Pregnancy and Newborn Cover

Prepare before pregnancy

Many people only begin looking for private health insurance once they’ve fallen pregnant and don’t realise that a waiting period may apply. If you arrange private health cover early, you’ll be able to serve your waiting period as soon as you begin planning for a family. This means by the time you actually need to use pregnancy and obstetrics services, you’ll be covered.

Waiting periods for pregnancy cover

If you are taking out health insurance for the first time, a waiting period of 12 months commonly applies before you can claim any benefits for pregnancy/obstetrics services. This waiting period will also apply if you are upgrading your current level of private hospital cover because you weren’t previously covered for these services.

Health funds are very strict in enforcing pregnancy/obstetrics waiting periods.

What does pregnancy cover include?

If you take out a hospital policy with full pregnancy cover, you will be covered for hospital admissions related to the pregnancy or birth which typically includes:

• Accommodation within a hospital and/or hotel
• Theatre/labour ward fees
• Intensive care relating to the birth, or post-birth for the mother
• Pharmaceuticals administered in hospital
• 100% of the Medicare Benefit Schedule fee for doctor fees (75% Medicare + 25% fund)

Insure your newborn baby

Having your baby covered from birth is important in case he or she requires immediate hospital care [1].

Health funds have different rules about how far in advance you need to make changes to your cover to insure your newborn baby. Depending on when your policy was purchased and when your baby is born, family health insurance may, in some cases, cover your new baby. However, singles/couples policies with pregnancy/obstetrics coverage means that you’ll be covered for the duration of the pregnancy, but not for your newborn baby in the period following the birth.

If you are on a singles/couples policy with cover for pregnancy/obstetrics, consider switching to family cover before your baby is born to ensure your baby is also protected.

In all cases, confirm your individual policy details with your chosen health fund. Some funds may require you to upgrade to family cover several months before your baby is born. Speak to our experts about your individual circumstances.

Be aware of policy specifics

Some health insurance policies don’t cover obstetrics, or if they do, they could be restricted to only offering limited benefits, such as covering you as a private patient in a public hospital. If you want to have your baby delivered in a private hospital, by a private doctor, you will need a specific policy that outlines and covers this. Without this cover, you could face heavy out-of-pocket costs [2].

Outpatient services

Any pregnancy-related consultations or treatments in which you are not formally admitted into hospital will not be covered by private health insurance.

Medicare, however, will pay benefits towards outpatient services. For any outpatient services where Medicare won’t pay a benefit, for example, birthing classes, some health funds could contribute through various coverage options. Speak to our experts about your individual needs.

IVF

The most common waiting period for IVF services is 12 months. Check with your individual health fund to determine the details of your policy and how far in advance you’ll need to ensure you are properly covered.

Keep in mind

When you’re looking at starting a family, consider taking out a policy six months before you try to conceive. This will allow you to see through your full waiting period before you wish to claim benefits for those services.