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Is Private Health insurance for Pregnancy Worth it?

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Anneke Van Aswegen Updated: 11 May 2020
Types of Health Insurance

If you’re planning to become pregnant, you might be wondering whether you need private health insurance.

Private health insurance with pregnancy cover might be worth considering if you want to choose your obstetrician, have a private room and shorter waiting times for appointments. Because there is generally a 12-month waiting period, be sure to purchase or upgrade to a hospital policy that includes pregnancy cover three months before falling pregnant.

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Do you need private health insurance for pregnancy?

Generally, if you have a Medicare card, private health insurance might not be necessary. However, it might be worth considering if you want to choose your obstetrician, the hospital you’ll go to and want the comforts that come with a private hospital.

Can you get health insurance when you’re already pregnant?

Yes, you can still purchase private health insurance when you’re already pregnant. Health funds cannot deny you coverage or charge you more because you are pregnant. However, you’ll typically have to serve a 12-month waiting period before you can claim benefits for pregnancy and birth-related services.

It’s important to plan ahead. Most health funds apply a 12 month waiting period to hospital benefits for pregnancy services. If your baby arrives earlier than your expected delivery date and you have not yet served the 12 months, private health insurers are not required to pay a benefit.

Can you get private health insurance for pregnancy with no waiting period?

Generally, no. While you can get health cover while pregnant, many health insurance companies usually require you wait 12 months before you can claim any pregnancy-related services. Therefore, you need to have purchased private health insurance with pregnancy cover at least three months before trying to conceive.

Don’t make the mistake of thinking you can take out pregnancy cover anytime before your baby is due. You must have served the 12 month waiting period before your hospital admission date. As soon as you start thinking of falling pregnant, contact your insurance provider and make sure you’ll be covered before the date of delivery.

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What is the cost of giving birth in Australia?

If you have a Medicare card and give birth in a public hospital, you’ll have little to no out-of-pocket costs. On the other hand, if you prefer the comfort and consistency of a private hospital, you could pay between $9,000 to $30,000. However, if you have private health insurance with pregnancy cover, your out-of-pocket cost will usually decrease to between $2,500 to $5,000.

Pregnancy costs you need to take into consideration:

Save money by choosing a GP that does bulk-billing. If you’re eligible for Medicare and your GP bulk bills, then your out-of-pocket costs will reduce significantly.

Private or public hospital for pregnancy

Benefits Private hospital Public hospital
Out-of-pocket costs without insuranceBetween $9,000 and $30,000$0 to $1,500 with Medicare
Choice of obstetrician and/or midwifeYes. However, your obstetrician might be on leave when you go into labourNo. You might also be cared for by junior doctors, who only calls a specialist when needed
Choice of hospitalYesNo. You’ll have to go to the hospital in the area you reside
Same obstetrician for all your appointmentsYesVery unlikely
Adhering to your birthing planHigher rate of intervention, with private hospitals performing more caesareansLower chance of interventions, with a higher number of natural births
Waiting times for check-ups and examinationsGenerally, very short waiting times for appointmentsLonger waiting times as it’s dependent on the availability of the doctor or midwives
Equipped for intensive or specialised careNot all private hospitals in Australia have emergency departments. If you need a c-section or intensive care, you and your baby may have to transfer to a public hospitalGenerally, yes
Private roomVery likelyVery unlikely. Family can usually only stay during visiting hours
Length of hospital stayUsually, up to 5 daysUsually, discharged within 1 to 3 days
Meals in the hospitalGenerally, delicious meals available to you and your partnerDepends on the hospital, but might not be as nice as a private hospital
Free lactation consultantVery likelyDepends on the hospital
Free nappies/formula and maternity padsVery likelyDepends on the hospital
TV to watchYes, freeGenerally, you’ll have to pay

Does Medicare cover pregnancy expenses?

If you have a Medicare card, pregnancy-related costs in a public hospital (via caesarean or vaginally) will be subsidised, including visits to your midwife or obstetrician. Other fees partially covered by Medicare include routine blood tests and ultrasounds, pregnancy counselling and other specialised tests.

Medicare generally does not cover:

What does private health insurance cover for pregnancy?

Generally, private health insurance that includes pregnancy covers the costs you incur while in the hospital. With a hospital policy that includes pregnancy and birth-related services, you can be a private patient in a private or public hospital, choose your obstetrician and preferred doctor, and enjoy a private room.

