• Private health insurance can offset costs for private obstetric care in private or public hospitals.
  • Without private health insurance, giving birth in a private hospital may lead to substantial out-of-pocket costs.
  • If possible, before becoming pregnant, review your private health insurance cover to make sure you have the right level of pregnancy cover

The Australian Healthcare System and Pregnancy

In Australia, parents-to-be can enjoy free medical services during pregnancy and birth as a public patient, all thanks to Medicare.

But, if you’re dreaming about having your baby in a private room with private obstetric care, either in a private or public hospital, you’ll need private health insurance and hospital cover. Without the right level of cover, you might find yourself facing out of pocket expenses you weren’t anticipating.

Before you start planning for a baby, it’s super important to check your health cover if you already have private health insurance. This can shape how you plan your care during pregnancy and even help you choose where you want to welcome your little one into the world.

In this article, we’ll cover everything you need to know about pregnancy cover so you can have the peace of mind you and your baby-to-be are covered throughout your journey into motherhood.

When Should I Take Out Health Insurance?

Typically, most health insurance policies include a 12-month waiting period, during which you cannot claim any pregnancy-related health expenses.

Therefore, if you want to use your health insurance for pregnancy care, including consultations with your obstetrician and ultrasound checks, you should either take out or upgrade your existing insurance product with relevant cover 12 months before you get pregnant.

What to Look for in a Health Insurance Policy for Pregnancy and Birth

To ensure you have the coverage you need, it’s a good idea to consult with the hospital, your doctor and/or midwife before taking out or upgrading your health insurance.

Not all health insurance policies cover obstetrics and midwifery services. Some may only offer restricted benefits, covering you as a private patient in a public hospital. Here are some things to consider when taking out a private health policy for pregnancy:

  1. Obstetric Care: Ensure that the policy covers obstetric care, which includes care provided by an obstetrician throughout pregnancy, childbirth and postnatal care.
  2. Hospital Cover: Look for policies that offer comprehensive hospital cover. This should ideally cover the costs of both public and private hospitals, as well as the costs associated with a private room, should you choose to have one.
  3. Waiting Periods: Most policies have a 12-month waiting period for pregnancy-related services, meaning you must hold the policy for 12 months before you can claim these services. It’s important to plan accordingly.
  4. Extras Cover: Consider a policy that includes extras cover for services such as physiotherapy, postnatal nursing, or breastfeeding consultations, which might be necessary during or after pregnancy.
  5. Cover for Your Baby: Check if the policy will cover your baby from birth, especially in the event they need immediate medical attention or care in a Neonatal Intensive Care Unit (NICU).
  6. Out-of-Pocket Costs: Be sure to understand any potential out-of-pocket expenses, such as specialist consultations, hospital admission fees, and co-payments, that might not be fully covered by your insurance.
  7. Inclusions and Exclusions: Carefully review the policy to understand what is and isn’t covered. Some policies might not cover certain procedures or care options, like IVF treatment or home births.
  8. Level of Cover: The level of cover you choose (basic, medium, or comprehensive) will determine the services and treatments that are included in your policy and the associated costs. A higher level of cover typically includes more services but comes at a higher premium.

Will My Health Insurance Cover the New Baby?

A critical consideration when choosing a health insurance product is ensuring your newborn is covered from birth for any immediate hospital services or medical care required.

Check your health fund’s rules for covering newborn babies. Ask if your baby will be automatically covered after birth or if you’ll need to upgrade to a family policy.

Some funds may require you to upgrade to a family cover 3 to 12 months before the birth of your baby.

Special Cases: Premature Births and Multiple Pregnancies

In the event of a premature birth or if your baby is unwell, they may need intensive care. The costs for nursery care and your hospital stay are typically charged separately. Therefore, it’s critical to check with your health fund to ensure your baby is covered for such events.

In cases of multiple pregnancies (twins, triplets, or more), each baby’s care in the hospital will be charged separately. Again, checking with your hospital for expected costs and your health fund for what costs are covered is essential.

Managing Out-of-Pocket Costs

Even with a comprehensive private health insurance policy, some extra costs will be involved.

These could include specialist consultations and check-ups with your obstetrician, a portion of the hospital fees, paediatrician visits, and extras services. However, a portion of these costs can often be claimed back via Medicare.

For more detailed information on out-of-pocket costs, consult with your health provider, insurer, and hospital staff. You can also visit the Commonwealth Ombudsman’s website for additional guidance.

Pregnancy Care Without Private Health Insurance Coverage

Even if you’re not covered by a private health insurance policy, rest assured that you can receive quality care in a public hospital or birthing centre, fully covered by Medicare.

But if you prefer to go to a private hospital, be prepared for substantial out-of-pocket costs. You can claim back part of the cost of care from a private obstetrician or eligible midwife from Medicare, but you’ll need to shoulder all hospital costs yourself.


What if I’m pregnant, and I don’t have a health insurance policy?

You can still receive high-quality care in a public hospital or birthing centre, completely covered by Medicare. But if you choose to go to a private hospital without private health insurance, you will face high out-of-pocket costs.

Does my insurance policy cover the care of my newborn?

It’s crucial to check with your health fund about their policies for newborn babies. Ask if your baby will be automatically covered after birth or if you’ll need to upgrade to a family policy.

What happens if I have a premature baby or multiple births?

Premature or unwell babies may need care in a Neonatal Intensive Care Unit (NICU), which can be costly. Similarly, each baby’s care in multiple pregnancies is charged separately. Always check with your hospital about expected costs and your health fund to see what costs are covered.

What are the typical out-of-pocket costs?

Even with private health insurance, some costs are not covered, including specialist consultations, a portion of the hospital fees, paediatrician visits, and some extras services. Check with your health provider, insurer, and hospital staff for specific details.

What’s the difference between outpatient and inpatient?

Outpatients visit a healthcare facility for treatment or consultation but don’t stay overnight. In contrast, inpatients are admitted to the hospital for overnight stays or longer, often for procedures or close monitoring.

Does pregnancy cover give me access to IVF treatment?

The coverage of IVF treatments under pregnancy cover varies with different insurance providers and policies. It’s important to check with your provider or read your policy details to understand the specifics.

What’s the Lifetime Health Cover Loading and does it affect my pregnancy cover?

Lifetime Health Cover Loading (LHC Loading) is an Australian initiative to encourage early adoption of private hospital cover. If you don’t have private cover by July 1 following your 31st birthday, you’ll pay an extra 2% on your premium for every year you’re over 30. This doesn’t change your pregnancy cover but increases the cost if it applies to you.

Let CHI Help Find You the Right Pregnancy Private Health Cover

Understanding the kind of insurance you need when pregnant can give you the peace of mind to focus on what matters most: the health and well-being of you and your soon-to-be newborn. Prepare early, understand your cover, and enjoy your journey to motherhood.

If you’re searching for private health cover but are overwhelmed by all the choices available, don’t worry, we can help! Simply use our free online tool below to get personalised health cover quotes from Australia’s leading health fund providers in minutes!