- Most health funds stipulate a 12 month waiting period of pregnancy cover, which is why you need cover before you’re pregnant
- Remember – pregnancy insurance is for the health services of the person giving birth, but does typically include postnatal care
- You can take out a singles policy, couples policy or family cover, depending on your exact situation
Starting a family is an exciting adventure, but it can be stressful too. Many Australians prefer giving birth in a private hospital with their own obstetrician for comfort and peace of mind.
But here’s the question: Is it worth getting private health insurance for pregnancy?
In this article, we’ll look at the differences between private hospital and public hospital options when it comes to choice, continuity of care, and costs.
By the end, you’ll know if private hospital cover is right for you and the birth of your baby. Let’s go!
Why You Need Private Health Cover Before You’re Pregnant
If you’re thinking about starting a family, taking our private health insurance should be on your “sooner rather than later” list.
This is because most private health funds require the birth-giver to have held private health insurance for at least 12 months prior to giving birth.
So, if you take out private health insurance only once you’ve found out you’re pregnant, you won’t be covered for pregnancy related health services because you’ll still be within your 12-month waiting period.
Of course, not all pregnancies are planned, and it’s not always possible to take out health cover before finding out you’re pregnant.
However, if you are thinking about starting a family and plan on trying soon, consider taking out cover today.
Do I Need A Private Health Insurance Policy for Pregnancy?
In Australia, both public and private hospitals offer excellent healthcare for expecting mothers throughout their pregnancy and childbirth.
But, if you opt for private health insurance, you get an added perk – the freedom to select your own obstetrician to care for you during your pregnancy and delivery.
Of course, this is only possible if your hospital cover includes pregnancy and birth-related services, often referred to as obstetrics cover. Having this coverage gives you more control over your healthcare journey, ensuring you receive personalised care from a doctor you trust.
Benefits of Private Health for Pregnancy
- Peace of Mind: Private health cover gives you peace of mind knowing that you’ll have access to quality medical care during your pregnancy journey. It’s like having a safety net in case any unexpected complications arise.
- Choice of Doctor and Hospital: With private health cover, you can choose your preferred doctor and hospital for prenatal care and childbirth. Having familiar faces and a comfortable environment can make the whole experience more reassuring and personal.
- Shorter Waiting Times: Going private often means shorter waiting times for appointments and procedures. When you’re expecting, time is precious, and quick access to healthcare services can be a significant advantage.
- Continuity of Care: Private health cover offers continuity of care, meaning you can stick with the same healthcare provider throughout your pregnancy. Building a rapport with your doctor ensures they have a comprehensive understanding of your health needs.
- Coverage for Extras: Some private health policies also provide coverage for additional services like prenatal classes, postnatal care, and even some maternity-related expenses.
- Control Over Your Birth Plan: Having private health cover allows you more control over your birth plan. You can discuss your preferences with your chosen doctor and work together to make informed decisions about the birthing process.
- Financial Benefits: While there are costs associated with private health insurance, it can help offset some of the expenses involved in private maternity care, reducing the financial burden on your family.
What is Covered Under Pregnancy Cover?
Once you’ve served your 12-month waiting period, pregnancy-related services can cover:
- Accommodation in a private room,
- Labour ward costs
- Doctors’ fees at a private hospital of your choice for childbirth.
- Outpatient services like pre-natal classes and lactation consultants
- A benefit towards your obstetrician’s fees during delivery
However, it won’t cover any consultations before being admitted to the hospital. You can claim a portion of these costs back through Medicare instead.
Obstetrics Cover: Out-of-Pocket Costs
While your private health insurance will absorb some of your medical expenses, some extra costs related to your pregnancy and hospital care might fall on you directly: You may have to bear the following costs personally:
- The Gap. This refers to the difference between the total hospital charges and the fee paid as per the Medicare Benefits Schedule (MBS), which is shared between your health insurance provider and Medicare. For medical services provided by your doctors and anaesthetist during your hospital stay, you are only covered for the MBS fee. This gap amount must be paid by you. However, some health funds and doctors have gap cover agreements, allowing the fund to exceed the MBS fee for your hospital treatment, thus lessening your out-of-pocket expense.
- Check-up of your new baby before discharge. The consultation fee for the paediatrician who examines your baby will have to be paid by you. In most instances (excluding complicated births), your baby will not be considered an inpatient and thus won’t be covered by private health insurance.
