Private health insurance and pregnancy
If you're thinking about having a baby – how exciting! Whether it’s your first time or you’re planning to grow your family, preparing for this journey is always a mix of anticipation and big decisions. We know planning for a baby can be overwhelming, exciting and, sometimes, scary – no matter how many times you’ve done it.
Along with deciding what kind of birthing experience you’d like, how many onesies to stock up on, and how long your maternity leave should be, you may need to make decisions about whether the private or public hospital system is right for you, and whether to upgrade your health insurance.
Understanding what different levels of health insurance will and won’t cover, and the pros and cons involved, can make a big difference in reducing stress and ensuring you get the care you need.
Before you have a baby
You’ll probably start planning the type of birth you want as soon as you start thinking about falling pregnant. How you want your baby to arrive in the world – and what happens if that changes on the day – is a good first step when you’re deciding whether private health insurance for pregnancy is the right choice for you.
Waiting periods and eligibility
Most private health insurance policies have a waiting period before you can claim for pregnancy-related services. This is typically 12 months for new members and also for members updating their policy to cover pregnancy.
If you’re already pregnant and don’t have pregnancy cover included in your health insurance, you might not be covered for pregnancy and birth-related services. This is because the 12-month waiting period for pregnancy-related services needs to be served before your pregnancy begins, so it’s suggested you take out pregnancy cover three months before you start trying to conceive, allowing time to complete the waiting period.
Choosing the right health insurance for your pregnancy is a big decision. To get the coverage you need, start by reviewing your current policy and checking if it includes pregnancy care. If it doesn’t, consider upgrading your cover. Don’t worry, the nib customer care team can guide you through the process and help you understand any waiting periods and costs. Contact us to have a chat.
Assisted reproductive services
Assisted Reproductive Services is the application of clinical technology for the purpose of reproduction. There are many types of Assisted Reproductive Services, the most common being IVF, GIFT and ICSI.
It is recommended that you register with Medicare’s Safety Net as it is common for couples on the IVF journey to reach this safety net and become eligible for higher benefits from Medicare for outpatient services.
The member's level of cover, if the hospital is contracted and how much the specialist is charging are all factors that contribute towards determining whether the member will be covered and if there are any out-of-pocket expenses.
There are large out of pocket expenses associated with Assisted Reproductive Services. It is important that a member asks their specialist for an Informed Financial Consent prior to commencing treatment.
How do I know if private health insurance is right for me?
Figuring out if private health insurance is right for you during pregnancy involves thinking through your personal preferences for care, benefits like choice of doctor and hospital and weighing up these advantages against the costs and waiting periods associated with insurance. Are you hoping for a natural delivery in a birth centre with your own doula, or are you thinking you’d rather opt for an elective C-section? These are personal decisions and only you know what feels right for you.
Along with the cost of private cover, you’ll need to factor in the gap between what the policy will cover and the cost of the service.
What’s covered under private health insurance?
Private health insurance for pregnancy typically covers a range of services and expenses, including:
Private hospital accommodation in a private room or birthing suite, sometimes with a bed for a partner, sometimes for a fee.
Access to a private obstetrician for birth in a private hospital and the ability to choose your hospital. If you do go private, you will usually see the same obstetrician for your entire pregnancy. Your doctor will usually refer you to an obstetrician of your choice once you know you’re pregnant.
Maternity services, including prenatal and postnatal care, such as antenatal classes conducted by a midwife for example.
Access to private hospital networks and additional services or amenities not available in public hospitals.
While private health insurance for pregnancy covers lots of things you need, you’ll still need to look after some expenses yourself, such as:
Additional fees charged by specialists beyond the Medicare schedule. For example, some obstetricians charge a Pregnancy Management Fee for managing your pregnancy care. Medicare might cover a small amount, but generally you’ll pay the difference.
Costs of antenatal classes, unless specifically covered by your policy.
Non-Medicare services or treatments.
Out of pocket expenses for medications or special treatments.
Fees for paediatrician and obstetrician consultations are usually considered outpatient costs unless your baby is admitted to the hospital. Outpatient services aren’t typically covered by private health insurance, so these fees may need to be paid out of pocket.
Potential extras like acupuncture or massage therapy during pregnancy, unless they are part of your extras cover on your insurance policy.
Check your insurance policy to fully understand how the policy works, or give nib a call and we can walk you through it.
Managing and minimising out of pocket costs
Having a baby can be expensive, but there are ways to get those costs down. For instance, try to choose healthcare providers within your insurer's network and know your policy's benefit limits to avoid any nasty surprises. Financial stress on top of what’s already an emotional time is the last thing you need.
Letting your doctor know
Don’t forget to let your doctor know early in your pregnancy that you intend to use your private health insurance to cover the cost of your baby or babies’ birth, if you know you’re pregnant with twins (or, dare we say, triplets?).
Booking in with the hospital
Choosing the right hospital is a big decision. While the one closest to where you live seems like the obvious choice, it may not always be the best choice for you. Whatever you decide, book your preferred hospital as early as possible so you can cross it off your to-do list and focus on more exciting things – like shopping for cute outfits for your new arrival and who you’ll invite to your baby shower.
Useful questions to ask your insurer
If this is your first pregnancy, you’re likely to have lots of questions along the way. These are some questions to ask your insurer:
What’s covered during pregnancy and childbirth?
What out of pocket costs can I expect and how can I reduce them?
Are there any restrictions when I choose my own obstetrician?
What if I choose to go public but change my mind?
What postnatal services are covered by my policy?
The better you know and understand what’s covered, the easier it will be to make decisions. Ready to discuss your options? Contact nib.
Please note: The tips throughout this article serve as broad information and should not replace any advice you have been given by your medical practitioner.