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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.

Please note: As of 1 April 2020, pregnancy cover will only be offered in Gold and some ‘plus’ (or ‘+’) tier policies. For more information on the government reforms and different categories, read our page explaining the four-tiered health insurance categories.

Do I need private health insurance for pregnancy?

Both public and private hospitals in Australia provide quality care for mothers during their pregnancy and the birth of their children. 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).

pregnant women in the hospital being examined by doctor

What is covered when your health insurance includes pregnancy cover?

Once you’ve served your 12-month waiting period, pregnancy-related services cover accommodation, labour ward costs and doctors’ fees at an ‘agreement private hospital’ of your choice for the birth of the baby. The costs of your pre-natal classes may also be covered if you take out an extras policy that offers this coverage.

With obstetrics cover (again, provided you’ve served your waiting period), you’ll also be paid a benefit towards your obstetrician’s fees during delivery; however, any consultations prior to being admitted to hospital will not be covered by your health fund. Like any other specialist consultation, you can claim some portion of these costs back through Medicare.

Obstetrics cover: what you should consider

While private health insurance covers some of your medical fees, some pregnancy-associated costs 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 things you will be required to pay out of your pocket for include:

  • the ‘gap’ on medical services by your doctors and anaesthetist while admitted to hospital. Between your health fund and Medicare, you’ll be covered for the equivalent of the Medicare Benefits Schedule fee, while the remainder is out-of-pocket. Some health funds and certain doctors/specialists have gap cover agreements enabling the fund to cover more than the MBS fee for your hospital treatment, reducing your out-of-pocket cost. If your doctor chooses to participate, you’ll likely pay out-of-pocket for their fees;
  • your newborn’s check-up before you go home. You’ll be required to pay the consultation fee for the attending paediatrician. As with most cases (except complicated births), your baby will not be admitted as an inpatient at the hospital;
  • Special Care Nursery or Intensive Care Unit costs. It’s important to make sure your new baby is covered from birth as in cases where your baby needs immediate inpatient hospital care (i.e. born prematurely, low birth weight or jaundice for example) in a private hospital, you could be out-of-pocket if they are not covered by the health insurance policy;
  • out-of-hospital medical services, such as obstetrician’s check-ups and specialist consultations; and
  • an excess or co-payment for hospital admissions is required by some policies. This is chosen when you take out the policy.

Assisted Reproduction Services and IVF

Private health funds can cover in-hospital Assisted Reproductive Services (ARS) to treat infertility, including In Vitro Fertilisation (IVF) treatment and Gamete Intra Fallopian Transfer (GIFT). That said, it’s important to note that these procedures have a 12-month waiting period and are only covered by Gold and some ‘plus’ (or ‘+’) policies.

Since only inpatient services 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:

  • blood tests
  • ultrasounds
  • scans
  • diagnostic and pathology services.

Be sure you check with your specialist and hospital to confirm 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 inpatient. 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. However, you may need to pay the ‘gap’ fee for medical costs that go above the Medicare Benefits Schedule fee.

More on waiting periods for obstetrics cover and IVF

Private health insurance should be taken out as early as possible, as everyone is required to sit through a 12-month waiting period before making claims on these two key services:

  1. obstetrics (i.e. services related to childbirth)
  2. assisted reproduction services (e.g. IVF).

Even if you deliver prematurely, some policies will not provide cover unless you have completed your 12-month waiting period. So, it’s important to speak to your fund as soon as you find out you’re pregnant, so you can be aware of all your options.

A couple with their newborn in the hospital

Extras cover for pregnancy

Extras cover can be especially helpful during pregnancy and can be selected in conjunction with a hospital insurance policy. Depending on your health provider, some extras policies include antenatal care, which educates and provides 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.

Being able to claim on psychology appointments can be helpful as well, especially since many women – about one in seven in Australia each year – develop Postnatal Depression.1 Having a child is a wonderful experience, but it’s 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. Always read the health fund’s PDS for more information specific to your policy or call them to discuss your options.

Can I get health insurance if I’m pregnant?

Yes – you can still get health insurance while you’re pregnant. However, since pregnancy-related services include 12-month waiting periods, you may not be able to claim any of these services if you take out a policy while you’re pregnant.

Are pregnancy scans covered by Medicare?

Medicare does subsidise some of the costs when it comes to ultrasounds. However, depending on what your doctor charges for your consultations, you may have to pay out-of-pocket expenses above the amount that Medicare contributes. For this reason, it’s recommended you discuss these charges with your doctor before undergoing any scans.

Can I go to a public hospital as a private patient?

Yes – you can choose to go to a public hospital as a private patient. However, by doing this, you might not get your own room for the birth. What’s more, doctors in public hospitals may charge private patients higher fees – some of which might not be covered by your health insurance.

Things to keep in mind when starting a family

Check your policy

It’s important to note that obstetrics cover is a standard inclusion in the Gold tier hospital policies only. However, some health funds may include it in lower-tier ‘plus’ or ‘+’ policies.

Upgrade to family cover

It’s a smart idea to take out a family or single parent family health insurance policy, so you can enjoy low-cost care for your children. Maybe they’ll need braces for their teeth one day, or perhaps a speech therapist if they develop a stutter. In any case, coverage for your family means you don’t need to worry about some unexpected costs.

Excess or co-payments

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.

Read more about what you should consider when starting a family.

Find a great-value policy today

Know what you are looking for? Whether you’re planning to have a child or are currently pregnant, it’s worth comparing health funds to see if you can find a great deal. Through our free health insurance comparison service, it only takes minutes to view prices from some of Australia’s most reputable brands.

Sources

  1. Heath Direct. Postnatal depression.

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