Pregnancy and health insurance

One of the first things to do before planning for a baby is to get your private health insurance sorted. If you want access to a private hospital, you’ll need to have held private hospital cover for at least 12 months before your baby is born.

We’ve compiled a list of the most common questions women should consider when they’re researching their options.

What’s the difference between private and public care?

The main differences between private and public pregnancy care are the choice of private hospital, a dedicated obstetrician and continuity of care.

Here’s a look at the essential differences between the two options:

  Private patient Public patient
Waiting period 12-month waiting period No waiting period
Practitioner for antenatal care Obstetrician of choice Obstetrician or midwife – allocated to you by the public hospital
Antenatal appointments Checks-ups in private consulting rooms Check-ups as an out-patient at hospital or with GP (shared care model)
Hospital Private or public hospital of choice Public hospital or birthing centre or homebirth
Room at hospital Private room Shared room (in most cases)
Birth Obstetrician and private hospital midwives Public hospital midwives or community midwives (hospital doctor if necessary)
Length of stay 4-5 nights 48-72 hours
Hospital accommodation (theatre or labour ward fees) Agreement private hospitals covered by private health insurance Covered by Medicare
Out-of-pocket expenses · Doctor’s fees in excess of Medicare Benefit Schedule fee

· Hospital excess (if your cover includes an excess)

· Out-patient appointments, tests and scans (partly covered by Medicare)

· Tests and scans (partly covered by Medicare)

When do I need to organise my private health insurance?

You’ll need to serve a 12-month waiting period from the day you start your private health insurance before you receive any pregnancy-related treatment.

If you already have private health insurance, be sure to check that it includes pregnancy, (or obstetrics) cover. If you’re a Defence Health member you can check the level of your cover right now.

What’s included in the cover?

Generally, private health insurance will cover your private hospital accommodation, theatre fees if you need a caesarean and any pharmaceuticals you are prescribed in hospital. It will also cover your newborn if he or she needs to be admitted to the special care nursery – but remember to add the baby to your policy as soon as possible.  Private cover also tops up the Medicare rebate to cover most (or possibly all) of your obstetrician’s fees.

Private health insurance cannot pay a benefit towards your out-patient appointments – but Medicare will partly cover these charges. Obstetricians all charge different fees. So be sure to ask your obstetrician for a breakdown of the costs for your antenatal care (which Medicare partly covers) and the delivery charge (which both Medicare and private insurance contribute towards).

Which hospital should I choose?

Most pregnant women like to choose hospitals that are nearby and have a good reputation for pregnancy care. You’ll need to choose a hospital that your insurer has a service agreement with to cover 100% of the hospital charges. Defence Health has agreements with more than 500 hospitals all over Australia.   And also make sure your obstetrician has admitting rights to your preferred hospital.

When do I book into hospital?

Once you’ve chosen a hospital and obstetrician, lock them both in and relax. The hospital will send you the paperwork you need to complete and later in your pregnancy you’ll be invited to take a tour and attend antenatal classes.

Do I really need private health insurance?

If you’re unsure if private health insurance is right for you, consider the following questions:

  • Is continuity of care important to me?
  • Do I want to see one doctor, or a variety of different doctors and midwives?
  • Do I want a private room in the hospital?
  • Are there any health concerns that might impact my pregnancy?
  • Is there a specific hospital that I want to go to?
  • How do my previous experiences of pregnancy and birth impact my thinking?

Answering ‘yes’ to just one of these questions suggest you should seriously consider private health insurance. You can get a quote now on our website.

Find out more about private health insurance with Defence Health.

Category: FamilyHealth


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Article by: Defence Health