Private Health Insurance and Obstetrics

As a private specialist, this choice is something that many of my patients value. It means that I am able to be their dedicated obstetrician throughout the pregnancy journey and so that in most cases, they can see a familiar face each time they need specialist obstetrics care pre and postpartum. This continuity of care can be very comforting through what may be a stressful and emotional time.

Going through the private system does come with higher costs but some of these may be able to be covered by your private health insurance.

Planning ahead with pregnancy cover

Basic hospital cover with private health insurers in Australia rarely provides any pregnancy and childbirth benefits so if you’re planning to use your private health insurance and go through the private system, you will need to understand your insurance in more detail.

Australian health funds also have a 12 month waiting period for obstetrics – which means that you need to have held the level of cover you want for pregnancy and childbirth well before you’re admitted to hospital.

Understanding your private health cover for obstetrics

In 2019, the Australian Government introduced a range of reforms which means that all hospital covers are now categorized into Basic, Bronze, Silver and Gold with minimum requirements of what it needs to include. You can find an overview of in this Department of Health fact sheet.

When it comes to obstetrics, it is important to note that pregnancy and childbirth benefits are only a requirement for Gold tier hospital covers but that does not mean that your health insurer cannot offer some benefits as part of your Bronze or Silver cover. In fact, many of the major insurers have pregnancy “add-ons” that can be combined with other tiers of hospital cover.

Even though it can be tedious, the best thing you can do is review the PDS for each policy or speak to the insurers themselves to understand what is covered, how much is covered, and what isn’t covered.

What else might I need to consider?

Private health insurances won’t cover every single possible cost that is associated with antenatal and postnatal care. What you want and need during from your pregnancy care and health insurances is also going to differ from other people. Some of the major things to consider when looking at private health insurance for obstetrics include:

• Assisted reproductive services – if you experience fertility issues when trying to conceive, you may need the help of assisted reproductive services like IVF which are not included in general pregnancy and childbirth cover
• Cover for your baby – your pregnancy and childbirth benefits may or may not include the costs of medical treatment for the baby after birth. You should check with your private health insurance provider what is included in your cover.