregnancy included on your hospital cover 12 months prior to your baby being born to be able to give birth as a private patient.
Out-of-pocket costs
Remember, you may have to pay out-of-pocket costs for the birth of your baby. It’s a good idea to ask your doctor to provide a breakdown of the out-of-pocket costs you’re likely to incur throughout the process.
Cover your family’s ongoing needs
The benefits of your private health cover don’t have to end with the delivery of your baby. Private health insurance could assist with your and your family’s ongoing needs, including a wide range of extras services such as post-natal classes, physiotherapy and even swimming lessons.
No gap pregnancy cover
When you’re treated as a private patient, Medicare and your private health insurance will pay a benefit towards your treatment costs if you hold the right level of cover. However, you’ll usually, you’ll still have to pay:
Your gap payment is the difference between what Medicare and your health fund pays, and what the hospital charges, while your excess is a flat amount you pay on admission.
Your total gap amount will also depend on your fund’s gap cover scheme. A no-gap scheme means your entire gap will be covered, while a known-gap scheme means your gap will be reduced to a predetermined amount that you’ll be made aware of before treatment.
Are pregnancy ultrasounds covered by Medicare?
Medicare subsidises some of the costs when it comes to ultrasounds and some other scans. However, depending on what your doctor charges for your consultations, you may have to pay out-of-pocket expenses. This happens when your obstetrician charges more than the Medicare Benefits Schedule amount. Your private health insurance probably won’t cover this gap. We recommended discussing these charges with your doctor before having any scans.
What is included in pregnancy cover
As a private patient in a private hospital
To be covered for the birth of your baby in a private hospital, you’ll need private hospital cover that includes pregnancy and birth-related services. This used to be known as obstetrics cover.
These services are included in:
- All Gold hospital policies – the most comprehensive hospital policy tier
- Some ‘plus’ policies – less comprehensive policies that sometimes include pregnancy cover.
| Included | Not included |
|---|---|
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As a private patient in a public hospital
You can choose to go to a public hospital as a private patient. However, you might not get your own room for the birth of your baby. Doctors in public hospitals may charge private patients higher fees, which may result in higher out of pocket costs.
Physio, prenatal classes and other extra services
Depending on your policy and level of cover, extras cover can help you pay for outpatient services during pregnancy and after the birth. These medical services might include:
- Prenatal and antenatal classes to prepare you for birth and parenting a newborn
- Remedial massage to ease pregnancy-related aches and pains
- Physiotherapy to help treat pregnancy complications, back or pelvic pain, or urinary incontinence
- Psychologist appointments to support your mental health
- Lactation consultants and sleep consultants for help with breastfeeding, caring for and settling your baby.
Important to know
Can you get health insurance while pregnant?
Yes, you can still get a health insurance policy while you’re pregnant. However, since pregnancy-related hospital services include 12-month waiting periods, you may not be able to claim all services if you take out a policy while you’re pregnant.
Waiting periods for pregnancy cover
There are different waiting periods for pregnancy health insurance depending on the service and your policy.
You should take out private health insurance for obstetrics and IVF as early as possible because you will have to wait for 12 months before making claims on these two key services:
- Obstetrics (services related to childbirth)
- Assisted reproduction (such as IVF).
Even if you deliver before your due date, some policies will not provide cover until after your 12-month waiting period. So, it’s important to speak to your fund as soon as you find out you’re pregnant to be aware of all your options.
Assisted reproductive services including IVF
Private hospital insurance can pay a benefit towards assisted reproductive services like In Vitro Fertilisation and Gamete Intra Fallopian Transfer.
Private hospital insurance pays a benefit towards the services you receive in hospital as an inpatient. This might include accommodation, operating theatre fees, part of your anaesthetist and doctors’ fees, and accommodation for egg collection procedures. However, you may have to pay an excess and/or co-payment as well as a gap fee towards these costs.
Private hospital insurance doesn’t cover procedures that happen at facilities outside the hospital, such as blood tests, ultrasounds, scans and diagnostic and pathology services. You may be able to claim a rebate for these services through Medicare.
Cover for your baby with family hospital insurance
A single person hospital policy does not include private hospital care for your newborn. This means that you’ll need to pay out-of-pocket if your baby is admitted to a Special Care Nursery or Neonatal Intensive Care Unit.
If you want your baby covered from birth, including seeing a private paediatrician, you’ll need a family or single-parent hospital insurance policy. Each health fund has different rules, but you may need to get a family policy as much as 12 months before birth for your baby to be covered.1
Meet our health insurance expert, Steven Spicer
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.
Want to know more about health insurance for pregnancy?
1 Commonwealth Ombudsman: obstetrics and pregnancy fact sheet. Accessed February 2024.
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