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Understanding pregnancy coverage under your health insurance

Pregnancy can be a disorienting time for many. The last thing you need thrown into the mix is the complexities of health insurance inclusions. It can be hard to know how pregnancy coverage works under your health insurance – or if you’re covered at all.

We’ve created this simple guide to help you understand the basics of pregnancy coverage.

Do I Need Pregnancy Cover?

Australians are fortunate to have most of their pregnancy costs covered by the public health system. In most cases, public patients will face hardly any out of pocket expenses throughout their pregnancy.

Those who do opt for pregnancy cover under their private health insurance typically do so for flexibility and peace of mind it offers.

What Are The Benefits Of Pregnancy Cover?

Choice of Doctor

A key benefit to pregnancy coverage is the options it offers. Many parents enjoy the security that comes with researching specialists to select who provides their support throughout the pregnancy.

You can then rely on having the same doctor for each of your appointments and during birth. Whereas in Australia’s public health system you will usually receive whichever doctor is available at the time of your appointment.

Better amenities and privacy

Depending on the cover, some policies will allow you to be treated in a private hospital, or even as a private patient within a public hospital. The chance of getting a private room depends on bed vacancies but your chances are far higher with pregnancy cover under private health insurance.

What Isn’t Covered By Pregnancy Cover?

Unfortunately, once your baby is born, they will no longer be covered under your pregnancy cover. Most funds will then require you to upgrade to a ‘family cover’. This is something to consider prior to the actual birth as timing is important. Some covers can require up to 12-months’ notice to upgrade your policy.

Although pregnancy coverage does afford you flexibility and additional cover, it doesn’t guarantee the entire process is taken care of. In fact, private patients often face higher out of pocket costs than public. Depending on the provider and your level of cover, there will still be some out of pocket expenses incurred. These can include

  • Consultations and appointments with specialists
  • Any out-of-hospital care
  • The ‘gap’ on some medical treatments received while in hospital, like a consultation with a paediatrics specialist
  • Any check ups required before you’re released

When Should You Get Pregnancy Cover?

If you’re considering having a baby, it’s best to sort out pregnancy coverage as part of your health insurance as soon as possible.

This is because there is usually a 12-month waiting period on most policies during which you aren’t able to claim any pregnancy-related expenses. In most cases it’s recommended to arrange pregnancy cover at least six months before conceiving. This ensures the final stages of your pregnancy and birth fall beyond the wait period.

Above all else, it’s important to remember that every health insurance policy is different. It’s always best to thoroughly research your provider’s pregnancy coverage in advance to ensure you’re adequately covered.

Sally Writes 05 Dec 2020