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Last Updated on 17 July 2019

Switching Health Insurance When Pregnant


Switching health insurance in Australia while pregnant

Pregnancy comes with a number of first-time decisions. Your head is probably swimming with car seats, cots, prams, and nappies.

But what if, amidst all of these thoughts and decisions, you realise you’re not happy with your current health insurance provider? You can switch health funds mid-pregnancy, and in this guide we’ll explain how that works.

Key Points
  • Portability laws allow you to switch hospital cover policies without repeating waiting periods you’ve already served.
  • Pregnancy cover has a 12 month waiting period, so you must hold the policy for a full 12 months before your baby is born.
  • After switching health funds, remember to provide your medical professionals with the details of your new fund.

 

 

Switching Health Insurance When Pregnant

There are a few reasons you might consider switching health insurance when you’re pregnant. You might have found a better deal on cover, or maybe you’re unhappy with the service your current fund offers.

Whatever your reasons, switching cover while pregnant is possible, and it’s not as complicated as it might sound. However, it’s important to note that waiting periods do apply.

You cannot get covered for pregnancy if you purchase health cover for the first time when you are already pregnant. That’s why it’s so important to make arrangements for health cover before you start trying for a baby.

But thanks to portability laws, you can switch hospital policies without repeating any waiting periods you’ve already served. There is one stipulation: this only applies when you’re switching to a policy with an equal or lesser level of cover.

 

7 Steps to Switching Health Cover While Pregnant

1. Compare health cover that includes pregnancy
First, shop around. If you’re not happy with your current health fund, now is the opportunity to find one that offers more value. Compare policies to find one that offers the cover you’re looking for at a price you’re happy with.

2. Confirm that there will be no lapse in cover when you switch
Great—you’ve found a policy. Before you apply, check the terms and conditions of the policy to ensure that there will be no gaps in cover when you switch. It should be a seamless transition.

3. Check that your new cover includes your obstetrician and hospital
Many funds have agreements with health providers, allowing them to offer reduced-cost services to members of the fund. Participating providers are part of the fund’s member network. If your new fund has a network, check whether your current obstetrician and hospital are part of it.

4. Ask for a clearance certificate from your old insurer
A clearance certificate is an important part of transferring funds. It establishes the waiting period you have already served with your old fund, so you can avoid repeating it with the new one. It’s especially critical during pregnancy, when there may not be much wiggle room!

The certificate must be issued within 14 days of your request.

5. Complete the transition between funds
Once your certificate has gone through and you’ve checked that all of the documentation is correct, it’s time to pull the plug. Cancel your old policy and officially start your new one. You’ll now be charged premiums from the new fund.

6. Let your providers know that you’re switching to a new insurance policy
Let your doctor and hospital know that you’ve got new health cover, to avoid any confusion with billing. Have the details of your new fund handy so it can be put into the system.

7. Monitor your new bills to be sure that they’re being managed correctly
Keep an eye on any bills or charges related to pregnancy services. Hopefully, everything will go smoothly so you won’t have anything to worry about—except for what colour to paint the nursery!

 

Pregnancy Cover FAQs

Pregnancy cover can be a complicated topic, and it’s hard to know which questions to ask. Here are some of the most frequently asked questions we receive about pregnancy cover.

When Should I Take Out Pregnancy Cover?

Since pregnancy cover has a 12 month waiting period, you should take out cover at least 12 months before your baby is born. That means you’ll need to have cover in place for a minimum of three months before getting pregnant.

Keep in mind that IVF and fertility services may also have a 12 month waiting period. If you anticipate needing these services, you’ll need to hold your cover for a full year before you can make a claim.

What Do I Need Covered?

When shopping for pregnancy cover, look for the following features:

  • Hospital accommodation
  • Pharmaceuticals given when you are in hospital
  • Labour ward or theatre fees
  • Intensive care during birth and while you are an inpatient
  • Fees for the doctor and other medical specialists present at the birth, such as an anaesthetist.

Will I Still Have Out of Pocket Fees?

Pregnancy cover generally does not cover 100% of the fees associated with having a baby. You may still have out of pocket costs if you visit a specialist. To avoid surprise costs, take a close look at the terms and conditions of your policy.

What is Not Covered by Pregnancy Cover?

The following features are not usually included as standard with pregnancy cover:

  • The gap between the Medicare Benefits Schedule and your doctor’s fees
  • Co-pay or excess fees. These can range from $0 to $500, and represent the amount you’ll have to pay before your insurance kicks in.
  • Medical treatments and services as a hospital outpatient, like blood tests and GP visits.
  • Your newborn baby. To cover your baby, you generally need family cover.

Do I Need to Insure My Newborn?

Yes. Pregnancy cover does not automatically extend to your newborn baby. Don’t worry, it’s not difficult to arrange cover, but you do need to look into this in advance. Some policies will allow you to add your baby to your cover for a limited period after birth (a few months to a year), and usually at an extra cost.

However, most policies will require that you upgrade to a family policy if you are not already on one. Waiting periods may apply, so don’t leave this to the last minute.

What if My Baby is Premature or Unwell?

If your baby is born prematurely or needs emergency medical attention at birth, he or she may be taken to intensive care. Some pregnancy cover includes these situations, but others do not.

If your baby is born prematurely, it could also affect your waiting period. For example, if you took out private cover three months before falling pregnant, your waiting period wouldn’t end for nine more months – a full gestation period. Avoid this situation by taking out cover early!

I’m Having Multiples! What Should I Do About Health Cover?

The news of twins or triplets can send many parents-to-be reeling. This may have some implications for your health cover.

First, multiple births often come early and may require a visit to the intensive care unit. Check to see if your cover includes specialist care.

Second, you’ll need to make sure all of your babies are covered once they’re born. In general, one or more of the babies will be admitted as an inpatient under their own name. This is true even if they’re all healthy! This could mean an additional excess or co-payment.

If you’re expecting more than one, it’s wise to get on a family policy as soon as possible.

Disclaimer: The above information is correct and current at the time of publication


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