Pregnancy and Health Insurance: What are the waiting periods?

by Jude Watson
Health Geek
3rd May, 2017 | 3 minutes

It’s exciting when you choose to expand your family, but there can be a lot to think about ­­– including whether your health insurance suits your timeline. You can, of course, have a baby without hospital cover, but you might prefer being able to choose the hospital and level of care that’s right for your needs.

Pregnancy and Health Insurance: What are the waiting periods?

Here’s what you need to know about health insurance waiting periods and pregnancy:

How long is the waiting period?

There’s generally a waiting period of 12 months before you can claim any benefits relating to pregnancy and birth. The Federal Government has set this as the maximum waiting period, and most insurers follow it as standard.

This waiting period applies regardless of whether you’re taking out health insurance for the first time or upgrading your current level of private hospital cover to include obstetrics.

Given the length of a pregnancy, it obviously pays to think ahead!

What happens if you give birth in the interim?

Pregnancy and childbirth rarely go as planned, and there’s always a chance you might go into labour before the waiting period is up. Unfortunately, the waiting period applies to the date the mother is admitted to hospital for the birth and there’s little chance of flexibility in the rule, even if it’s just by a few days. This is why it’s so important to plan your health insurance in advance.

Are there different waiting periods for IVF?

Some of the costs involved with IVF and similar services are covered by Medicare and private health insurers. However, you’ll still generally have a 12-month waiting period with your chosen insurer before being able to claim. For some assisted reproductive products and services the waiting period can be up to three years, depending on the insurer.

Is there any way around the waiting period?

You might see insurers advertising shorter wait periods, but on closer inspection you’re likely to find this doesn’t apply to obstetrics. Providers might also pay restricted benefits that cover you for obstetrics as a private patient but only in a public hospital. Always read the fine print before making your final decision.

Keep in mind that under Medicare, all Australians are covered for care in a public hospital, birth centre or a publicly funded homebirth program. However, you won’t have the same level of flexibility and care options as with private health insurance.

Should I upgrade my existing policy to cover pregnancy and childbirth?

Before you decide if it’s worth upgrading your policy and contending with another waiting period, make sure to confirm what your existing policy includes.

Also, don’t assume your baby will automatically be covered. If you’re currently on a Singles or Couples policy, it’s a good idea to talk to your insurer about switching to Family cover well before your due date – or even before you’re pregnant.

Whether you’re starting or growing your family, you’ll want to choose the right level of care throughout your pregnancy and childbirth.

Consider upgrading your health insurance well in advance to avoid being caught out by insurer waiting periods.

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