Pregnancy Health Insurance

A Gold level health insurance policy will provide the cover you need for pregnancy. If you have private health insurance and are pregnant, you have the flexibility to select your obstetrician and hospital. For pregnancy you’ll find that private insurers have policies that cover it. However, there is a 12 month waiting period you’ll have to serve after finding the health insurance that covers your pregnancy.

Pregnancy and private health insurance

If Medicare tends to be your preference, you still might want to sign up for private health insurance to help cover your pregnancy and birth. The way to finding the right coverage for great value is by combining private health insurance with your Medicare to ensure any random scenarios that occur are sorted. Medicare doesn’t offer the benefits for pregnancy that private health cover does, such as:

• Choosing your preferred hospital or doctor. If you are at a high risk of pregnancy-related problems or have certain medical needs it could be a good idea to have a doctor who is no stranger to your health complications.
• Having your own private room. Having a room for yourself can aid in the reduction of stress that comes with pregnancy and normally means your significant other can be in the room throughout the entire birth.
• Some extras. Non-essentials like in vitro fertilisation (IVF), birthing classes and a range of other assisted reproductive services are included in some health insurance policies.

Private health insurance eligibility:

• Taking out a policy ahead of time, generally around 3 months before you attempt to conceive. A 12 month waiting period is what you can expect for obstetric services with most Australian private health funds.
• Ensuring your health insurance policy has your baby on it. There are some policies out there which will only provide cover for the parent and not the baby.
• Upgrading your policy where needed, to a family policy, but make sure to consider the extra costs it may concur.

What areas of pregnancy do health funds in Australia cover?

It is common knowledge that having a baby is expensive so its smart to plan ahead to ensure every area of your pregnancy is covered. If you’re looking for great value, combine your private health insurance and Medicare to provide coverage for anything that may pop up with minimum overlap.

Below are the main aspects of pregnancy that private health insurance covers.

• Things like accommodation in your selected hospital, anaesthetics, theatre fees or pharmaceuticals can be covered by private health insurance.
• You can receive cover for your birth as well as the option to choose your own paediatrician and obstetrician and partial coverage of whatever their fees are.
• Any hospital or medical treatments after birth can be covered by your policy to protect your newborn baby.

Private health insurance costs for pregnancy

Additional expenses are to be expected even if you have a health insurance policy that has pregnancy services:

• Out of hospital medical services. Services like GP visits, antenatal classes (postnatal), ultrasounds, blood tests, obstetrician check-ups and specialist consultations are not normally covered. Besides the antenatal classes, most of these can be partly claimed via Medicare.
• The gap. The difference between what your health fund will cover for in-hospital procedures and the Medicare Benefits Schedule (MBS) is what is considered, the gap. The gap is normally paid by you but there are some funds and policies that will cover it. Asking your doctor if they include “no gap” agreements with your private health fund is a good way to have an overview of your expenses before treatment, this can be done by requesting a written quote from them.
• Co-payments and Excesses for hospital admissions. Co-payments and excesses are costs that you need to pay for. Whether the baby was born healthy or requires postnatal treatments will determine the amount you will have to pay, however it does vary with fund and policy.
• Baby’s check up before being released. Check-ups don’t normally receive coverage; however, Medicare can partially cover some of the costs.
• Insurance for your baby from birth. While your baby is still in hospital most health funds will cover potential bills for this, although, you’d have to pay a bit more for this service and it also has a waiting period (from two to 12 months, depending on what fund you are with).

Are ultrasounds covered by health insurance?

In relation with Medicare, your private health can help pay for a lot of your in-hospital procedures and if a no-gap scheme is something your health fund has, potentially all of the costs can be covered (applicable to a range of hospitals where there are caps on fees). However, for services and procedures outside of the hospital, private health insurance will not provide coverage. There are commonly referred to as outpatient services, which include diagnostic tests like X-rays, special consultations, ultrasounds and pathology. Outpatient clinics are where you would find these services, and can be affiliated with both private and public hospitals.

Private health cover for pregnancy generally involves theatre and labour ward fees, pharmaceuticals, hospital accommodation, birth-related intensive care and 100% of the MBS fee for doctors fees (25% health fund + 75% Medicare). Ultrasounds that are given prior to the birth at the hospital are not covered. Outpatient services like these can be covered by Medicare and are quite frequently bulk-billed. For any outpatient service that is pregnancy-related and is not covered by Medicare, there are a few private health funds that can cover it. For example, you have birthing classes that are covered by certain pregnancy policies yet not by some others.

Can pregnancy be covered by Medicare?

Medicare will cover you for some areas of your pregnancy if you don’t have private hospital insurance, some of these include:

• Part of your antenatal expenses such as partial payments of obstetrician appointments, GP visits, ultrasounds, blood tests and any other specialized tests.
• Partial payment of anaesthetics fees and baby delivery fees as well as some of your other in-hospital costs.
• Partial payment for postnatal health check-ups by your midwife or paediatric check ups can be assisted with.

Medicare provides parental or newborn leave payments for those who are eligible after they leave hospital. The parental leave payment is assistance up to about 18 weeks while you’re away from work looking after the newborn baby. An increase to your family tax benefit is what you’ll receive from your newborn upfront payment.

Are assisted reproductive services and IVF covered?

Gamete intrafallopian transfer and in-vitro fertilisation are two assisted reproductive services that private health funds tend to cover. However, not every fund covers these particular services, and those that do provide coverage normally have a waiting period of up to 12 months before you can make a claim. They can also cover services that involve hospital admission (theatre fees associated with embryo transfer and egg collection as well as accommodation) and those that have a Medicare item number.

Things can start to get very expensive when you’re dealing with assisted reproductive services as they can require several attempts with no real assurance of success. Thus, it is very important to communicate with your fund before enrolling in any GIFT or IVF procedure to ensure that you will be covered for as many costs as you possibly can.

What are the costs for having a baby?

Below is an overview of how much it costs to have your own baby and how much of those expenses are to be paid by you, your health fund and Medicare:

Pregnancy

• Out-of-hospital costs: Obstetrician visits (can be up to $300), GP visits (If not bulk billed, $75-80), ultrasounds (around $150-300), blood tests (around $30-200). 85% of MBS fee is paid by Medicare so you must pay the difference.
• Antenatal classes: There are many free-of-charge antenatal classes at a lot of public hospitals, but there are a few that can incur costs of up to $300, in which case you will have to cover all of its costs.

In hospital

• Public birth: You will be sharing accommodation in a public hospital including midwife-manage birthing centre, maternity clinic and community based midwifery program. Apart from any extra expenses, you will pay very little (around $400 in total).
• Private birth: The average costs for your own private accommodation, specialists, labour ward and theatre fees will be around $8,500. 75% of the MBS fee will be covered by Medicare, and your health fund will cover the remaining 25%, for any extra amounts charged on top of the MBS fee, they will be covered by you (unless of course the specialist doctor you have has a “no gap” agreement included with your selected health fund), and any excess that applies to your police as well as personal costs like pharmaceuticals or meals.

After hospital

• Postnatal care: Midwife visits (from $100-200) and paediatrician visits (from $100-400). 85% of the MBS fee will be covered by Medicare.
• Baby necessities: Cot (can be up to $300+), nappies (you can buy 50 nappies for around $15-35 depending on the quality), pram ($400-1000) and any maternity wear (around $100-200 per item).
• Loss of income: Any Paid Parental Scheme will help partially offset any costs of being reduced to one household income.