Need to Know

  • Most health funds stipulate a 12 month waiting period of pregnancy cover
  • When the newborn baby arrives, the mum is considered the patient – your baby doesn’t need cover unless they require additional treatment.
  • To make sure your baby’s health needs are covered without any waiting period, certain insurers require the policy be upgraded to family cover a few months before the birth, while others require this upgrade 12 months prior.

Navigating Private Health Insurance & Hospital Cover for Pregnancy

Australian parents-to-be, this one’s for you. If you’re considering welcoming a little one into your life, there’s a lot to prepare for – especially when it comes to your private health insurance.

Unfortunately, some parents fall into the trap of waiting periods, a commonly overlooked aspect of private health insurance.

Did you know there’s a standard 12-month waiting period on pregnancy cover for hospital insurance?

This means parents-to-be need to have their health insurance policy upgraded to cover delivery at least 12 months before giving birth. Otherwise, you might be left in the lurch by an earlier-than-anticipated birth, or if the baby needs additional care.

The Importance of Timely Coverage

Many people believe they can take out pregnancy cover just before their baby’s arrival. However, to be covered, you need to have this insurance at least a year before the birth.

Remember, when your baby arrives, the mum is considered the patient. The baby doesn’t need cover unless they require additional treatment, such as when born premature and needing a humidicrib.

To ensure the baby’s health needs are covered without any waiting period, certain insurers necessitate the policy be upgraded to family cover a few months before the birth, while others require this upgrade 12 months prior. Therefore, reaching out to your insurance provider to clarify these details is crucial.

CHI TIP: If your baby arrives before this waiting period ends, you’ll be ineligible to claim any expenses associated with the birth or other pregnancy-related admissions.

Advantages of Private Hospital Cover for the Birth of Your Baby

Private hospital cover offers a host of benefits for expectant mothers and families. Below are some of the key advantages:

1. Choice of Obstetrician: One of the major advantages of private hospital cover is the ability to choose your own obstetrician. This can provide significant peace of mind during pregnancy, as you will be able to choose a professional you feel comfortable with, have confidence in, and who understands your unique health history and pregnancy needs. On the other hand, if you’re going through the public system, while you will still receive excellent care, you may not have the same doctor throughout your pregnancy and delivery.

2. Shorter Waiting Times for Non-Emergency Services: While public hospitals can efficiently manage emergency situations, waiting times for non-emergency services can be longer. If you have private cover, you’ll often experience shorter waiting times for these services. This can be beneficial for antenatal check-ups and postnatal care, making your journey through pregnancy and beyond more convenient and less stressful.

3. Access to a Private Room: Many expecting parents prefer the privacy of their own room during such a significant life event. Private hospital cover typically ensures access to a private room, subject to availability. This private space allows new parents the opportunity to bond with their newborn baby in a more intimate setting. Also, having a private room can provide a quieter environment, more conducive to rest and recovery after childbirth.

4. Comprehensive Coverage of Birth-Related Services: Private health insurance often provides a more comprehensive range of cover for birth-related services compared to Medicare. These might include childbirth preparation classes, lactation consultations, and additional postnatal support, such as physiotherapy or mental health services. It can also provide coverage for a private paediatrician for your newborn, offering more personalised care.

5. Flexibility in Birth Planning: With private hospital cover, expectant mothers have more control over their birth plan. This could include the choice between a vaginal birth or a C-section (if medically appropriate), the option for water birth, or the availability of additional pain management options.

6. Cover for Assisted Reproductive Services: If you’re planning to start or expand your family through methods such as IVF, private health insurance often covers these treatments, subject to a 12-month waiting period. This isn’t typically covered by Medicare and can significantly reduce the overall cost of these procedures.

It’s essential, however, to thoroughly check the specifics of your private hospital cover policy to understand what is and isn’t covered, so there are no surprises when it’s time to welcome your newborn baby into the world.

Does Medicare Cover Pregnancy Healthcare?

