Pregnancy Health Insurance

Pregnancy health insurance

Are you in need of health cover that covers maternity? Compare your options and find the best health insurance for pregnancy.

Pregnancy can be difficult and unpredictable, but knowing you have the right health insurance to cover it makes things easier. Health insurance for pregnancy is often referred to as obstetrics, and it’s important to note that this only covers hospital admission for the pregnancy itself. Unless stated otherwise you should assume that birthing classes, ultrasounds and other services are not included in pregnancy health insurance, so look for these specific details in the insurance policy.

Pregnancy health insurance is recommended as it’s a cost-effective way to get a high standard of medical care for yourself and your baby, and because until the baby is born it’s difficult to be certain that there won’t be any complications. Without the right health insurance there’s a risk of needing to pay out-of-pocket for these unpredictable costs. This guide looks at the benefits of public and private pregnancy health insurance and some of the things that are covered by each.

Pregnancy benefits from funds in the finder.com.au panel

Health fundPolicies that include pregnancy coverBenefit waiting periodFind out more
HIF LogoHospital only policies

  • Gold Star Hospital
  • Gold Hospital
  • Gold Saver Hospital
  • 12 months
More info
health.com.aulogoHospital only policies

  • High Hospital
  • 12 months
More info
ahmHospital only policies

  • Top Hospital
  • 12 months
More info
Australian UnityCombined hospital + extras policies

  • Smart Combination (restricted benefit*)

Hospital only policies

  • Gold Hospital with Pregnancy Cover added
  • Mid Hospital with Pregnancy Cover added
  • 12 months
More info
GMHBACombined hospital + extras policies

  • Premium Family
  • Everyday Family

Hospital only policies

  • Gold Hospital
  • Bronze Hospital (restricted benefit*)
  • 12 months
More info
HCFCombined hospital + extras policies

  • Young Starter Package (restricted benefit*)

Hospital only policies

  • Premium Hospital
  • Mid Hospital (restricted benefit*)
  • 12 months
More info
nibHospital only policies 

  • Top Hospital
  • 12 months
More info
Transport Health LogoHospital only policies

  • Top Hospital
  • Top Hospital with Excess
  • Top Hospital with Co-Payment
  • Basic Hospital (restricted benefit*)
  • 12 months
More info

For a more comprehensive list of pregnancy benefits from Australian health funds, consult the table at the end of this article.

*Benefit only applies if you are treated as a private patient in a public hospital. If you attend a private hospital you will incur significant out-of-pocket expenses for your treatment.

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 best coverage for the best value is to combine Medicare with private health insurance to make sure all likelihoods are taken care of. Private pregnancy health insurance 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 private pregnancy health insurance plans include non-essentials such as birthing classes, in vitro fertilisation (IVF) and other assisted reproductive services.

In order to be eligible for private pregnancy 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 paediatrician 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 private pregnancy health insurance, 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 insurers 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 insurer 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 insurer).

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.

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 insurer 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 insurer), 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.

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 pregnancy health insurance?

  • 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?

Q: What is the waiting period for pregnancy cover?

  • A: While it may vary with insurers, 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.

Compare your health insurance for pregnancy options online or with the help of an adviser

Which health policies cover pregnancy?

Health fundPolicies that include pregnancy coverBenefit waiting periodFind out more
ahmHospital only policies

  • Top Hospital
  • 12 months
More info
Australian UnityCombined hospital + extras policies

  • Smart Combination (restricted benefit*)

Hospital only policies

  • Gold Hospital with Pregnancy Cover added
  • Mid Hospital with Pregnancy Cover added
  • 12 months
More info
BupaHospital only policies

  • Gold Hospital
  • Silver Hospital
  • Thrifty Hospital
  • Smart Cover (restricted benefit*)
  • 12 months
More info
cdhlogoHospital only policies

  • Gold Hospital
  • Silver Hospital
  • Thrifty Hospital
  • Smart Cover (restricted benefit*)
  • 12 months
More info
cuaHospital only policies

  • 100% Private Hospital
  • 90% Private Hospital
  • 75% Private Hospital
  • Public Hospital (restricted benefit*)
  • 12 months
More info
FrankHospital only policies

  • Best Hospital
  • Basic Hospital + some private
  • Basic Hospital
  • 12 months
More info
gmflogoHospital only policies

  • Complete Hospital
  • Mid Hospital
  • 12 months
More info
GMHBACombined hospital + extras policies

  • Premium Family
  • Everyday Family

Hospital only policies

  • Gold Hospital
  • Bronze Hospital (restricted benefit*)
  • 12 months
More info
HBFCombined hospital + extras policies

  • Smart Saver Twin Pack (WA only)

Hospital only policies

  • Top Hospital
  • Mid Family Hospital
  • 12 months
More info
HCFCombined hospital + extras policies

  • Young Starter Package (restricted benefit*)

