Understanding private health insurance for pregnancy

Average customer rating: 4.3/5
Written by Joshua Malin
Reviewed by Steven Spicer
Updated 09 May 2024

Pregnancy and birth cover explained

Pregnancy and birth cover explained by Dr Ginni Mansberg.
Dr. Ginni Mansberg

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 a private hospital
  • 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 cover for pregnancy and birth

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

Factor in 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 can 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.

Medical costs you’ll have to pay

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:

  • Out-of-pocket expenses, such as gap fees
  • An excess and/or co-payment.

Your total out-of-pocket cost will depend on the policy you hold, what your hospital and doctors charge, and whether they participate in your health fund’s gap cover scheme.

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

As a private patient in a public hospital

Physio, prenatal classes and other extra services

Important to know

Can you get health insurance while pregnant?

Waiting periods for pregnancy cover

Assisted reproductive services including IVF

Cover for your baby with family hospital insurance

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.

Want to know more about health insurance for pregnancy?

1 Commonwealth Ombudsman: obstetrics and pregnancy fact sheet. Accessed February 2024.