Is Private Health insurance for Pregnancy Worth it?

Published: August 12, 2019

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.

Planning to start or grow your family? Get pregnancy cover now!

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:

  • Antenatal classes
  • Hospital parking
  • Obstetric appointments
  • Midwifery fees
  • Ultrasound scans
  • Blood tests
  • Accommodation
  • Labour ward fees
  • Epidural
  • Surgeon and Anaesthetists’ fees (C-section)

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 insurance Between $9,000 and $30,000 $0 to $1,500 with Medicare
Choice of obstetrician and/or midwife Yes. However, your obstetrician might be on leave when you go into labour No. You might also be cared for by junior doctors, who only calls a specialist when needed
Choice of hospital Yes No. You'll have to go to the hospital in the area you reside
Same obstetrician for all your appointments Yes Very unlikely
Adhering to your birthing plan Higher rate of intervention, with private hospitals performing more caesareans Lower chance of interventions, with a higher number of natural births
Waiting times for check-ups and examinations Generally, very short waiting times for appointments Longer waiting times as it's dependent on the availability of the doctor or midwives
Equipped for intensive or specialised care Not 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 hospital Generally, yes
Private room Very likely Very unlikely. Family can usually only stay during visiting hours
Length of hospital stay Usually, up to 5 days Usually, discharged within 1 to 3 days
Meals in the hospital Generally, delicious meals available to you and your partner Depends on the hospital, but might not be as nice as a private hospital
Free lactation consultant Very likely Depends on the hospital
Free nappies/formula and maternity pads Very likely Depends on the hospital
TV to watch Yes, free Generally, 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:

  • Hospital stay as a private patient in a public or private hospital.
  • Gap fees associated with the care received from a private healthcare provider, for example, private obstetricians or midwives.
  • Shared care with a GP that doesn’t bulk bill.
  • Child birthing education classes.
  • Out-of-pocket private hospital expenses, including medicines.

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

  • Choose your obstetrician,
  • Hospital accommodation as a private patient in a private or public hospital,
  • Labour ward fees,
  • Private obstetrician fees during delivery,
  • Fees associated with private midwifery care, including at-home births,
  • Pharmaceuticals administered when in the hospital.
  • You’re more likely to have a private room and/or double bed.
  • Your partner or a family member might be able to stay overnight with you.

Services generally not covered by health insurance

  • Any appointments you have outside of the hospital, for example, ultrasounds and blood test as an outpatient,
  • Checkups with your obstetrician outside of the hospital, before the birth,
  • Some specialist consultations, like a paediatrician,
  • Baby’s pre-release check-up.

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:

  • Being a private patient in a public hospital,
  • Asking your obstetrician for a detailed breakdown of their expenses,
  • Choosing a hospital and obstetrician that uses your health fund’s gap scheme,
  • Shared care with a GP that bulk bills.

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:

  • Ante-natal and post-natal classes
  • Lactation specialist
  • Dietary advice
  • Vaccinations

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

  • Peoplecare Gold Hospital & Premium Extras
  • Medibank Gold Ultra Health Cover
  • CBHS Premium Package (Gold)
  • Nib Top Cover – Gold
  • myOwn Gold Hospital & Top Extras
  • Bupa Ultimate Health Cover – Gold

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.

Frequently asked questions and answers

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.

Request and compare hospital policies that cover pregnancy

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6 Comments

  • worrywort |

    Hi there, I’m in between a rock and a hard place. I and just found out yesterday that I am pregnant. I didn’t think about insurance as I wasn’t planning a family.

    However, everything is different now that I’m 6 weeks pregnant. I’m worried now because private health insurance has the obligatory 12-month waiting period.

    Help, what should I do?

    • SPECIALIST
      Anneke Van Aswegen |

      Hi Worrywart,

      It’s natural to be anxious and you have valid concerns. However, in Australia, you will receive a high quality of care in public hospital and generally, the birth itself will cost you nothing. The fact that you’re planning now will work in your favour.

      You generally have a couple of options for public hospital births, including using the full public system, or the shared care option. If you have a Medicare card, your pregnancy and birth-related costs are covered by Medicare. However, Medicare might not cover the cost of scans and pathology tests outside the hospital, childbirth classed or shared care with a GP who doesn’t bulk bill.

      I suggest you start with some advice from the experts. The Australian Governments offers you 24/7 assistance for all your pregnancy and birthing queries. Give them a call here. Also, have a look at your financial help entitlements here.

      You might still want to apply for private health insurance so that when the 12-month waiting period has passed, and your baby is born you can add him or her to your plan and ensure they are protected.

      Good luck and congratulations.

  • Suz |

    Hi there, I’d like to ask you which health insurer and policy would be the best for me. I do not mind public hospital birthing, because I could organise a bulk billing GP. However, I would like to do a C-section because of my history.

    Can you help me with this? Which insurance would be suitable for me, while also being affordable? I’m in North Shore, NSW.
    Cheers,
    Thanks

    • SPECIALIST
      Anneke Van Aswegen |

      Hey Suz.
      Please note that private health insurance companies generally request you serve a 12 month waiting period before you can access pregnancy and birth-related services. So, if you’re already pregnant you typically won’t have access to these benefits when applying for private health cover.

      However, if you’re only thinking about starting a family, then private health insurance with pregnancy cover allows you to choose your obstetrician, you’ll have access to a private room in a public or private hospital and you can usually select your appointment dates and times.

      With a C-section birth that your doctor has ordered, you’re most probably looking at the surgeon’s fee and cost of the anaesthetist, for which Medicare generally pays for, although, it depends how much they charge, so you might have out-of-pocket costs for which private health cover might be useful. However, if you wanted an elective C-section, meaning it’s your choice and not for medical reasons, you might be looking at higher fees.

      Usually, pregnancy cover is included in the top-hospital packages or combined family health insurance options, which is typically more expensive. Please call 1300 786 328 or a fill in the quote form and a consultant will assist you with your decision.

  • Bexxy |

    HELP! After a very traumatic experience with my son who at birth was transferred to another hospital and very nearly passed with six weeks in the NICU on a ventilator and major operation at 4 days old, we have finally decided that we are ready to have another baby.

    I took out cover 3 months ago and was initially on a policy with CBHS (through my work) that had restricted pregnancy and birth cover – after taking out the policy I went through compare the market to make sure we were getting the best value and was advised that they could offer the same cover at a cheaper price with NIB. I even went as far in the call to explain what had happened and the trauma that we had experienced and named the public hospital that I needed cover to be a private patient with a chosen OB (that we will pay $5500 out of pocket for).

    I have now found out just as we have started trying to conceive that the cover is actually not of an equal level and does not have the restricted pregnancy and birth cover that my other policy did. I escalated a complaint with NIB and they have sided with compare the market.

    Can you help me with what my options are here? I am 40 and don’t have time on my side and conscious of the changes in hormones and fertility in six months (my GP has reminded me of this)

    Is this something that the Ombudsman would assist with?

    • SPECIALIST
      Anneke Van Aswegen |

      Hi Bexxy. I’m sorry to hear about your frustrations.

      The Private Health Insurance Ombudsman generally recommends that you should try to resolve the complaint with your health fund first, before contacting them. You can find nib’s Feedback and Complaints page here.

      Take note, if you did not have pregnancy cover before and upgrade or change to a plan that includes it, you generally have to wait 12 months before you can claim on this benefit. So, you generally want to get pregnancy cover 3 months before becoming pregnant.

      Best of luck.