Pregnancy health insurance

If you’re pregnant and have private health insurance, you’ll be able to choose both your hospital and obstetrician.

Without the right health insurance, there’s a risk of needing to pay out-of-pocket for unpredictable costs.

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How private health insurers cover pregnancy

Most private insurers will have a policy that covers pregnancy. It will cost you some money since it’s a top tier, or premium level policy. First, you'll need to find health insurance that covers it and then you'll have to serve the waiting period of 12 months. The following table shows insurers from the finder.com.au panel..

Provider	Excess	Treatments included	Cost per month	Apply
	$400	Obstetrics Labour ward	$155.47	Go to Site
	$500 excess	Pregnancy and birth related services	$155.29	Go to Site
	$500 excess	Obstetrics Pregnancy and birth related services	$160.37	Go to Site
	$500 excess	Pregnancy Birth related services	$183.15	Go to Site

*Prices based on individual female living in NSW

Private health insurance and pregnancy

Even if you normally prefer just using Medicare, you may wish to purchase private health insurance for pregnancy and birth. The secret to getting the right coverage for the best value is to combine Medicare with private health insurance to make sure all likelihoods are taken care of. Private health cover for pregnancy offers benefits that Medicare doesn’t, including:

• Choosing your preferred doctor and hospital. If you have special medical issues or are at a high risk of pregnancy-related complications it can be beneficial to have a doctor who is familiar with your health issues. Also a hospital close to home can make it easier for your partner to visit you in hospital.
• A private room. A private room can reduce the stress associated with pregnancy and often means that your partner can share the room with you throughout the birth.
• Extras. Some health insurance policies include non-essentials such as birthing classes, in vitro fertilisation (IVF) and other assisted reproductive services.

In order to be eligible for private health insurance you must:

• Take out the policy well in advance, possibly as much as three months before attempting to conceive. Most Australian private health funds have a 12 month waiting period for obstetric services.
• Make sure that your baby is included on your health insurance policy. Some policies will only cover your health, but not the baby’s.
• Upgrade your policy to a family policy where applicable, and be aware of the additional expenses this may involve.

What aspects of pregnancy are covered by health funds in Australia?

Having a baby is an expensive affair so it’s important to plan well ahead and make sure you have cover for every aspect of your pregnancy. For the best value, combine Medicare and private health insurance to cover everything you need with a minimum of overlap. While you will have to pay some out-of-pocket expenses yourself, the right health cover can reduce your costs to a manageable level. Most importantly, it will ensure that your expenses are predictable and can be budgeted for accordingly.

The following are the main elements of pregnancy covered by private health insurance:

• Hospitalisation. Private health insurance can cover you for costs including accommodation in your choice of a public or private hospital, theatre fees, anaesthetics and pharmaceuticals.
• Birth. Your health insurance can provide you with cover including choice of your own obstetrician and pediatrician and partial coverage of their fees.
• Postnatal. After your child is born your policy can protect your newborn baby for any hospital or medical treatments required after birth.

What are the costs of pregnancy with private health insurance?

Even with a health insurance policy that covers pregnancy services, there will still be additional expenses, which can include:

• Medical services incurred outside of hospital. Services including antenatal (postnatal) classes, GP visits, blood tests, ultrasounds, specialist consultations and obstetrician check-ups tend to not be covered. Aside from antenatal classes, these can all be partially claimed through Medicare.
• The gap. The gap refers to the difference between the Medicare Benefits Schedule (MBS) fee and what your health fund will pay for in-hospital medical services. Usually this gap must be paid by you, but some fund and policies can cover it. You can ask your doctor if they have a “no gap” agreement with your private health fund and request a written quote of expenses at the start of your treatment.
• Excesses and co-payments for hospital admissions. Excesses and co-pays are expenses that must be paid by you. This amount mostly depends on whether your baby is born healthy, or whether they require postnatal care, but also varies with fund and policy.
• Your baby’s pre-release check-up. Check-ups are usually not covered, but can be partially claimed through Medicare.
• Insuring your baby from birth. Most health funds allow you to do this to cover potential medical bills while your baby is still in hospital, but you will pay extra for this and a waiting period applies (anywhere from two to 12 months, depending on fund).

Does health insurance cover ultrasounds?

In conjunction with Medicare, private health insurance pays for much of your in-hospital treatment and if your health fund has a no-gap scheme, possibly all of it (this is a network of preferred hospitals where fees are capped). But private health insurance doesn't provide cover for treatments and services performed outside of hospital. Known as outpatient services, these include specialist consultations and diagnostic tests such as X-rays, pathology and ultrasounds. They are often performed by outpatient clinics, which can be affiliated with both public and private hospitals.