Benefits of private health insurance for pregnancy

Services generally not covered by health insurance

Important: Most hospital policies require you to pay an Excess or co-payment when being admitted to hospital.

To cut down on out-of-pocket costs, you might want to consider:

Which health insurance plans cover pregnancy?

Only Gold level hospital policies must include pregnancy as part of its minimum clinical category. However, a health fund can choose to include these birth-related services, as an optional extra, in their Bronze and Silver hospital tiers, which will generally be indicated by a plus (+) symbol.

Some health funds also offer Extras cover specifically for people starting or growing their family. These services go beyond treatments inside the hospital, generally providing access to:

Examples of private health insurers in Australia offering pregnancy cover include:

Health insurance after giving birth

To receive private coverage for your baby after it’s borne, you’ll generally need to purchase or upgrade to a family health insurance plan.

If you upgrade within a specified period, many health funds will give you a buffer of a few days or even weeks during which time the baby will be covered. Waiting periods differ between health funds, so be sure to check with your insurer.

How do you add your newborn to Medicare?

As soon as your child is borne, you can add them to Medicare. After you’ve given birth, your hospital or midwife will generally provide you with a Parent Pack that includes a Newborn Child Declaration form. Complete the form and have a doctor or midwife sign on the last page.

You can use this declaration as proof of birth and then go to a service centre to enrol them in Medicare. If you lost your declaration form, you could use your child’s birth certificate as proof. Be sure to enrol them before their first birthday or up to 52 weeks after they’re borne. Once added, you’ll receive an updated Medicare card.

  • Does Medicare cover ultrasounds?

    Yes, if bulk billed, Medicare generally pays for ultrasounds. However, if scans are not bulk billed, you’ll usually only receive a Medicare rebate for part of the costs. When ultrasounds are not done for medical reasons, Medicare will not typically cover the cost.
  • Is pregnancy a pre-existing condition for health insurance?

    Yes, pregnancy is generally viewed as a pre-existing condition by health funds, and thus, a 12-month waiting period applies. Meaning you must wait 12 months before claiming any pregnancy or birth-related services. Pregnancy is generally still considered “pre-existing” even if you weren’t aware you were pregnant or received confirmation from a doctor within the six months before taking out cover.
  • Can you switch health insurance providers while pregnant?

    Yes, changing health funds while pregnant is possible. You are not obliged to stay with an insurer and can freely compare your options and switch insurers. Generally, you won’t need to re-serve waiting periods when you transfer to another health fund with a policy that is of the same or lower level of cover.

    However, if you’re pregnant and switching to another insurer that includes services not available on your old policy or you increase your annual limits, then you’ll need to serve the waiting periods applicable to those services.
  • How to do Share Care with your GP and reduce costs?

    First, make sure that your GP and chosen hospital participates in shared care. Generally, your GP will order any initial blood tests and ultrasounds, while also providing early antenatal care, up until 36 weeks.

    After that, your GP will typically refer you (with a referral letter) to the ante-natal clinic at the hospital you are using to go through the ‘Booking In’ process, which includes taking a comprehensive medical history and answering any questions you may have.

    Your hospital will confirm with your GP that you have chosen GP Antenatal Share Care. From 36 weeks on your follow up visits will usually be done at the hospital by a midwife.
  • Which private health insurance is best for pregnancy?

    To find the best health insurance for your pregnancy, you might want to compare similar hospital pregnancy policies from some of Australia’s major health insurance brands and decide which one meets your requirements.
  • Will my health insurance cover fertility treatments like IVF?

    If you have a Gold hospital policy, assisted reproductive services, like IVF, will be covered. However, if you took out a new policy or upgraded to a plan that includes cover for fertility treatments, you’ll have to serve a 12-month waiting period before claiming these benefits.
  • Can I get travel insurance if I’m pregnant?

    Yes, generally you can get travel insurance while you are pregnant. Many travel insurances companies in Australia provide cover for women pregnant up to 24 weeks; some are extending to 32 weeks. The premium for such a policy is generally more expensive because you are a higher risk client than people that aren’t pregnant.

Health Insurance Quotes

  • Reduce out-of-pocket expenses
  • Keep your family healthy
  • Easy and convenient
  • Free to use

Want to talk to a specialist? Call 1300 743 254

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