Private health insurance for pregnancy

Pregnancy health insurance

Planning for a baby can be one the most exciting stages of our lives. It can also be a time that calls for important decisions around whether to take out pregnancy health insurance. This choice can shape your prenatal care, where you have your baby, and some of the costs associated with having a newborn.

Do I need health insurance for pregnancy?

If you’re Medicare eligible then you don’t strictly need private health insurance for pregnancy in Australia. This is due to Australia’s public health system providing pregnancy services at little or no cost to you through Medicare. This applies if you wish to be a public patient at a public hospital, birth centre or even at your own home when having your baby.

Prenatal (before birth) care, which can include visits to your doctor or midwife, various pathology tests and diagnostic imaging may also be funded, or partly funded, by Medicare.

That being said, many Australians choose to take out private health insurance that covers obstetrics (pregnancy services) and birth. Being a private patient at either a private or public hospital may allow you to have your own private hospital room (if one is available) when giving birth and your choice of medical professionals to help you along the way.

Whether or not you decide to take on pregnancy health insurance will depend on your personal circumstances.

Public vs private pregnancy journey: what’s the difference?

Public patient

When giving birth as a public patient you’ll have very few hospital related expenses, if any, due to being covered under Medicare. You won’t have to observe any waiting periods for coverage either, which is common practice with private health insurance. One potential drawback to keep in mind, though, is that you generally won’t be able to choose your obstetrician or receive care from the same medical professional throughout your pregnancy journey. You’ll also typically utilise the public hospital closest to where you live and won’t often receive a private room.

Private patient

As a private patient in either a private or public hospital you’re usually able to choose your own obstetrician and other certain medical professionals, as well as the hospital you want to give birth at. You may also get your own private room, however, this will depend on availability.

A Gold or Silver Plus tier hospital insurance policy with pregnancy and birth cover included (such as the ones in the table above from our Online Partners) is required in order for you to claim any benefits for in-hospital services provided in relation to your pregnancy and the delivery of your child/children. A waiting period of 12 months generally applies to these kinds of policies, which means you’ll need to have taken out and held the pregnancy health insurance policy for at least 12 months before any pregnancy related claims will be approved.

What will my out-of-pocket expenses be when I have a baby?

The Commonwealth Ombudsman, an independent body that investigates complaints about Australian Government agencies and certain private sector organisations, notes that private hospital insurance won’t cover all the costs associated with your pregnancy. Medical expenses during pregnancy, such as the services of a GP, obstetrician visits, scans and blood tests, are unlikely to be covered by private health insurance, though these costs might be partially covered by Medicare.

Private health insurance is designed to offer cover to people for treatment while in hospital, and, if you elect to also take on an ‘extras’ policy, certain out-of-pocket expenses in other medical settings.

Generally speaking, pregnancy does not require hospitalisation until it comes time to give birth, unless there are complications. So, the type of policy you choose will determine what out-of-pocket expenses are covered during your pregnancy.

Extras cover may let you claim for some of the costs, such as remedial and pregnancy massages, physiotherapy and chiropractic care during your pregnancy and recovery period. Check any claim limits that apply to these services (such as a capped $ amount per year) and consider if you can make the most of them before and after the birth of your baby. Out-of-pocket expenses may apply.

Out-of-pocket expenses in hospital

You may have particular preferences about where your baby is born, your choice of obstetrician and whether you have a private room during your hospital stay following delivery. Having health insurance that covers pregnancy may help you fulfil these choices.

But it’s worth contacting the hospital and/or healthcare provider you’ve selected, to find out if they charge above the Medicare Benefit Schedule (MBS) listed fee. You may face greater out-of-pocket expenses if your obstetrician charges above the MBS fee and doesn’t have a ‘no gap’ agreement with your health insurance provider.

It’s also important to speak with both the hospital and your health insurance provider to understand exactly what you can claim for, and what you’ll end up being billed for. There may be expenses that aren’t covered by your policy, such as certain tests or medication, which you may be required to pay for when you check out of the hospital.

Also it’s a wise idea to check how much excess you may have to pay, including if you need to pay it just for your hospital stay, or if you also need to pay it for your newborn if they require care.

The best time to take out health insurance for pregnancy

If you’re considering taking on private health insurance for your pregnancy and the delivery of your baby, some forward planning may be essential. There are valid reasons to purchase a private health insurance policy that includes hospital pregnancy cover well ahead of time—even before you become pregnant.

The Commonwealth Ombudsman says all health funds apply a 12-month waiting period for pregnancy services, and that in most cases this rule is strictly applied. So it may be advisable to have appropriate cover in place for at least a year before your baby is due, possibly longer as babies can come early.

You may need to check with your insurance provider to see if your newborn baby is also covered by your policy. You may need to upgrade to a ‘family’ policy to ensure that your baby is covered if it requires any treatment, such as needing specialist health care while in hospital. There could also be waiting periods that apply to this type of cover.

You can use the table at the top of this page to compare private health policies with hospital and extras cover for families from our Online Partners. You can also change the filters to better suit your requirements.

Am I covered for pregnancy and birth?

If you already have private hospital insurance and you’re thinking about starting a family, then it’s important to check that your policy covers you for everything you need. As mentioned, health funds apply a 12-month waiting period for pregnancy and birth services, so if you’re already pregnant when you realise your current insurance does not include obstetrics, by then it will be too late to be covered for this pregnancy.

If in doubt, read the policy documents that came with your health insurance, such as the Private Health Information Statement (PHIS), or contact your provider directly to make sure that you’re on a suitable level of cover for pregnancy and birth-related services. While many Australians choose to give birth in the public hospital system, you may prefer to go private, and if so, then it’s important to make sure you have appropriate cover in place.

Which are the best funds for pregnancy health insurance?

The best pregnancy health insurance for you will ultimately depend on your needs and financial situation. Families facing the cost of a newborn may be tempted to select the cheapest health cover available to them, but bear in mind that not all policies will cover obstetrics.

According to privatehealth.gov.au, a Gold tier hospital policy is the only tier that provides cover for pregnancy and birth as a minimum requirement. That said, some health insurers may offer Plus policies on other hospital tiers, such as Silver Plus, with these services included.

Once you’re aware of the level of cover you require, it may be a good idea to compare family or singles health insurance policies that include pregnancy services to find a policy that best suits your needs at a competitive price. Also, consider what kind of excess you can afford to pay; for instance, choosing a higher excess will typically give you a cheaper premium, but it will mean you have to pay more when claiming on your policy.

You may also be interested in Canstar’s Health Insurance Awards. These awards recognise the providers that offer outstanding value to Australian consumers based on both price and features. We also have a dedicated Most Satisfied Customers award for the health insurer with the highest level of customer satisfaction as assessed and calculated by our expert researchers.

Overall, it’s important to make sure the private health cover you choose suits your needs and budget during pregnancy, the delivery and post-delivery.

Canstar Star Ratings and Awards

Looking for an award-winning product or to switch providers or brands? Canstar rates products based on price and features in our Star Ratings and Awards. Our expert Research team shares insights about which products offer 5-Star value and which providers offer outstanding value overall. We also reveal which providers have the most satisfied customers in our dedicated Customer Satisfaction Awards.

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