Last Updated on 21 August 2020

Health insurance for pregnancy, obstetrics and birth


Pregnant woman holds an ultrasound scan against her belly

Planning to have a baby can be incredibly exciting, but there’s a lot to think about: your health during pregnancy, obstetrics, baby and nursery equipment, parental leave, finances – the list goes on!

If you’re new to pregnancy you’ll be making a lot of first-time decisions, and one of those might be whether or not to get private health insurance.

Most private health funds have a policy that covers pregnancy and birth. Although these tend to be top-tier policies, they often come up with extra support and some funds offer packaged policies for families-to-be.

With lots of options, it can be easy to feel overwhelmed. That’s why it’s good to know what’s included before deciding what’s right for you and your bub. This guide covers the ins and outs of pregnancy cover to help you get started.

Key Points
  • One of the biggest benefits of private pregnancy cover is that you can choose your doctor and hospital.
  • Most pregnancy health insurance policies include cover for in-hospital treatment as standard.
  • Some policies also include health cover for additional services like IVF and prenatal/postnatal care.
  • If you have private pregnancy cover for in-hospital treatment, you can often claim other services such as GP visits through Medicare.

How does pregnancy and health insurance work?

In Australia, doctors and obstetricians (specialists trained to look after mothers and babies) provide treatment during pregnancy and birth in both public and private hospitals. If you choose to have a baby under the public healthcare system, most costs will be covered by Medicare but you can’t choose your doctor.

If you want to choose your doctor and hospital, you’ll need private health insurance with pregnancy cover. Pregnancy cover is typically included as part of a health fund’s top-tier hospital cover policy.

To get cover for both you and your baby, you’ll need to:

  • Choose a policy well in advance: Most health funds have a 12-month waiting period on pregnancy cover, so you’ll probably want to get your cover in place well before you start trying for a baby. Of course, not every pregnancy is planned, but if you think children may be on the horizon, it’s worth reviewing your cover.
  • Consider whether you need a family policy: Some single pregnancy policies will cover you but not your baby. If you want your baby to be covered for treatment (in case they need extra care after birth, for example), you should choose a family policy well before the birth. Some health funds do offer packages specifically aimed at parent-to-be, so it’s worth comparing your options.

What are the benefits of public vs private care for pregnancy and birth?

One of the main advantages of public care for pregnancy and birth is that most costs are covered by Medicare.

However, you can’t choose your doctor or obstetrician, and you might have to see a different person each time you have a check-up.

During your hospital stay, you might also need to share a room with other mothers and their babies.

Private care for pregnancy and birth can offer more choice and flexibility, including:

  • Being able to choose your doctor and hospital: You’ll also receive care from the same team throughout your pregnancy.
  • Having a private room: In many cases, you can also share a room with your partner.
  • Being covered for non-essential services: Some policies include cover for services that aren’t covered by Medicare, like birthing classes and some IVF related services.
  • Access to additional support: Some insurers run dedicated support programs for parents-to-be. This is often part of their top-tier coverage.

What’s covered by private health insurance for pregnancy and birth?

Exactly what’s included depends on the health fund and the insurance policy, but pregnancy cover typically includes in-hospital treatment such as:

  • Hospital accommodation
  • Theatre/labour ward fees
  • Birth-related intensive care treatment
  • Medication provided in hospital
  • Doctor’s fees, up to the amount set out in the Medicare Benefit Schedule (MBS)
  • Medical ‘Gap’ Cover: Some policies cover some or all of the doctor’s fees in excess of the amount set out in the Medicare Benefit Schedule (MBS)

Some private health funds also offer additional cover options for treatments such as:

  • In-vitro fertilisation (IVF)
  • Care by a private midwife or doula (pregnancy support professional)
  • Prenatal and postnatal classes
  • Lactation consultancy
  • Pregnancy massage and physiotherapy

There’s a lot to consider when it comes to pregnancy cover, and every parent’s needs are different. That’s why it makes sense to compare policies from multiple insurers to find one that’s right for you.

What’s not covered by private health insurance for pregnancy and birth?

