Pregnancy & Health Insurance - What’s covered and will it help my family’s health needs?

Thinking of starting a family soon? Starting a family is one of the biggest decision you’ll make in life. The prospect of having a baby is both exciting and daunting.

So knowing you have the best health insurance for pregnancy can give you certainty and peace of mind. It also means you’ll receive the highest standard of care for you and your baby.

Many people start looking for pregnancy insurance after they’ve conceived and don’t realise that 12 month waiting periods apply. If you’re wanting health cover that includes maternity, you’re best to start comparing policies as soon as you begin planning for a family. This means by the time you need pregnancy and obstetrics services, you’ll have the appropriate cover.

Whether you need to upgrade your current health insurance or take out a new policy all together, finding the right cover that suits your health needs can be overwhelming.

That’s why the Members Own team have put together the following guide. We’ll take out the confusion by covering all the simple facts to help you make an informed decision for your family. If you think you’ve got a pretty good handle on the basics of health cover for pregnancy, you can always skip ahead and get started with an online quote right now.

Related: Family Health Insurance - Everything You Need To Know

Ready to compare? Use the Members Own comparison tool and in just a few minutes, you'll be provided with a range of policy options from 20 not-for-profit health funds.

The Members Own Health funds exist to give their members more benefits and better coverage, while investing a higher percentage of your premiums to improve services and keep you happy. In fact, over one million Australians are already with one of our not-for-profit or mutual funds

Do I need private health insurance for pregnancy?

Many Australians ask themselves if it’s worth having private health insurance for pregnancy. Deciding to take out health insurance for the first time or to upgrade your cover is a big decision and does come with a financial burden. While we have one of the best public health systems in Australia, some families want to enjoy the added benefits that comes with private health cover.

With private health insurance, you’ll have more options available to you when it comes to your pregnancy and birthing care. Here are a few potential benefits:

  • Your insurance will cover the costs of your accommodation and labour ward fees.
  • You may be able to choose your own obstetrician and preferred doctor or hospital if you have special medical issues.
  • You may even be able to enjoy your own private room during the birth of your child.
  • You may also benefit from some of the non-essential items such as fertility treatment and birthing classes.

Without pregnancy insurance, you won’t have any choice over your health care provider during the birth of your child. You’ll give birth in a public hospital and often won’t know the doctors or midwives attending your birth. In the event complications occur with you or your baby, you may need to pay out-of-pocket for these unpredictable expenses.

Starting a family is a life-changing event. Not only is it an exciting time, it’s also an anxious one. For many new parents-to-be, the option of choosing where they’re going to give birth and the health professionals present during the delivery can help them feel more confident and relaxed throughout the experience.

What’s covered under pregnancy health insurance?

It’s no secret that having a baby is expensive. Beyond the costs of furniture for your nursery and baby goods, the unforeseen costs of medical treatment can be substantial. That’s why planning well ahead and making sure you’re covered for every aspect of pregnancy is important.

While you’ll have to pay some health cover expenses yourself, the right health cover can reduce your overall costs to a more manageable level. Not only that, you’ll be aware of any out-of-pocket costs and can budget accordingly. That means paying less on medical treatments and more on cute baby outfits!

As a general rule of thumb, there are three main elements of private obstetrics cover:

  • Hospitalisation

    The expenses of your hospitalisation costs will be covered by private health insurance. This includes your accommodation at your choice of private or public hospitals, birthing wards, theatre fees, anaesthetics and pharmaceuticals.

  • Birth

    With private health insurance, the costs of your chosen obstetrician and paediatrician will be partially covered by your fund.

  • Postnatal

    Private health insurance can also protect your newborn baby in the event he/she requires hospitalisation or medical treatments after birth.

What are the waiting periods for pregnancy health cover?

If you’re lucky you may find a private fund offering a 9-month waiting period for pregnancy health insurance, but most enforce 12 months. This is why it’s vital to take out a policy well in advance when you’re first thinking about starting or growing your family.

The waiting periods also apply if you’re upgrading your current level of private health insurance to include obstetrics cover. Health funds are very strict in enforcing these waiting periods and unlike other extras insurance, finding a pregnancy cover with no waiting period is unlikely.

Are there any additional costs of pregnancy with private health insurance?

Even if you’ve found the best pregnancy health cover for your needs, there will still be additional expenses you’ll need to pay out-of-pocket. The exact amount will depend on your fund and individual policy. These can include:

  • Out-of-hospital medical services

    The costs associated with GP visits, blood tests, ultrasounds, postnatal classes, specialist consultations and obstetrician check-ups that occur outside of the hospital tend not to be covered by private health insurance. Excluding postnatal classes, the costs of these services can be partially claimed through Medicare.

  • Excesses or co-payments

    Any excess or co-payments stipulated by your health fund for hospital admissions must be paid for by you. This amount will vary from fund to fund. However, it mostly depends on the health of your newborn at birth and whether they require postnatal treatment.