- Special Care Nursery or Neonatal Intensive Care Unit (NICU) charges. It’s vital to ensure your newborn is covered from birth in case they require immediate inpatient care in a private hospital. If you add your newborn to your policy within your fund’s specified timeframe and have an appropriate policy, your baby can be covered for special care and NICU from birth. However, some health funds might necessitate you to switch to a family policy as early as 12 months prior to the birth to have your baby covered. Thus, it is advisable to confer with your insurance provider to understand how to guarantee your baby’s coverage from birth and avoid paying hospital costs from your pocket.
- Out-of-hospital medical services. Private hospital insurance won’t cover obstetrician check-ups and specialist consultations.
- An excess or co-payment. Certain policies mandate you to choose an excess or co-payment that must be paid upon hospital admission.
Choosing Your Specialist
A major perk of private healthcare is the ability to pick your obstetrician. In contrast, the public system assigns care based on various factors, including your hospital’s options and your pregnancy risk level. Common public options include:
- Antenatal clinic care: Regular check-ups at your maternity hospital’s clinic. Choice of midwives or obstetricians is not available.
- GP shared care: Shared care between your GP and maternity hospital, provided your GP has special training and a hospital agreement.
- Midwifery-led care: A midwife or team looks after you during pregnancy. Availability depends on risk level and waiting lists.
- Continuity of Care: In private pregnancy care, you generally stick with the same specialist throughout pregnancy, while public antenatal clinic care may involve different staff. However, midwife-led care and GP-shared care can offer some continuity.
Are Assisted Reproduction Services Like IVF Covered?
If you’re thinking about seeking treatments like In Vitro Fertilisation (IVF) or Gamete Intra Fallopian Transfer (GIFT) to help with infertility, good news! Private health insurance can help cover some of the costs. Just keep in mind that there’s usually a 12-month waiting period, and this kind of coverage is only offered in Gold and some ‘plus’ policies.
Here’s the tricky part though – your private insurance mainly covers in-hospital services. So, some expenses related to these treatments that happen outside the hospital might have to come out of your pocket. These include things like:
- Blood tests
- Diagnostic and pathology services
Don’t worry too much though, because you might be able to claim some of these through Medicare.
It’s always a good idea to check in with your specialist and hospital before going in for the procedure. This way, you can make sure you understand any costs that might come your way.
When it’s time for the main event in IVF – egg collection, which is done in an operating theatre – your health fund’s got your back. They’ll help cover the cost of using the operating room and your stay in the hospital. They’ll also chip in for the fees of the anaesthetist and doctors. Just remember, if the medical costs go above the MBS fee, you might need to cover the difference, known as the gap fee.
Extras Cover for Pregnancy
Extras cover can be a real lifesaver during pregnancy. You can tag it onto your hospital insurance policy, and it can offer a whole bunch of really useful stuff. Exactly what’s included can vary depending on your level of cover, so you’ll need to check with your health insurance provider. Here are some common extras:
- Antenatal care: This is all about preparing and guiding expectant moms and dads before the little one arrives. It’s like getting a roadmap for your pregnancy journey!
- Postnatal classes: These could help you claim for birthing and breastfeeding classes, visits from a midwife, or consultations about getting your baby to sleep (because we all know how important that is!).
- Physiotherapy: If you’re feeling a bit achy after your pregnancy, some extras cover could help with physiotherapy. It’s a great way to get exercises to relieve back pain, pelvic pain, or urinary incontinence.
- Mental health: You might be able to claim psychology appointments too. This can be a real comfort, especially because about one in seven Aussie mums develop postnatal depression each year. Becoming a parent is amazing, but it’s also a big change. Having someone professional to talk to can really help.
Is it possible to get health insurance while already pregnant?
Yes, you can secure health insurance during pregnancy, but due to the 12-month waiting period for pregnancy-related hospital services, you might not be able to claim these if the policy is taken out after you’ve become pregnant.
Does Medicare cover pregnancy scans?
Medicare does provide some financial assistance for ultrasounds. However, there might be additional out-of-pocket expenses depending on the fees charged by your doctor.
Can I choose to be a private patient in a public hospital?
Absolutely, you have the option to use public hospitals as a private patient. Keep in mind, this doesn’t guarantee a private room for birth, and the fees charged by doctors in public hospitals might exceed what your health insurance covers.
What are the waiting periods for obstetrics and IVF coverage?
Before claiming for obstetrics and IVF services, you need to complete a 12-month waiting period. Therefore, it’s advisable to get your private health insurance as early as possible. This applies even if you deliver prematurely – some policies won’t provide coverage unless the waiting period is fulfilled.
Need Help Finding the Right Pregnancy Cover? Compare Health Funds Today
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Simply use our free online tool below to get personalised health cover quotes from Australia’s leading health fund providers in minutes!