Pregnancy insurance

Not sure if you might use a private obstetrician for your birth? Is there a possibility that you might prefer a private hospital? Don’t leave it too long to decide. If you choose either option, you’ll probably need private health insurance to cover your pregnancy and birth – and you can’t make that decision at the last minute.

“You need to think about it in advance, and know what model of birth care you want,” says Ann Robertson, spokesperson for the Royal Australian and New Zealand College of Obstetricians and Gynaecologists. “Check any existing policy you have to ensure you’re covered.”

In fact, says Suzanne Still, chief executive for HICA (Health Insurance Consultants Australia), waiting periods for obstetrics-related services can vary from private health fund to private health fund and may be anywhere from 12 months to three years. “You must check the waiting period to ensure you have served your waiting period for your policy before the baby’s due date,” she says.

What does your insurance cover?

It’s also important to understand what you are covered for should you choose a private obstetrician in a private hospital. “When admitted, you expect to be covered fro the accommodation, the labour ward, the delivery suite fee and the obstetrician,” says Still. “In the case of a caesarean section, there is typically an additional theatre fee. If your baby is healthy, her or she is not admitted and there will be no charge for the baby if all goes well. But if there’s even a touch of jaundice, the baby is admitted and incurs costs.” Check that your private health cover includes any additional services that you or your baby may require in the event that something goes wrong.

All in all, it can be an expensive business. “The minimum charge, assuming an uninsured woman who is admitted to a private hospital and in a shared room, with all going well, is around $6300,” says Still. “That’s four days at $700 for accommodation, a delivery suite fee of $1000 and a private obstetrician at around $2500.” Of course, a slight deviation from that plan incurs costs, and some hospitals charge a lot more for accommodation.

Technically, it should all be covered by private health insurance, but policies differ so widely, it pays to read the fine print, or to talk to a professional broker service such as HICA (hica.com.au) or iSelect for advice. Check with the broker to see how many funds and/or policies they represent before you begin to ensure you are getting the benefit of a wide variety of options.

“It’s important to focus on ‘the gap’ between the scheduled fee and what you’re actually going to be charged,” says Still. “The Medicare benefit scheduled fee for management of delivery by any means is $443.60. Of that, Medicare refunds $385. All private health funds have to pay the balance ($58.60), but they will also have a policy that pays more. If someone comes to us looking to have a baby, we look for a policy that pays a substantial gap.”

Choosing private heath insurance for your pregnancy

HICA offers the following checklists for choosing health insurance for your pregnancy:

Before you become pregnant

• Make sure your policy includes obstetric-related services – if not, take out, or transfer to one, which does.
• Check the waiting periods
• Check if any access applies to your cover and, if so, consider reducing the excess before you become pregnant.

Once you are pregnant

• Choose your obstetrician and hospital
• Check that your chosen hospital is party of your policy’s “contract hospital” list
• Ask your obstetrician for any specialists involved in your treatment for a written quote of any “out of pocket” expenses you might have. Or if they are participating in the “no gap or known gap” cover scheme.

After your baby arrives

• Add your new baby to your health cover after birth
• Check what post-birth support services are available with your fund.

How much will private health insurance cost?

There are a lot of different policies around, but Still suggests that HICA has policies with no excess (that is, nothing to be paid by you at the time of billing) from around $114 a month, if you require to be covered as a private patient with your choice of obstetrician in any public hospital.

“If you require to be covered as a private patient at top level cover with your choice of obstetrician in a private hospital, HICA has policies with no excess from around $180* a month,” says Still.
Adding an excess to a policy can bring down the premium (monthly payment) while adding benefits and services will increase it.

“You don’t have to get the dearest cover, just make sure you get something that will cover you for what you really need,” says Still.

*Prices quoted are the NSW/Vic base rate and include the 30 per cent rebate.