Health Insurance for Pregnancy

When it comes to Hospital Cover, generally only Gold Policies – or the rare Silver Plus Policy – cover pregnancy. When it comes to Extras, you have more freedom to choose your own pregnancy adventure. Prenatal classes? Acupuncture? Remedial massage? It’s up to you.

No matter what your plans are, the time to get Pregnancy Cover could be now. That’s because once you’re already pregnant, it’s a little too late. Generally, there’s a 12-month waiting period before you can claim pregnancy treatments on your Private Health Insurance. A good rule of thumb is to get your insurance sorted six months before you conceive, so your bundle of joy is born safely outside the 12–month waiting period, once you’ve locked in your obstetrician and hospital of choice.

Having a baby in a private hospital can be expensive. For this reason, it’s important to understand your coverage before choosing a policy. As well as your chosen excess, you might be expected to pay for all or some of: 

• your hospital fees 
• check-ups with your obstetrician 
• visits to a paediatrician 
• ultrasounds. 

The good news is that some of these costs can still be covered by Medicare. There’s also potentially a gap between what a treatment costs and the cost it has listed on the Medicare Benefits Schedule. Unless your provider has a gap cover agreement with the hospital you choose, you’ll probably need to pay that too. 

The definition of Pregnancy Coverage is pretty literal: It insures your pregnancy and birth, but not your child once they’re born. To make sure your baby’s covered, you’ll need to investigate the options under Family Cover. 

Timing is also important here. Many providers ask you to upgrade your Health Insurance to a Family Policy three months before your baby’s birth. But some expect you to upgrade as much as a year in advance. So it’s worth checking directly with your fund. 

The Private Healthcare System divides its Hospital Cover Policies into tiers – Basic, Bronze, Silver and Gold. Each tier has the same minimum treatments it has to cover, no matter which provider you choose.  

You’ll find treatments related to pregnancy and birth in a category called, you guessed it, ‘pregnancy and birth’. Treatments like IVF are in a different category, ‘assisted reproductive services’.  

Any Gold Plan covers both of these categories, while the lower tiers generally don’t. A ‘plus’ plan, like Silver Plus, contains the minimum treatments for its tier plus some additional ones. If you’re looking at Silver Plus, you’ll want to check whether it includes both ‘pregnancy and birth’ and ‘assisted reproductive services’. 

Even if you’ve got Hospital Cover that includes assisted reproductive services, keep in mind that you might have to serve a 12-month waiting period before accessing treatment, and you’ll likely still have significant costs. 

Yes it does, as long as you’re covered for pregnancy and birth. That doesn’t mean you’ll have no out-of-pocket costs, though. Like with any treatment, there could be a gap between the cost of the treatment and what your insurance covers. 

If you’re on a plan with unrestricted cover for pregnancy and birth – that is, generally a Gold Plan – it will cover a broad range of treatments related to being pregnant and giving birth. Some treatments that might seem related, like fertility treatments, treatment of reproductive conditions and termination of pregnancy, fall under different clinical categories. But here’s the good news: if you’re on a Gold Plan, those clinical categories are covered too.

Yes, some Extras Policies have coverage for a range of classes related to labour, birth and being a new parent. Not every Extras Plan covers classes, so if it’s something you’re interested in, it’s definitely worth doing your homework (or getting in touch with us for some help!).

Yes, you’ll be covered for treatments related to being pregnant with and giving birth to twins or multiple babies. Keep in mind, though, that when you’re having multiple births, at least one baby will be formally admitted to hospital, which makes it more likely you’ll have baby-related hospital costs. Your newborns won’t usually be included in your Pregnancy Cover. To make sure they’re covered for any treatments they need, you’ll need to switch to a Family Policy, sometimes as long as a year before they’re born.

Whether you’re looking for Hospital Cover, Extras, or both, figuring out which policy is right for you can be overwhelming. That’s where we come in! Give us a call on 1800 784 772 and our friendly team of comparison experts can help you find a policy that matches your priorities. Or if you’d rather sort it out online, you can do that in just a few clicks.