GUIDES & RESOURCES

Pregnancy Cover Through Health Insurance

Planning to start a family is an incredibly exciting time! Learn more about private health insurance and pregnancy cover in this article from iSelect.
Pregnant woman looking out window

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You’ve probably got a lot on your mind at the moment when thinking about when to start a family. Is our house going to be big enough? Are we in the right school zone? Are we ready for the great pram debate? Will we ever sleep again?

So many of us have been there! But before you solve those problems, there’s ensuring you’re properly set up for the birth itself. And the most important question for that is ‘Do we have suitable health cover?’ This is really question number one when preparing for having a baby.

What are the waiting periods for pregnancy cover with private health insurance?

No matter what your plans are, the answer to when should you get pregnancy cover as part of your private health insurance could be now. And that’s because once you’re pregnant, it’s too late. This is due to the general requirement of a 12 month waiting period which needs to be served before you can claim on pregnancy related procedures. Working out your health cover is integral to the planning process when having a baby.

The general rule is to get yourself sorted six months before you conceive so your bundle of joy is born safely outside the 12 month waiting period with your obstetrician of choice and your chosen hospital.

What are the benefits of health insurance for pregnancy?

Firstly, something to keep in mind is that pregnancy is already covered by the public health system1.  It’s not uncommon for expecting mothers or couples considering conceiving to ask ‘is private pregnancy cover worth it?’

And this is really a personal question depending on your situation, needs and expectations. It typically provides flexibility and choice for the expecting couple, and the potential of further continuity of care.

Pregnancy cover lets you choose your doctor.

For many, this is a crucial benefit of pregnancy cover. Being able to choose your own obstetrician and have them provide ongoing support throughout your entire pregnancy is a significant comfort factor for many.

Within the public system, it is not uncommon to see whichever obstetrician is available at the time of your appointment, which may well be a different doctor each and every time. In many cases you see a midwife not a doctor through the pregnancy, and potentially a different one for each check up. Many parents who go private also like the ability to have a quick ultrasound scan of their little bub when they go for an obstetrician consultation.

These little touches can be very reassuring for parents to be to see their little person growing. In the public system, aside from a 12 week and 20 week scan, you may not get these regular scans as part of routine unless there is an issue.

The quality of doctors in the public system isn’t in question, it’s more around the comfort factor of having the same healthcare providers with you throughout your journey. If this is something you deem important, then private health insurance may be a worthy investment.

Access to potentially better accommodation and facilities.

The environment you give birth in is something to genuinely consider. For some, it might not be a major issue, but for many this can make or break their decision. Private health offers the opportunity to access the hospital facilities that are important to you, ranging from choosing a hospital that has high special care nursery, so you aren’t separated if complications arise, to more of the comfort features, such as having your own private room all the way through to the quality of food.

In the public system, you may be required to share wards with others, which generally means your partner cannot stay overnight with you. So it’s something to keep in mind if you value privacy during what is ultimately a very intimate experience. With pregnancy cover, you’ve got flexibility, you can be a private patient in a private hospital or even a private patient in a public hospital.

Depending on circumstance, private cover can offer hotel accommodation (if medically approved) which allows your partner and even your other children to stay with you with a midwife around to support you. So, again, choice and flexibility is really the major benefit for each and every individual who has pregnancy cover. Not only in planning your experience, but for when those plans change, which as we all know isn’t uncommon.

Down the road you can also use your cover to access sleep school privately, which is good to know as often the public services have long waiting lists for these types of admissions.

Helpful Tip:

Having a baby is one of the most exciting and special times in your life. And quite often this is when we start to consider our health insurance needs more carefully. Having choice is invaluable, particularly being able to choose who your obstetrician is and which hospital you would prefer to deliver at.

Remember, if you want to be covered for a private birth (which may also include wanting a private room and better accommodation and facilities), make sure that you are covered for a full 12 months before the baby is born.

Author Canna Campbell

Canna Campbell, Financial Planner & Founder of SugarMamma TV 

What out of pocket expenses can come with pregnancy cover?

While having pregnancy cover does provide you with extra cover and choice, it doesn’t mean that every service will be covered, or covered in its entirety. What is covered differs from provider to provider, so make sure you’ve thoroughly researched or discussed your plan to avoid any unexpected expenses.

What is included in your pregnancy cover?

As mentioned, cover differs from insurer to insurer and plan to plan, but we’ll do our best to give you a general overview. Typically, full pregnancy cover can provide you:

  • Hospital accommodation
  • Theatre and labour ward fees
  • Intensive care (during and after birth)
  • Access to the special care nursery provide you are on a family or single parent cover
  • Hospital-administered pharmaceuticals
  • Medicare Benefit Schedule fees
  • Hotel accommodation

What could your out-of-pocket expenses be?

Having a baby in a private hospital can be expensive. For this reason, it’s important to understand your coverage before choosing a policy. Your obstetrician generally charges a pregnancy management fee. Medicare pays part of this, so does your health fund and there is often a component that you will need to fund – also known as the “GAP”.

In many instances, these expenses won't be covered by your pregnancy cover:

  • Some specialist outpatient consultations
  • Appointments made outside of being an inpatient (eg. outpatient ultrasounds)
  • Elements of IVF treatments
  • The ‘gap’ on medical services incurred in hospital i.e. a pead consultation.
  • Pre-release check-ups
  • Food for your partner

While this list is a lot shorter than the one above, these costs can add up. The good news is that some of these costs can still be covered by Medicare. Which is why, even with a good public health system, having private health insurance in combination can be a beneficial set up.

When is a good time to upgrade to a family health insurance policy?

Pregnancy insurance is quite literal in its definition. It insures your ‘pregnancy’, but not your child once it’s born. Complications can still happen post-birth, and to cover yourself for those you’ll need to investigate the options you have under family cover.

Timing is also important here. Some providers might require you to have this cover in place for a set period prior to the birth. Some insurers might allow it, but the rules, requirements and options can differ from provider to provider.

Many insurers offer free cover for children up to the age of 18 under a family policy, so if you’re planning a family, it’s something to consider well beyond the birthing process.  

Compare health cover for pregnancy with iSelect

If you’re planning on having a baby, there’s a lot you’ll need to organise. There is absolutely nothing to lose and everything to gain by comparing health insurance providers in any situation, but when it comes to the birth of your child it really should be of the utmost importance. Putting a plan in place for your birthing process goes without question, and having the appropriate level of care is an essential part.

You’ve also got a LOT of other things to organise and save for, so let iSelect do the comparing of policies for you from our range of providers. You never know how much you might be able to save.

Sources:
1. https://www.health.gov.au/about-us/the-australian-health-system

Canna Campbell

Endorsed by:
Canna Campbell

Financial Planner and founder of SugarMamma TV

Canna is a qualified financial planner, the founder and director of SASS Financial Services, a boutique financial planning firm, and the founder of SugarMamma TV. She is Channel 9's exclusive 'money expert', and best-selling author of The $1000 Project & Mindful Money.

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