Pregnancy is an unpredictable time, and even when your baby is born there can be complications that require medical attention. It might be worth considering private health insurance for pregnancy to help you pay for a higher standard of medical care for yourself and the adorable new addition to your family.
The Best Health Insurance For Pregnancy
Our guide distinguishes between public versus private healthcare for pregnancy and maternity services, to help you find the right health insurance and avoid paying out-of-pocket expenses for unexpected costs.
What is pregnancy health insurance?
Pregnancy health insurance is one of the best ways you can responsibly off-set the costs related to pregnancy and birth. The details of what is covered differ between health cover plans, but generally, health insurance will cover some or all of the costs associated with hospital accommodation and your doctor’s fees.
Take note: Private pregnancy health insurance plan will not cover any medical costs for your baby once he or she has been born. To receive private cover for any hospital treatments and services for your baby after the birth, you must take out family health insurance.
If you upgrade to family cover within a specified period, then many health funds will give you a buffer of a few days or even weeks during which time the baby will be covered. These time frames differ between health funds, so make sure to ask your insurer.
Considering this 12-month waiting period, it might be more beneficial to get health cover that includes pregnancy at least three months before planning to become pregnant. However, you can still get health insurance during your pregnancy, but you will only be able to claim for treatments and services included in your policy.
For example, if you were to fall and injure your arm while pregnant, then treatment to heal your arm is covered. However, if you visit your obstetrician to check that your unborn baby is fine and the waiting period is still in effect, you will be responsible for those costs.
Switching health insurance during pregnancy
Switching health insurance during pregnancy is possible. There are no “lock-in” health insurance contracts, meaning you’re 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 that is of the same or a lower level of benefit.
However, if you’re pregnant and switching to another insurer and decide to include services that weren’t included in your old cover or increase your annual limits, then you’ll need to serve the waiting periods applied to those new services before making a claim.
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Pros and cons of private health insurance
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What does private health insurance cover for pregnancy?
Private health insurance covers a range of hospital costs related to your pregnancy and birth, which can protect you from various out-of-pocket expenses. It can also give you more options when it comes to your pregnancy and birthing care.
Pregnancy health insurance generally meets some or all the following costs that are not covered by Medicare:
- Gap fees for private obstetricians, private and eligible midwives, or your doctor caring for you during pregnancy.
- Out-of-pocket private hospital expenses, including medicines and prenatal classes.
- Obstetricians’ fees for pregnancy care prior to birth.
- Obstetricians’ fees during delivery.
- Fees associated with private midwifery care for you during labour and at-home births.
- Delivery suite costs for the birth.
- Hospital stay as a private patient in a private or public hospital.
The cost of pregnancy without private health insurance
Without private health insurance, the cost of private hospital pregnancy care and birth can range anywhere from $9,000-$30,000, although this varied depending on you and your baby’s medical needs.
The cost of pregnancy, without private health cover:
- Obstetric appointments and delivery, costs can range from $2,000 to $10,000, depending on where you live and how many appointments you have.
- Hospital accommodation after you have given birth.
- Some tests and ultrasound scans.
- Birthing (antenatal) classes.
- Paediatric appointment to give your baby a health check.
- Anaesthetists’ fees, for instance, if you have an epidural or a C-section.
Health insurance after pregnancy
There are several costs you can expect to pay after your pregnancy, and it’s important to consider this when looking at pregnancy cover. For instance, your paediatrician will conduct a pre-release check-up before you, and your baby can be discharged from the hospital.
If your baby has been admitted as an in-patient, then the cost of this consultation will be covered by your health fund. However, you can only admit your baby as a patient if he or she is covered by the appropriate health insurance policy.
It is because of reasons like these that you might want to consider taking out a family or single parent family health insurance policy. Not only will you be able to give your baby the best medical attention they deserve, but you’ll also get to enjoy low medical costs in the years to come. In future, your child might need braces, a speech therapist, or physiotherapy if they get injured playing sports.
Compare the best health insurance companies for pregnancy
The only way to determine the best health insurance for your pregnancy is to compare the top companies and see which one offers the right cover for you at the most affordable price.
Note: Premiums below were calculated on 2017 using privatehealth.gov.za
Ways to save on your pregnancy cover
To avoid any expensive and unexpected costs involved with having your baby, you should check with your health insurer and carefully read through your policy documents. For example, most private health insurance pregnancy policies do not cover out-of-hospital appointments and costs, like obstetrician appointments or antenatal tests and screenings.
How to save on your pregnancy costs:
- You can reduce out-of-pocket costs by choosing to be a private patient while having your baby in a public hospital.
- What you pay out-of-pocket will vary between health insurers and your choice of health care provider. It’s thus a good idea to consider gap cover when comparing pregnancy insurance policies to reduce these expenses.
- Save money by choosing a GP that does bulk-billing. Your pregnancy care is then divided between the local provider and the hospital. If you’re eligible for Medicare and your GP bulk bills, then you won’t have any out-of-pocket costs.
How to share care with your GP and reduce costs:
Many women prefer this option because it gives them the opportunity to use their own GP, with whom they feel comfortable and knows about their medical history.
- First, make sure that your GP and hospital participates in shared care.
- 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 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.
FAQs about health insurance and pregnancy cover
Yes, you can get travel insurance while you are pregnant. Many travel insurance companies, including Columbus Direct Pregnancy Extension and Travel Insurance Direct, provide cover for up to 24 weeks, and some even extend this to 32 weeks, like Tick Travel Insurance and Insure And Go.
The premiums for these policies are higher, and you might have to apply for a special level of cover because during pregnancy you are at a higher risk – especially in the later months.
Generally, travel insurance won’t cover the costs of normal pregnancy or childbirth while you’re overseas, but you might be covered for some unexpected medical complications, including:
- Premature delivery
- Extreme vomiting
- Emergency caesarian section
- Miscarriage or stillbirth
Yes, usually it is safe to fly while you are pregnant. However, before booking your ticket, check with your healthcare professional that you can do so and make sure that you have travel insurance that will cover pregnant travellers. Some airlines require a signed letter from your doctor, stating that you are fit to travel.
An airline might restrict you from flying if:
- You’re pregnant with twins, triplets, or more;
- You conceived using IVF or had other fertility assistance;
- You experienced any complications during your pregnancy;
- You have any pre-existing medical conditions; or if
- You have a history of pregnancy complications or premature birth.
Yes, your existing policy will cover you for obstetrics, but only if your health fund already includes pregnancy. If you are pregnant and don’t have sufficient cover, you can upgrade to a family policy. However, you will have to serve the mandatory 12-month waiting period before you can claim on services and treatment.
Yes, Medicare does cover certain aspects of pregnancy. For example, you will receive free accommodation and treatment in a public hospital, free (or subsidised) treatment from healthcare professionals, including obstetricians, doctors, and eligible midwives, as well as subsidised tests and ultrasound scans.
However, Medicare doesn’t cover hospital stay as a private patient in a private or public hospital. They do not cover any gap fees for private obstetricians or private midwives, or out-of-pocket private hospital expenses, including medicines.
Yes, many private health insurers will cover fertility treatments, like IVF. These treatments are usually partially or wholly covered under comprehensive health policies. However, if you took out a new policy or upgraded to a policy that includes cover for fertility treatments, you’ll have to serve a 12-month waiting period before claiming on fertility treatment and services.
The only way to ensure that your partner can stay with you while you are in hospital is in a single, private room in a private hospital. Either you will pay for this, or it is covered under the private health insurance policy that you have selected.
Before choosing a health insurance provider, you might want to compare other top health funds to determine which one will provide you and your baby with the best cover at the best price.
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