Even if you have private health insurance with pregnancy cover, you might have to pay some out-of-pocket costs. These can include:

  • Out-of-hospital treatment: Services such as postnatal classes, GP visits, ultrasounds, specialist consultations and obstetrician check-ups typically aren’t covered by private health policies, but they may be partially or fully claimed through Medicare.
  • Gap payments: This is what you pay out of pocket when you receive treatment that costs more than what you can claim back from Medicare or your health fund. When a doctor or specialist charges more than what your health fund agrees to pay for a particular service, you will be charged a gap fee. However, you may be able to avoid these payments by finding an insurer with a “no gap” scheme.
  • Excesses: This is the out-of-pocket cost you agree to pay before you insurance kicks in. Some policies have no excess, while others are upwards of $500. You only need to pay the applicable excess once before claiming on pregnancy treatment.
  • Pre-release check-up: Before you leave the hospital, a doctor will do a check-up on your baby’s progress to make sure you’re ready to go home. In most cases, this check-up isn’t covered by private health insurance, but it may be partially or fully claimed through Medicare.

What are the waiting periods for pregnancy cover?

Health funds have a 12-month waiting period for pregnancy cover. This means you need to have had private health cover for at least 12 months before you can make a claim on in-hospital treatment.

With this in mind, it’s a good idea to choose a policy before you plan to conceive – or if you think there’s a possibility a pregnancy could be on the horizon.

How much does pregnancy cover cost?

The following table gives you a rough idea of the cost of pregnancy cover from some popular funds.

The actual cost will depend on your health fund, your situation and the level of cover you choose.

Table of weekly cost of pregnancy cover from popular health insurance funds.

Looking for more pregnancy cover options? Compare health insurance policies.

How to choose the best health insurance for your pregnancy

Choosing a policy comes down to your budget and your preferences. Some questions to consider include:

How much cover do I need?

Most private pregnancy health insurance includes cover for in-hospital accommodation and treatments. However, exactly what services are covered depends on the insurer and the policy – so it’s a good idea to compare different options.

Is IVF covered under related pregnancy extras?

Some insurers do offer IVF as part of their pregnancy packages but IVF and other assisted reproductive services aren’t automatically included on policies that cover obstetrics and birth*.

Even on policies that do include IVF, you may only be covered for hospital admission and not other steps associated with the procedure, so it’s worth discussing what’s included in the policy with the team at Health Insurance Comparison before committing to a policy.

Is postnatal depression included in pregnancy cover?

Typically, postnatal depression for either parent would come under other types of extras or hospital cover. If you needed to access psychology services such as therapists, you’d need to have this included in your extras cover.

Unfortunately, in some cases, hospitalisation may be needed. This treatment would come under psychiatric services in your hospital cover.

Given that pregnancy cover is usually a top tier product, there’s a reasonable chance you’ll also have psychiatric cover in your policy.

However, it’s a very good idea to ask specifically about these services to make sure you’re covered and on the right policy that covers all your pregnancy needs. Again, this is something the Health Insurance Comparison team can help with.

Are prenatal conditions such as preeclampsia covered?

If you’re hospitalised with a condition such as preeclampsia, then yes, your health fund should cover you. If you need to see a specialist, then it will depend on your policy. Health funds don’t generally cover specialists you see out-of-hospital although Medicare usually does.

Is my baby covered by my pregnancy cover?

If you want peace of mind that your baby will be covered in case they need separate treatment, make sure they’re included in your policy as well.

You’ll generally need to take out a family policy well before the birth for the baby to be covered. Some insurers offer packaged policies for families-to-be, so ask your insurer or an adviser at Health Insurance Comparison.

What are my options?

Even if you have private health insurance already, you might be able to save money or find a policy that better suits your needs by comparing your options. Best of all, if you switch to an equivalent level of cover, no new waiting periods will apply.

Good luck with your exciting journey ahead, and if you’re considering private health insurance with pregnancy cover, you can quickly and easily compare policies by clicking the button below.

 

This guide is opinion only and should not be taken as medical or financial advice. Check with a financial professional before making any decisions.

*Commonwealth Ombudsman, Obstetrics and Pregnancy, August 2020


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