Private health insurance and pregnancy

When should I take out a health insurance policy?

Most private health insurance policies have a 12-month waiting period. During this time, you can’t claim any pregnancy-related health expenses.

If you want private obstetric care during your pregnancy and birth, you will need to do one of the following:

• take out private health insurance with relevant cover, 12 months before you are pregnant
• upgrade your existing policy 12 months before you are pregnant
• pay for your care yourself

What should I look for in a health insurance policy for pregnancy and birth?

It's a good idea to check with the hospital, your doctor and/or midwife before taking out private health insurance, to ensure you have the cover you need, and so you understand any costs you may need to pay.

Check the health insurance policy carefully, as some don’t cover obstetrics, midwifery, or may only pay restricted benefits that will only cover you as a private patient in a public hospital.

Will my policy cover the new baby?

It’s important your baby is covered from birth in case they need immediate hospital or other medical care.

Check with your fund about their rules for covering newborn babies, and ask if your baby will automatically be covered after the birth or if you will need to change to a family policy.

Some funds ask you to upgrade your policy to a family policy 3 to 12 months before your baby is born.

What if my baby is unwell or premature?

Your baby will be charged separately for their nursery care, as well as the charges for your hospital stay. Check with your health fund to see if your baby is covered.

Babies who are born premature, and those who are very unwell, may need care in a Neonatal Intensive Care Unit (NICU) in a large public hospital. If you’re a public patient in a public hospital, most costs would be covered by Medicare. If you’re a private patient and have a preterm baby within your health insurer’s waiting period, your baby may not be covered for costs. This is another reason to consider your level of private health cover ahead of time if you can.

What if I am having twins or triplets or more?

If you are expecting a multiple pregnancy, you will be charged for the care of your babies in hospital. Check with your hospital about the costs to expect with multiple births and with your private health fund to see what costs are covered.

If you’re expecting twins or more, there’s a higher chance they could be born prematurely. Some multiple births involve care in the NICU for days or weeks.

What are my out-of-pocket costs?

Some costs are not covered by private health insurance. These may include:

• specialist consultations and check-ups with your obstetrician
• a portion of the hospital fees
• paediatrician visits

Some of these costs can be claimed on Medicare. For more information about out-of-pocket costs, check with your health provider, your insurer and hospital staff. You can also visit the website of the Commonwealth Ombudsman.

What happens if I’m pregnant but I’m not covered by my health insurance policy?

You can receive very good care in a public hospital or birthing centre, fully covered by Medicare. If you’re not covered by private health insurance and you want to go to a private hospital, you will have high out-of-pocket costs. You will be able to claim back part of the cost of care from a private obstetrician or eligible midwife from Medicare, but you will need to pay all hospital costs.

Where can I find more information?

The Private Health Insurance Ombudsman has more information about private health insurance and can help you to compare policies.

Speak to a maternal child health nurse

Call Pregnancy, Birth and Baby to speak to a maternal child health nurse on 1800 882 436 or video call. Available 7am to midnight (AET), 7 days a week.