Starting your own family is an exciting adventure, although it’s not one without the unknown. Because of this, many of us prefer the comfort of a private hospital room and our own doctor when it comes time to giving birth.
However, with growing expenses (cue thousands of nappies – and then some), many also wonder if they really need to take out private health insurance for their pregnancy. To help you make the most informed decision for your needs, we’ve broken down important factors regarding how pregnancy is covered in private health insurance.
Both public and private hospitals in Australia provide quality care for mothers during their pregnancy and the birth of their child. When it comes to private health insurance, however, you are able to choose the obstetrician who looks after you during both your pregnancy and delivery, provided your hospital cover includes pregnancy and birth-related services (otherwise known as obstetrics cover).
Once you’ve served your 12 month waiting period, you’ll be covered for accommodation, labour ward costs, and doctors’ fees at an ‘agreement private hospital’ of your choice. Depending on your health fund, you may even be able to cover the costs of your pre-natal classes.
With obstetrics cover (again, provided you have served your waiting period), you will also be paid a benefit towards your obstetrician’s fees during delivery (ask early on for a breakdown of the costs from your doctor and insurer). However, any consultations prior to being admitted to hospital will not be covered by your health fund, so set aside some money for those expenses. That being said, you can claim some portion of these costs back through Medicare.
While private health insurance covers some of your medical fees, there are some pregnancy-associated costs that may come out of your pocket. It’s therefore important you carefully check the Product Disclosure Statement (PDS) of your health insurance policy to see what is and isn’t included as part of your cover. Some policies will not cover obstetrics, or may only pay restricted benefits; some may also only cover you if you’re a private patient in a public hospital – this means if you want to deliver your baby in a private hospital, you’ll need to make sure coverage as a private patient in a private hospital is included in your policy.
Some things you will be expected to pay out of your own pocket for can include:
Private health funds can cover Assisted Reproductive Services (ARS) to treat infertility, including In Vitro Fertilisation (IVF) treatment and Gamete Intra Fallopian Transfer (GIFT). It’s important to be aware that these procedures have a 12 month waiting period and aren’t always automatically included in policies that cover natural birth and obstetrics.
As only in-patient services, like your hospital admission, are covered under private health insurance, you may be out-of-pocket for certain costs associated with ARS procedures. Certain out-of-hospital procedures that won’t be covered by your insurance, but may be claimed through Medicare, include:
Be sure your hospital advises you before your admission of any procedure costs and charges.
When it comes to IVF, egg collection is considered the main procedure, which is carried out in an operating theatre as an in-patient. These theatre fees and your accommodation are both covered by your health fund, and you will also be paid a benefit towards anaesthetist and doctors’ fees. You may need to pay the ‘gap’ fee for medical costs that go above the Medicare Benefits Schedule fee.
Private health insurance should be taken out as early as possible, as everyone is required to sit through a 12 month waiting period for two key services before making claims:
Even if you deliver prematurely, some policies will not provide cover unless you have completed your 12 month waiting period.
Extras cover can be especially helpful during pregnancy, and can be chosen in conjunction with a hospital insurance policy. Depending on your health provider, some extras policies include antenatal care, which educate and provide advice to pregnant women and their partners before their baby arrives. Postnatal classes are also valuable for new mothers. With these extras, you might be able to claim on birthing and breastfeeding classes, midwife visits pre or postnatal, and sleep settling consultations.
Physiotherapy is also a helpful service available in extras cover that can help women who have suffered from pregnancy complications, as well as provide exercises that can help ease back pain, pelvic pain, and urinary incontinence.
Claiming on out-of-pocket psychology appointments can be helpful as well, especially since many women – about one in seven in Australia each year – can develop Postnatal Depression. Having a child is a wonderful experience, but it is a life-changing adjustment. As such, it can be a great idea to organise a safety net where you can receive advice and guidance from a professional.
Waiting periods for extras cover varies between individual health funds.
Any excess or co-payment on your hospital cover will need to be paid when you are admitted to hospital. You may also be required to pay an excess for your baby if they need to be formally admitted to hospital. Be sure to budget for these costs well before having your baby.
It is a smart idea to take out a family or single parent family health insurance policy. Why? So you’re able to enjoy low cost care for their future. Maybe they’ll need braces for their teeth one day, or perhaps a speech therapist if they develop a stutter. In any case, complete coverage means you don’t need to worry about certain unexpected costs.
When it comes to obstetrics cover, you will be faced with some out-of-pocket expenses, excess, and co-payments; these aren’t considered exclusions. On the flipside, obstetrics cover can be excluded from some hospital policies.
Not too sure what you need cover for? Call one of our experts on 13 32 32. Know what you are looking for? Try comparing health funds to see if you can find a better deal.