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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 period1, 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!
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.
Generally, health insurance policies always require the 12 months waiting period.
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 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.
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. Just keep in mind that some policies also apply a ‘benefit limitation period’ where they’ll only cover the minimum amount possible for certain treatments2.
Depending on the insurer, these periods can last from one to three years2. It never hurts to check out whether these kinds of conditions apply to your policy, so speak to your insurer if you’re unsure.
Again, this will depend on the terms of your policy.
Nib health insurance is the only provider that cover immediate treatment for newborns3. But this of course depends on the conditions of your policy4. 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.
Other insurers might require you to add your baby to your policy before any cover comes into effect. Many will also offer a grace period where you can add your child to your policy and they won’t have to serve any waiting periods. For some insurers this grace period is within 90 days of birth5, for others it’s 24 months3.
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.
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. iSelect can help you compare your health insurance options from their range of policies and providers today*.
1 Commonwealth Ombudsman | Private Health Insurance Ombudsman - Waiting periods for private health insurance
2 Commonwealth Ombudsman - Assisted Reproductive Services
3 nib - Managing your family's cover
4 Privatehealth.gov.au - Clinical categories (under Pregnancy and birth)
5 Bupa - Dependants on your policy