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Understanding Pregnancy Health Cover in Australia

The pregnancy journey is both an exciting and scary period in any parent’s life. This journey is one that brings new life into the world, but with the numerous procedures, scans, treatments, and other medical necessities, it can often become daunting to keep up with the mounting expenses. Health insurance attempts to assist expecting parents through this journey by providing the policyholder with enough coverage to lower the total out-of-pocket costs.
Fact Checked

Updated: 19 May 2024

We’ll guide you to understanding health insurance that covers pregnancy and factors such as the expected waiting periods of policies, in-hospital services, obstetrics, postnatal care, and newborn health.

Key facts

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Why Choose Private Health Insurance for Pregnancy?

Private Health Insurance in Australia is designed to go hand-in-hand with Medicare. Private health insurance grants the expecting parent access to important additional benefits such as:

What Should I Know Before Getting Pregnant?

If you are planning your pregnancy, it is important first to understand how essential it is to prepare for the future. Health Insurance policies typically have waiting periods associated with their packages that a policyholder may have to sit through before they can access their personalised coverage. Setting up the right policy before falling pregnant can ensure that you have the right cover that will adequately assist you throughout the journey and lower the amount of stress that you may go through.

Another important consideration that you should make is with regard to your personal health. Before pregnancy, it is always a good idea to go for a pre-pregnancy medical check-up, which can often identify underlying potential health issues. Rectifying these issues, or understanding the root of their cause, could save you money and the wellbeing and health of you and your unborn child.

Do I Need Hospital or Extras Cover?

Along with the many different policy tier types, there are also three main categories that a policy provides coverage for. These three categories are Hospital, Extras, and Combined. Each policy type provides specialised coverage for specific healthcare services, and understanding the difference between the three will assist you in making the perfect decision.

Hospital Cover

Hospital cover covers in-hospital services such as obstetrician fees and in-hospital stays. These costs can often quickly amount to extremely high amounts, so having hospital cover can provide a great deal of relief for expecting parents. Hospital cover also allows for the policyholder to choose their own doctor and healthcare facility, which can make the journey easier and more comfortable.

Extras Cover

Extras cover provides coverage for out-of-hospital services. These out-of-hospital services are typically not covered by Medicare and can amount to large costs when seeking out these services without coverage. Some of the important pregnancy-related services that Extras policies provide coverage for include services such as physiotherapy and dental.

Combining Covers

Combined policies provide coverage for both out-of-hospital and in-hospital services. These policies are typically designed to provide the policyholder and their dependants comprehensive coverage matching their personal health requirements. Combined policies are recommended during pregnancy and for families so that there is access to a wide range of benefits, services, procedures, and healthcare facilities.

Postnatal Care and Newborn Coverage

Postnatal services are crucial in supporting new mothers during the critical period following childbirth, addressing physical and emotional needs. Extending coverage to newborns ensures timely medical attention, vaccinations, and developmental assessments, fostering a healthy start in life.

Adequate postnatal care contributes to maternal recovery, early detection of potential health issues in newborns, and the overall health and happiness of the growing family. Prioritising postnatal care and extending coverage to newborns is fundamental in promoting the long-term health and well-being of parents and their precious infants.

How Much Does Pregnancy Health Cover Cost?

The cost of pregnancy health coverage in Australia varies based on many factors. Monthly premiums are influenced by personal characteristics, lifestyle choices, coverage levels, and the choice of provider. Age plays a role, with younger individuals often experiencing lower premiums. 

To determine the most suitable and cost-effective pregnancy health coverage, individuals should assess their specific health requirements, consider coverage options, and compare premiums from different providers. Comparing websites, information provided by insurers, and online reviews are all good ways to receive the necessary information to make a final decision.

Out-of-Pocket Costs in Pregnancy Health Cover

There are many out-of-pocket costs that may occur during the journey of pregnancy. These may include specialist consultations, certain prenatal tests, and other ancillary services. ‘Gap fees’ play a crucial role in understanding overall expenses. Gap fees occur when there is a difference between the amount covered by health insurance and the actual cost charged by the healthcare provider. 

