What kind of health insurance do you need if you are having a baby? It’s a big question and will require you to ring around health insurance companies about the plans they offer – though here are some points to consider before those phone calls.
If you are planning on starting a family or growing a family it is a good idea to make sure you have enough private health insurance to cover your medical bills and quality of care. This should be done well in advance, as private health insurers have waiting periods of 12 months on pregnancy covers before you can enter hospital be covered for expenses (in most cases).
Why do you need private health insurance if you are having a baby?
A study conducted by the Medical Journal of Australia found a number of benefits for babies (and mothers) who were born in private hospitals
- Babies were less likely to need resuscitation or admission to intensive care
- Women who gave birth in public hospitals had twice the rate of perineal tearing (measurement of trauma to the perineum during childbirth)
- Babies born in public hospitals had lower Apgar scores (indicating possible health problems)
- In private hospitals neonatal death rates were 1 in 1000 compared to 3 in 1000 in public hospitals
What does private health insurance cover for pregnancy?
If you have private hospital cover is will insure your choice of private hospital and doctor. It should also cover hospital accommodation, costs of labour ward, delivery room or birth centre, surgery related expenses if this is needed, medical costs such as fees for doctor, obstetrician, anaesthetist and paediatrician, costs of drugs and other therapies which may be associated with your delivery.
You should also investigate whether assisted reproductive services such as IVF can be covered which can be costly procedures (these services may have longer waiting periods).
Other things to consider
Make sure you check with your insurer that your hospital and doctor choice is covered.
There are some costs that may not be covered which you need to investigate. This may include medical services incurred outside of hospital such as obstetrician check-ups (can be claimed on Medicare).
There also may be a gap on medical services. The health fund and Medicare cover the equivalent of the Medicare Benefits Schedule Fee but the reminder is your own expense.
Depending on your policy you will usually have to pay an excess or co-payments for admission to hospital.
In most cases your baby will not be admitted to hospital as a patient unless complications arise. Before you leave though, you need to have a pre-release check-up done by the hospital paediatrician. The fee for this cannot be claimed on your private health insurance when the baby has not been admitted. It can be claimed on Medicare but again there is usually a health insurance gap you will have to pay.
Covering your baby
You should make sure that around 2-3 months before the birth of your baby you upgrade your health insurance from single or couple cover to family or single parents cover, to make sure they are covered under your health insurance from the time of their birth. This ensures that if complications arise and you baby has to be hospitalised you will have appropriate cover. Make sure you check with your insurer as some may require you to upgrade your family cover much earlier.
Make sure you investigate different health insurance providers and what they cover/do not cover. Before you have your baby ask them questions on what is covered, which hospital/doctor you can use and any other conditions. Also get their help providing you with information on any out of pocket expenses that may occur so you can plan before the birth. Also remember the waiting period and make sure that you get cover ahead in preparation.