  • The gap

    Depending on your policy and health fund, any gap for in-hospital medical services will be paid for by you. This fee refers to the difference between what your insurance provider will pay and the Medicare Benefits Schedule fee.

  • Pre-release check-up

    The pre-release check-up of your newborn baby is generally not covered by your private health insurance. This can be partially claimed through Medicare.

  • Newborn medical treatment

    Most funds will cover the costs of potential medical bills your baby may incur while still in hospital in the event they need immediate care. A waiting period for this applies and depending on your fund, you may need to pay extra for this level of insurance. It’s worth considering switching to family cover before the birth of your baby to ensure he or she is protected.

    To cut down your costs you can ask your chosen health fund to recommend an obstetrician who uses the fund’s gap scheme and has an agreement with your insurer. You can also utilise shared care with a GP who bulk bills and ask your obstetrician to provide a detail of the costs before engaging their services. You can also consider being a private patient in a public hospital.

Won’t Medicare cover me for pregnancy?

Yes, Medicare will cover some aspects of your pregnancy if you don’t have private health insurance.

  • Some of your antenatal care costs are partially covered such as GP consults, obstetrician visits, blood tests, ultrasounds and other specialised tests.
  • A partial payment of in-hospital costs including baby delivery and anaesthetic fees.
  • Some of your postnatal care costs are partially covered such as postnatal health visits and paediatric check-ups.

Depending on your circumstances, you may be eligible for a Newborn Upfront Payment or Parental Leave Payment from Medicare. This can increase your family tax benefit and help provide financial assistance for up to 18 weeks you’re off work to care for your new baby.

Will ultrasounds be covered under private health insurance?

Private health insurance in conjunction with Medicare pays for a large portion of your in-hospital treatment. If your policy has a no-gap scheme, you’ll be insured with no out-of-pocket expenses.

However, private health insurance doesn’t cover the costs of services and treatments required outside of the hospital setting. These outpatient services include diagnostic testing including ultrasounds, X-rays and pathology, and specialist consultations. If these services are covered by Medicare, they can generally be bulk-billed by the provider.

Will fertility treatments be covered?

Two fertility treatments that are commonly covered by private health funds include in-vitro fertilisation (IVF) and gamete intrafallopian transfer (GIFT). This is welcome news for many as assisted reproductive services can be expensive and usually several attempts are required to conceive, although there is no guarantee of success.

If offered by your health insurer, there is generally a 12-month waiting period for fertility treatments. It’s important to note, to be covered these services need to have a Medicare item number and require admission to the hospital.

We recommend you speak with your fund prior to considering these services to ensure you’re covered for as much of the costs as possible.

Will my baby be covered under the pregnancy insurance policy?

Obstetrics insurance is designed to provide you with private health cover during your pregnancy and birth of your child. Depending on your health fund and individual policy, your baby may not be covered when he or she is born.

That means if you’re on a singles or couples policy with pregnancy coverage, in most cases your baby won’t be protected. It’s worth considering switching to family cover before your baby is born.

It’s important to note, some funds will require you upgrade to family cover at least a few months before the birth of your child. With this in mind, comparing policies as early as possible is recommended.

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Some key things to keep in mind

If you’re starting or growing your family and considering health insurance, there are a few key things to keep in mind, including:

  • Excess or co-payments

    If excess or co-payments apply to your policy they’ll need to be paid upon your admission to hospital. If your baby requires medical treatment and also needs to be formally admitted, you’ll need to pay for the additional excess. It’s worth budgeting for this expense in advance to ensure you’re not caught out financially at the time of your baby’s arrival.

  • After your baby’s born

    If your baby doesn’t require formal admission, a pre-release check-up will discharge you and your baby from the hospital. This isn’t covered by your private health insurance, but may be claimed under Medicare.

  • Upgrade to family cover

    Consider upgrading your health insurance to protect your baby in the event he/she requires in-hospital medical treatment after the birth. Taking out family cover can also help protect your child’s health in the future. Maybe they’ll require braces one day to assist in straightening their teeth or need orthotics to help rectify their feet. With the right insurance, you won’t need to worry about these unexpected costs.

Ready to compare?

To ensure you’re covered for pregnancy when you want to start a family, you’ll need to take out private health insurance at least 5-6 months before you conceive. If you’ve decided pregnancy insurance is for you, comparing policies will help you get the most value out of your obstetrics cover.

With the Members Own comparison tool, comparing policies couldn’t be any easier. In just a few minutes you’ll be able to compare a range of extras cover options from 20 Australian not-for-profit funds. Once you’ve found the best policy for you, you can have the peace of mind the health costs of starting or growing your family are covered.

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If you have any questions or queries with your pregnancy health cover, we have friendly staff who are all health insurance experts. You can call one of our team on 13 10 66.

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