The Role of Health Insurance in Your Baby’s Healthcare

Welcoming a newborn into your family is an exciting life stage. Every parent wants their child to be happy and healthy, and when it comes to your newborn baby’s healthcare, there are two primary options in Australia:

Medicare is a great option for many families – but sometimes, you want that extra peace of mind with private health insurance.

In this article, we’ll cover everything you need to know about getting private health insurance for your baby – from pre-conception, to after the birth.

Pregnancy Health Insurance Vs Child Dependant Health Insurance

When we say pregnancy health insurance (obstetrics cover), we’re talking about what you’re covered for while the baby is in-utero, including:

  • HOSPITALISATION: The expenses of your hospitalisation and medical care costs will be covered by private health insurance. This includes your accommodation as a private patient at your choice of private or public hospitals, birthing wards, theatre fees, anaesthetist fees, and pharmaceuticals.
  • BIRTH: With private health insurance, the costs of your chosen obstetrician and paediatrician will be partially covered by your hospital insurance.
  • POSTNATAL: Private health insurance can also protect your newborn baby in the event he/she requires hospitalisation or intensive care medical treatments after birth. and the birth of your child. This is generally covered under

After the birth of your baby, however, they become a child and can be added to your single parent or family policy at no extra cost (depending on your policy and private health fund provider).

Adding a Baby to Your Health Cover

If you’re an existing policyholder welcoming a new baby into your family, there are certain steps you need to take to include them on your health insurance policy:

  • First, you’ll need to complete a Newborn Child Declaration form, which is included in the Parent Pack provided by your hospital or midwife. This form must be signed by a doctor or midwife upon your baby’s birth.
  • Next, you’ll need your child’s birth certificate. This document is essential for enrolling your child in Medicare. Once completed, you’ll receive an updated Medicare card featuring your child’s name and Medicare number.

To add your child to your existing family health insurance policy, you’ll need to present their proof of birth and newly acquired Medicare details. Your health insurance provider may require additional paperwork which will be facilitated by these documents.

It’s crucial to understand the specific rules set by your health fund for your newborn to be covered from birth, as these rules can vary. Generally, you must contact your health fund within a stipulated time frame to include them in your policy without any waiting periods.

By adding your newborn within this timeframe, they will be entitled to the same coverage level as you, and won’t be subject to any waiting periods that you’ve already served. However, bear in mind that if there are any waiting periods you have yet to complete, these will also apply to your child.

How Does Medicare Cover Pregnancy?

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 when you’re off work to care for your new baby.

The Benefits of Pregnancy Insurance

Private health cover offers a range of benefits beyond those covered by Medicare and what you’ll receive as a public patient, providing policyholders with more flexibility, choice, and peace of mind.

From faster access to medical treatment to the choice of preferred doctors, private health insurance brings several additional advantages. One of the key elements of a private health insurance policy is the inclusion of extras cover. Let’s delve a bit deeper into this.

Shorter Waiting Periods

One of the most significant benefits of private health insurance is the potential for shorter waiting periods for procedures. For non-emergency surgeries or treatments, public hospital waiting times can sometimes be long. Private health insurance often provides faster access to these treatments, minimising waiting times and allowing patients to begin their recovery sooner.

Private Rooms and Hospitals

Private health insurance often guarantees the option of a private room during hospital stays, offering comfort and privacy. Furthermore, policyholders have the flexibility to access private hospitals, renowned for their high-quality facilities and care.

Specialist Consultations

Having private health insurance can grant more effortless access to specialist consultations. While referrals can streamline this process in the public system, private health insurance often allows you to consult specialists like obstetricians or paediatricians directly.

Access to Additional Treatments

Private health insurance can cover a variety of treatments not typically covered by Medicare, including ultrasounds and IVF treatments. This wider coverage ensures that policyholders can access the care they need without incurring high out-of-pocket expenses.

Upgrading to a Family Policy

If you’re currently on an individual or couples’ health insurance policy, you’ll need to bump up to a family policy to make sure your little ones are covered. Depending on your health fund, you may need to switch to a family policy up to 12 months before your bundle of joy arrives to ensure they’re covered from day one.

This is really important because, sometimes, newborns may need a little extra help, like a stay in the special care nursery or intensive care unit. These costs can add up pretty fast if they’re not covered by your insurance.

Now, upgrading to a family policy might take you to a higher level of cover, which often comes with waiting periods before you can access the new benefits. But don’t worry, many times you can find a family policy that offers similar coverage levels as your previous one. Just keep in mind that this can vary between health funds.

Here’s the good news: any waiting periods you’ve already served on your singles or couples policy will carry over to your new family policy, as long as it’s for the same level of cover. For example, if you were previously covered for something like heart surgery, and your new policy also includes this, you’ll be covered from the get-go.


What does ‘hospital cover’ mean for my baby’s health insurance in Australia?

Hospital cover is a part of private health insurance that covers costs associated with hospital stays. For your baby, this might include accommodation in a private or public hospital, medical services, treatments, and certain procedures that might be necessary in the first few years of life.

How do premiums work when adding my baby to a private health insurance policy?

When adding your baby to a health insurance policy, your premiums typically will not increase. However, this will depend on the type of cover you have chosen and the specific policy of your health fund.

Can I claim a rebate on my private health insurance for pregnancy and baby-related services?

Yes, the Australian government provides a private health insurance rebate to help cover the costs of your premiums. The amount you can claim back depends on your income, age, and the number of dependents you have.

What are the potential out-of-pocket costs when having a baby on private health insurance?

Out-of-pocket costs refer to the medical expenses not covered by your health insurance. When having a baby, these costs might include specialist fees, diagnostic tests, or certain procedures. It’s important to check what your policy covers so you can budget accordingly.

Does private health insurance cover both inpatient and outpatient services for my baby?

Yes, depending on your policy, private health insurance can cover both inpatient (those admitted to a hospital) and outpatient services (such as specialist consultations or diagnostic tests). However, what’s covered can vary between different policies, so it’s crucial to check the specifics with your health fund.

Need Help Finding the Right Health Insurance for You & Your Baby?

If you’re searching for private health cover for you and your baby 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!