Hospital only policies

  • Premium Hospital
  • Mid Hospital (restricted benefit*)
  • 12 months
More info
health.com.aulogoHospital only policies

  • High Hospital
  • 12 months
More info
hcilogoHospital only policies

  • Premier Hospital Cover
  • 12 months
More info
HIF LogoHospital only policies

  • Gold Star Hospital
  • Gold Hospital
  • Gold Saver Hospital
  • 12 months
More info
latrobehealthlogoCombined hospital + extras policies

  • Healthy Start (restricted benefit*)

Hospital only policies

  • Top Hospital
  • Family Care
  • MemberShare
  • CoverWise
  • Loyal Members
  • 12 months
More info
 medibankCombined hospital + extras policies

  • Growing Family Comprehensive
  • Growing Family Essentials Plus (restricted benefit*)

Hospital only policies

  • Top Hospital
  • Standard Hospital (restricted benefit*)
  • 12 months
More info
 mildurahealthfundlogoHospital only policies

  • Five Star Hospital Benefits
  • Basic Hospital Benefits (restricted benefit*)
  • 12 months
More info
nibHospital only policies 

  • Top Hospital
  • 12 months
More info
onemedifundlogoHospital only policies

  • Private Plus Hospital
  • 12 months
More info
peoplecare provider page linkHospital only policies

  • Premium Hospital
  • Mid Hospital (restricted benefit*)
  • 12 months
More info
phoenix health fund provider linkCombined hospital + extras policies

  • Top Cover
  • Value 500

Hospital only policies

  • Top Hospital
  • 12 months
More info
queensland country health fund provider linkHospital only policies

  • Top Hospital
  • Intermediate Hospital (restricted benefit*)
  • Public Hospital
  • 12 months
More info
St. Lukes Health LogoCombined hospital + extras policies

  • Included in all St Lukes Health combined policies unless you've opted to restrict pregnancy services to public hospital cover.

Hospital only policies

  • Included in all St Lukes Health hospital policies unless you've opted to restrict pregnancy services to public hospital cover.
  • 12 months
More info
Transport Health LogoHospital only policies 

  • Top Hospital
  • Top Hospital with Excess
  • Top Hospital with Co-Payment
  • Basic Hospital (restricted benefit*)
  • 12 months
More info
westfund provider linkCombined hospital + extras policies
  • Platinum Plus
  • Platinum Extended
  • Platinum
  • Gold Extended
  • Silver Plus
  • Silver
  • Platinum Public
  • Gold Public

Hospital only policies

  • Gold Hospital
  • 12 months
More info
CBHS Health Fund LogoRestricted fund**Combined hospital + extras policies

  • Prestige
  • StepUp
  • KickStart (restricted benefit*)

Hospital only policies

  • Comprehensive Hospital
  • Limited Hospital (restricted benefit*)
  • Basic Hospital (restricted benefit*)
  • 12 months
More info
defencehealthlogoRestricted fund**Combined hospital + extras policies

  • ADF Total Package (not available to defence connections)

Hospital only policies

  • Premier Hospital
  • Value Hospital
  • 12 months
More info
doctorshealthfundlogoRestricted fund**Hospital only policies

  • Top Cover
  • Prime Choice
  • 12 months
More info
navyhealthlogoRestricted fund**Hospital only policies
  • Premium Hospital
  • Healthy Hospital
  • Saver Hospital (restricted benefit*)
  • Saver Plus
  • NT Hospital
  • NT Hospital 300
  • 12 months
More info
policehealthlogoRestricted fund**Combined hospital + extras policies

  • Platinum Health
  • Platinum Plus

Hospital only policies

  • Top Hospital
  • 12 months
More info
rbhslogoRestricted fund**Combined hospital + extras policies

  • Combination Cover

Hospital only policies

  • Gold Hospital
  • 12 months
More info
rthealthlogoRestricted fund**Hospital only policies

  • Premium Hospital
  • Smart Hospital
  • Step Up Hospital (restricted benefits*)
  • Public Hospital
  • 12 months
More info
teachersRestricted fund**Hospital only policies

  • Top Hospital
  • Mid Hospital (restricted benefit*)
  • Basic Hospital (restricted benefit*)
  • 9 months
More info
tuhRestricted fund**Combined hospital + extras policies

  • Ultimate Choice
  • Easy Choice

Hospital only policies

  • Total Care Hospital
  • Mid Range Hospital (restricted benefit*)
  • 12 months
More info

*Benefit only applies if you are treated as a private patient in a public hospital. If you attend a private hospital you will incur significant out-of-pocket expenses for your treatment.
**Restricted funds only provide cover to members of specific industries, groups and organisations. In some cases family members may also be eligible to join.

Compare your health insurance for pregnancy options online or with the help of an adviser

Picture: Shutterstock

Richard Laycock

Richard is the senior insurance writer at finder.com.au and is on a mission to make insurance easier to understand.

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