Australia’s healthcare and medical services system offers a unique blend of public and private services. Medicare provides a broad range of healthcare services. However, it doesn’t cover everything, especially when it comes to pregnancy and birth-related services. This is where private health insurance steps in.

While Medicare covers some inpatient hospital costs and consultations with an obstetrician, there can be significant out-of-pocket costs. These costs can include anaesthetist fees, intensive care if your baby needs it, private patient hospital costs, and specific antenatal and postnatal services.

Understanding Obstetric Services in Public vs Private Hospitals

Obstetric services vary significantly between public and private hospitals. If you choose to have your baby in a public hospital as a public patient, your costs will typically be covered by Medicare. But bear in mind that you may not have a choice of obstetrician, and you might not get a private room.

However, as a private patient in a public or private hospital, you’ll typically be able to choose your obstetrician and potentially secure a private room. But this comes with additional out-of-pocket expenses, even after Medicare benefits.

Choosing the Right Health Fund and Level of Cover

When it comes to private health insurance, choosing the right health fund and the appropriate level of cover is crucial. The level of cover varies among insurers, but ideally, it should include both hospital policy and extras cover.

The hospital policy takes care of inpatient services – those you avail while admitted to the hospital, like childbirth. Extras cover helps with outpatient services – those that don’t require hospital admission, such as antenatal check-ups and postnatal services like breastfeeding consultations and paediatrician visits.

Your chosen health fund can greatly impact your out-of-pocket costs. Policies vary, and premiums are influenced by factors such as the level of cover, co-payments required, and the degree of choice over healthcare providers.

Understanding Out-of-Pocket Expenses

While Medicare and your health insurance may cover a large part of your healthcare costs, you’re likely to face some out-of-pocket expenses. These can include consultations with specialists like an anaesthetist or paediatrician, outpatient services not covered by your policy, or the difference between what your healthcare provider charges and what your health fund and Medicare will cover.

If you choose to be a private patient, it’s a good idea to ask your obstetrician and hospital for an estimate of costs in advance. For some procedures, your doctor may need to provide you with an Informed Financial Consent, including an estimate of charges, an explanation of Medicare Benefits Schedule (MBS) items, and information about whether your doctor participates in your health fund’s gap cover scheme.

Six Pregnancy Waiting Period Traps to Avoid

  1. There is a minimum 12-month waiting period for pregnancy and birth-related coverage in private hospitals. Make sure you’re covered for pregnancy at least three months before trying to conceive.
  2. The waiting period’s completion must be on or before the hospital admission date for delivery.
  3. A premature birth within the waiting period is not covered.
  4. Even giving birth a day before the waiting period ends might not be covered, depending on your policy.
  5. Some policies require a switch from couples to family cover anywhere from 1-12 months before birth.
  6. Insurance policies covering assisted reproductive services like IVF also have 12-month waiting periods.


How long is the waiting period for pregnancy cover?

The standard waiting period for pregnancy cover in private health insurance is 12 months.

Do I need to switch to a family cover before the baby is born?

This depends on the insurance provider. Some require the policy to be upgraded to family cover a few months before the birth, while others require this 12 months prior.

Are family policies more expensive than couple policies?

Not necessarily. Often, dependents are covered at no extra cost. However, it’s always best to compare policies against your specific health needs to find the best deal.

Is my premature baby covered under my policy:

If the birth occurs within the waiting period, the insurance policy may not cover it, even if it’s a premature birth. Always check with your provider to understand your level of cover.

How does the Australian Government support private health insurance?

The Australian Government provides a rebate to help cover the cost of premiums for private health insurance. The level of government rebate you receive depends on your income, age, and family status.

Does my health fund cover the cost of outpatient services?

This depends on your level of cover. While a hospital policy covers many inpatient services, you will need extras cover for outpatient services like antenatal and postnatal check-ups.

What is a co-payment?

A co-payment, or gap fee, is the difference between what the healthcare provider charges and what Medicare and your health fund will pay.

Need Help Finding the Right Cover for Your Pregnancy? Let CHI Help

If you’re searching for private health cover for your pregnancy 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!