Private health pregnancy cover typically includes hospital accommodation, theatre and labour ward fees, birth-related intensive care, pharmaceuticals administered in hospital and 100% of the Medicare Benefit Schedule fee for doctor’s fees (75% Medicare + 25% health fund). It doesn't cover ultrasounds performed prior to going to hospital to give birth. Outpatient services such as these are covered by Medicare and can generally bulk-billed. If there is a pregnancy-related outpatient service that isn’t covered by Medicare, some private health funds may cover it. An example is birthing classes, which are covered by some pregnancy policies and not by others.

Does Medicare cover pregnancy?

If you don’t have private hospital insurance, Medicare will pay for some aspects of your pregnancy including:

• Some of your antenatal costs including partial payment of GP visits, obstetrician appointments, blood tests, ultrasounds and other specialised tests.
• Some of your in-hospital costs including partial payment of baby delivery fees and anaesthetics fees.
• Some of your postnatal costs including partial payment of a paediatric check up and postnatal health check-ups (eg, by a midwife).

Once you leave hospital, you may also be eligible for a newborn or parental leave payment from Medicare. The newborn upfront payment is an increase to your family tax benefit and the parental leave payment is payment for up to 18 weeks while you are off work caring for your new baby.

A recent study from finder.com.au found that 70% of first-time mothers chose the public hospital system for the pregnancy and delivery. The reason most first-time mums go public comes down to cost, with childbirth in a public hospital is free whereas a standard private delivery can cost between $9,000 and $10,000.

Are IVF and assisted reproductive services covered?

In-vitro fertilisation (IVF) and gamete intrafallopian transfer (GIFT) are two assisted reproductive services that are commonly covered by private health funds. Not all funds cover such services, though, and those that do usually enforce a 12 month waiting period. They also only cover those services that have a Medicare item number and involve an admission to hospital (eg, accommodation and theatre fees associated with egg collection and embryo transfer).

Assisted reproductive services can be expensive and usually require several attempts, with no guarantee of success; it is important to speak with your fund prior to signing up for such procedures to make sure you are covered for as much of the costs as possible.

How much does it cost to have a baby?

The following is a rough breakdown of what it costs to have a baby and how much of that expense is borne by you, by Medicare and by your health fund:

Pregnancy

• Out-of-hospital expenses: GP visits ($75-80 if not bulk billed), obstetrician visits (up to $300), blood tests ($30-200) and ultrasounds ($150-300). Medicare pays 85% of the MBS fee and you pay the difference.
• Antenatal classes: You can find free antenatal classes at many public hospitals, but some can also cost up to $300, in which case you will have to pay for all of it.

In hospital

• Public birth: Shared accommodation in a public hospital including maternity clinic, midwife-managed birthing centre and community-based midwifery program. You pay very little apart from additional personal expenses ($400 total on average).
• Private birth: The average cost is around $8,500 for accommodation, labour ward, specialists and theatre fees. Medicare pays 75% of the MBS fee, your health fund pays the other 25% and you pay any extra amount charged above the MBS fee (unless the specialist doctor has a “no gap” agreement with your fund), plus any excess applying to your policy and any personal expenses such as extra meals or pharmaceuticals.

After hospital

• Postnatal care: Paediatrician visits ($100-400) and midwife visits ($100-200). Medicare pays 85% of the MBS fee.
• Baby necessities: Pram ($500-1,000), cot ($300+), changing table ($80-150), nappies ($15-35 for 50) and maternity wear ($100-200 each).
• Loss of income: Cost of being reduced to one income, partially offset by any Paid Parental Scheme.

Australian funds covering pregnancy

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Still have questions about pregnancy and health insurance?

• Q: Is pregnancy cover normally included on a standard health insurance policy?

  • A: No. Unless you have a higher level of cover which includes obstetrics, you will not normally be covered for pregnancy. Even then, you will only be covered for certain procedures unless stated otherwise.

• Q: What are the main advantages of having private health insurance if I'm planning to have a baby?

  • A: You can choose your own hospital and obstetrician and you can often be accommodated in a private room. Some policies will also cover “non-essentials” like IVF that Medicare won’t.

• Q: When will I have to pay the co-payment on my hospital cover?

  • A: Any excess or co-payment will need to be paid when you are admitted to hospital.

• Q: What is a pre-release check up?

  • A: This is a check up conducted by your paediatrician before you and your baby can be discharged from hospital. The cost of this can be partially claimed through Medicare, but is not covered by your health fund.

• Q: How soon should I upgrade from couples insurance to family insurance to make sure my baby is covered from birth?

  • A: It depends on the fund, but usually you will need to do this at least three months before going to hospital, as waiting periods apply.

• Q: What is the waiting period for pregnancy cover?

  • A: While it may vary with funds, most require you to serve a 12 month waiting period.

• Q: How can I ensure my partner will be with me while I’m in hospital?

  • A: Some policies include accommodation in a private room, which your partner can share with you during the birth and subsequent days, but you’ll need to shop around.

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