Pregnancy And Health Insurance: What Are The waiting Periods?

Content OageHero Image CRO Overlay Image

Written by

|

Edited by

|

Reviewed by

Updated 13/06/2024
What changed?
Reviewed by Dr Jill Gamberg and tip added, and referencing style updated.
|
Fact checked
Our aim is to help you make better informed decisions. That’s why iSelect’s content is produced in accordance with our fact-checking and editorial guidelines.
|

Find out more about how we make money.

View our Privacy Policy.

Written by

Francis Taylor

Updated 13/06/2024

What changed?

Reviewed by Dr Jill Gamberg and tip added, and referencing style updated.
Our aim is to help you make better informed decisions. That’s why iSelect’s content is produced in accordance with our fact-checking and editorial guidelines.

Find out more about how we make money.

View our Privacy Policy.

Compare health insurance policies the easy way

Save time and effort by comparing a range of Australia’s health funds with iSelect

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. 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.

Is there any way around the waiting period?

Generally, health insurance policies always require the 12 months waiting period for pregnancy and birth. You might see some insurers advertising shorter waiting periods, but on closer inspection you’ll usually find this doesn’t apply to obstetrics. Providers might also pay restricted benefits, which cover you for obstetrics as a private patient but only in a public hospital. So always read the policy brochure and find out what kind of cover you’re getting before you make a decision.  

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

Are there different waiting periods for IVF?

Some of the costs involved with with assisted reproductive treatments including IVF and similar services are covered by Medicare and Private Health insurers. However, you’ll still have a 12-month waiting period with your chosen insurer before being able to claim on your insurance. Just keep in mind that some policies also apply a ‘benefit limitation period’ where they’ll only cover the minimum amount possible for certain treatments.

Depending on the insurer, these periods can last from one to three years. It never hurts to check out whether these kinds of conditions apply to your policy, so speak to your insurer if you’re unsure. 

Helpful Tip:

Do you know which policies cover pregnancy-related conditions? Health Insurance can be complicated! Here’s one rule to make it easier: Gold Hospital policies will always cover obstetrics. ‘Plus’ policies, like Silver+, might offer cover obstetrics, but this will depend a lot more on the terms of the specific policy and is quite rare. This is just one more reason reading the policy documents is so important, since it will outline what will (and won’t) be covered.

Dr. Jill Gamberg

GP, Coach and Lifestyle Medicine Coach

Will my baby have a waiting period for medical treatment?

Again, this will depend on the terms of your policy.  

Generally, if you add your new baby to your existing family policy, they will be covered from when you add them, without having to serve waiting periods (provided you’ve served your waiting periods). Their level of cover will depend on what type of policy you hold and what inclusions you’re covered for.

For example, let’s say Anna holds a policy that covers her for ‘bone, joint and muscle’ conditions as well as obstetrics. Her baby suffers a minor fracture during childbirth but, because Anna’s covered for bone, joint and muscle conditions—including fractures—then so is her baby (if the newborn has been added within the correct timeframes). In this case, her policy ends up covering the costs for the bub’s immediate treatment. 

There is usually a timeframe in which you have to add your baby to your policy before any cover comes into effect. For some insurers this grace period is within 90 days of birth, for others it’s 24 months. If you want to know how a particular policy treats grace periods and immediate treatment, you’ll need to speak to the insurer directly and read the Policy Brochure. That way, you’ll know exactly what you’re getting. 

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 or Single Parent 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. iSelect can help you compare your health insurance options from their range of policies and providers today.  

WE’RE HERE TO HELP

Need help with health insurance?

We can help you find a suitable product for your needs

iSelect does not compare all health insurance providers or policies in the market. The availability of policies will change from time to time. Not all policies available from its providers are compared by iSelect and due to commercial arrangements, your stated needs and circumstances, not all policies compared by iSelect are available to all customers. Some policies and special offers are available only from iSelect’s contact centre or website. Click here to view iSelect’s range of providers