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Private health insurance and pregnancy

4-minute read

In Australia, care in a public hospital or birth centre is free because it is covered by Medicare.

However, if you want to have private obstetric care in a private or public hospital, you will either need to pay for it yourself or take out a private health insurance policy for yourself and your newborn.

When should I take out a health insurance policy?

For most health insurance policies, there is a 12-month waiting period where you can’t claim any pregnancy-related expenses.

So if you want private obstetric care during your pregnancy, you will need to take out private health insurance or upgrade your existing policy well before you get pregnant, or pay for it yourself.

If you become pregnant with your first child, you may need to speak to your insurance company about having family cover.

What do I need in a health insurance policy for pregnancy and birth?

It's a good idea to check with the hospital, your fund and your doctor before booking with a hospital to ensure you will be covered and to discuss any costs you may have to pay.

Some policies don’t cover obstetric or midwifery care. Many of the lower cost policies don’t cover obstetrics, or pay restricted benefits that will only cover you as a private patient in a public hospital. If you’re planning a pregnancy, check to see that your policy covers these areas and whether your child is automatically covered after the birth or if you need to change to a family policy.

Will my policy cover the new baby?

It’s important to ensure your baby is covered from birth in case they need immediate hospital care.

Check with your fund to ask about their rules about covering newborn babies. Most funds require you to upgrade your policy to a ‘family’ policy 3 months before the baby is born, but some require 12 months’ notice.

What if my baby is unwell or premature?

Specialist nursery care is available in private hospitals for any baby who is unwell or any baby born between 32 and 37 weeks of pregnancy. Your baby will be charged separately for their nursery care, in addition to the charges for your hospital stay. Check with your health fund to see if your baby is covered.

Babies who are very premature (born before 32 weeks of pregnancy), and those who are very unwell, are transferred to a Neonatal Intensive Care Unit (NICU) in large public hospitals and the costs are covered by Medicare. If you go into labour before 32 weeks, you will usually be transferred to give birth in a large public hospital where your baby can receive specialist care as soon as it is born.

What if I am having twins or triplets or more?

If you have a multiple pregnancy, you will be charged for the care of at least one of your babies in hospital. Check with your health fund to see how many of your children are covered.

What are my out-of-pocket costs?

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

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

However, some of these costs can be claimed on Medicare. For more information, check with your insurer and ask your hospital or visit the following websites:

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

You can receive very good antenatal care and have your baby in a public hospital or birthing centre, covered by Medicare. If you’re not covered by insurance and you want to go to a private hospital, you will have significant 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.

More information

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

Learn more here about the development and quality assurance of healthdirect content.

Last reviewed: March 2020

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