Specialist consultations, for instance, might incur a gap fee, which the policyholder is responsible for paying. It is essential for individuals with pregnancy health coverage to be aware of potential gap fees and their impact on overall expenses. Understanding these costs and the coverage offered by the insurance policy, allows policyholders to make informed decisions about their prenatal care while managing financial considerations effectively.

Government Benefits and Medicare

Medicare, and private pregnancy health cover in Australia work together to provide comprehensive care during pregnancy. Medicare serves as the public healthcare system, covering a broad range of medical services, including essential prenatal care, hospital stays, and some specialist consultations. Private pregnancy health cover enhances and personalises these services. It offers additional benefits such as choosing a preferred obstetrician, access to private hospital facilities, and coverage for specific maternity-related expenses. Individuals with private pregnancy health coverage often experience shorter wait times for elective procedures and a more personalised healthcare experience.

What’s Not Covered in Pregnancy Health Cover?

While pregnancy health coverage can significantly reduce pregnancy-related costs, it’s important to note that insurance may not cover certain aspects. Typically, cosmetic procedures, such as elective caesarean sections without medical necessity, are not included.

Pre-existing conditions or any complications arising from these conditions may also fall outside the coverage provided. Expenses related to infertility treatments and assisted reproductive technologies may not be covered. Understanding the limitations of your pregnancy health coverage is crucial for managing expectations and planning financially. It’s advisable to carefully review the policy terms and conditions to identify any exclusions or limitations, ensuring you understand what is and isn’t covered during your pregnancy journey.

Policy Exclusions

Pregnancy health cover typically excludes certain aspects, such as elective procedures without medical necessity and non-medical treatments. Cosmetic procedures, like elective caesarean sections for non-medical reasons, may not be covered. 

Fertility treatments and assisted reproductive technologies often fall outside the coverage provided. Understanding these policy exclusions is crucial to avoid unexpected costs during pregnancy. Thoroughly reviewing policy limitations ensures you know what is not covered, allowing you to make informed decisions about your healthcare. By being aware of these exclusions, you can better plan and navigate your pregnancy journey, mitigating the risk of unforeseen expenses and ensuring your health coverage aligns with your specific health requirements and expectations.

Frequently Asked Questions and Answers

Health insurance for pregnancy typically has a 12-month waiting period. This is a longer duration than the actual pregnancy itself. It is always a good idea to preplan for these factors to ensure that you receive the coverage that you need when you need it. Acquiring a health insurance policy that covers pregnancy before the pregnancy occurs could be a good way to safeguard your out-of-pocket costs and make the experience less stressful.

Yes. Depending on your chosen policy, health insurance typically provides comprehensive coverage for you, your family, and your newborn child. These policies often provide coverage for services such as prenatal check-ups, delivery, and postnatal care, but these services may also vary based on your policy and your insurer.

Yes. Every policyholder is allowed to switch policies and insurers whenever they may need to. The most important factor to consider when deciding is the waiting periods involved. When switching policies, you may have to wait for an additional amount of time to elapse before you are able to access the coverage provided by the policy. If you need the coverage immediately, it may not be a good idea to switch policies until after the pregnancy.

Private health insurance is designed to work hand-in-hand with Medicare. Private health insurance typically assists policyholders in receiving coverage for services that are not covered by Medicare. Additionally, private health insurance for pregnancy also provides the expecting parent with more choices in obstetricians and hospitals.

Not always. Since there is a countless number of policies and insurers out there, the coverage that you, your family, and your newborn baby may receive is completely dependent on the policy that you have chosen. It is crucial that you review your current policy to ensure that it provides coverage for your newborn baby; if not, switching to a policy that does provide coverage could be the best possible plan.



Megan has extensive experience writing about health and life insurance in Australia. Megan has a special interest in health and wellness. She relies on her background in counselling psychology to convey the latest findings in a manner that is most beneficial to ComparingExperts readers. In every article she writes, Megan aims to uphold the standards of the Private Health Insurance Intermediaries Association (PHIAA) which ComparingExpert is part of.

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