Planning to have a baby can be an exciting time, but it’s also one filled with many questions, including “where am I going to have my baby?” and “will I need health insurance?”.
Below we explore the ins and outs of private health insurance for pregnancy, including what may be covered before and after the delivery of your new bundle of joy.
Should you get private health insurance before falling pregnant?
If you are thinking of having your baby at a private hospital or as a private patient in a public hospital then you may want to consider purchasing a private health insurance policy that includes hospital pregnancy cover ahead of time. Most health funds have a 12-month waiting period for pregnancy-related expenses, meaning you are unable to claim for these services for a year after purchasing a policy.
When looking at your private health cover options, it’s also important to remember that not all policies will cover pregnancy services (also called obstetrics) at a hospital. According to privatehealth.gov.au, a Gold tier hospital policy is the only tier that is required to cover you for pregnancy and birth, although it’s possible that some insurers may decide to offer Silver Plus policies with these services included.
Once you are aware of the cover you need, it may be a good idea to compare family or single 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.
Overall, it’s important to make sure the health cover you choose suits your needs and your budget during pregnancy, the delivery and post-delivery.
Keep in mind it may be worth keeping your partner’s insurance separate until after the delivery, so that you’re not paying for the unnecessary higher level of obstetrics cover for them as well as for you.
To check whether you have the right cover, review your policy and make sure you aren’t paying for something you don’t need. You can find information about what you are and are not covered for in your product disclosure statement (PDS), or by contacting your insurer.
Family health insurance during pregnancy
Most medical expenses during pregnancy will not be covered by your health fund. These costs include the services of a GP, obstetrician visits, scans and blood tests. However, they might be partially covered by Medicare.
One of the benefits of private health insurance is, via extras cover, potentially being able to claim for things like remedial and pregnancy massages, physiotherapy and chiropractic care. It is a good idea to have a look at any 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. Your body will be taking on an extra weight load and transformation so you may want to speak with your health practitioner about preventative care exercises and making extra visits when you need it. However, it’s important to check what your out-of-pocket expenses may be if you do seek treatment.
Pregnancy: What are you covered for when you deliver?
If you have chosen the hospital where you would like to have your baby, then it may be a good idea to contact that hospital or the healthcare provider you have selected, to find out whether 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 insurer.
It’s important to also find out exactly what you can claim for and what you’ll end up being billed for by checking with both the hospital and your health insurer. It is a good idea to review and update your single or family health insurance policy to select the options you are looking for and determine how much the premium and excess will be.
Post-delivery: Health insurance for your newborn baby
You will generally have to pay out-of-pocket costs for the paediatrician who comes to check on your newborn. Your baby will be considered an outpatient, so your health insurance does not usually cover this service but Medicare may provide a partial payment.
Once your baby has been delivered, it may be a good time to consider adding your baby to your family health insurance policy, if you have such a policy in place. Most family private health insurance policies offer free cover for children until they are at least 18 years old, and longer if they are still dependent (up to 21 years old). Every fund has different rules about covering newborn babies so check with your health fund as early as possible. The Private Health Insurance Ombudsman also suggests these questions to ask your insurer when you are planning family private health insurance.
Cover image source: Rido (Shutterstock)
Article was originally written by Elizabeth McLardy on October 18, 2016.