7 questions to ask your private health insurer before you get pregnant

Posted in Pregnancy Health.

Whether you are expecting your first child or hoping to be in the near future, there really is no time like the present to start thinking about your health insurance.

Even if you’re already covered, you may need to consider updating your policy with your current provider or shop around to ensure you’re getting the best coverage to accommodate your growing family plans.

We have put together a quick guide to help you ask the right questions, get the best price and make the most of your coverage.

In Australia, Medicare will cover the cost of your pregnancy and birth care in any publicly-funded hospital, birth centre or homebirth program. But if you want private obstetric care, you will need to pay all costs or have in place a private health insurance policy that covers you for pregnancy.

Important questions to ask before you buy

Before signing up to a health insurance policy, the Commonwealth Ombudsman recommends asking the following questions:

1. Exactly what pregnancy and birth related services (obstetrics) are covered by the policy?

Some lower cost policies won’t cover obstetrics or have restrictions such as only covering you as a private patient in a public hospital. If you do want to deliver your baby in a private hospital and you don’t read the fine print, you could be left with a sizeable bill when you leave the hospital after bub’s birth.

2. Is baby also covered by the policy?

It is important to check the hospital policy you have will also cover dependent children without waiting periods. You want to ensure your baby will be covered from birth in case they need hospital care immediately. Admission to special care nurseries and intensive care units can be very costly but may be required if your baby is born prematurely or with certain congenital conditions. It is also important to check if there are added costs associated with multiple births such as twins or triplets.

3. What excess payments apply for mum and bub?

Some policies require you to pay an excess or co-payment for admissions to hospital for mum and, in some cases, bub so it is important to understand what charges you can expect to pay. Also check what, if any, extra costs apply should you need things such as a c-section or an epidural.

4. What isn’t covered?

Many insurers will boast about all the wonderful things their policy promises you but it is important you are aware of what it does not cover. Some costs not covered by private hospital health insurance include a portion of the hospital fees, specialist consultations and check-ups, and paediatrician visits. Make sure you are aware of these to avoid any unexpected blows to the budget later.

Know the difference between your ‘must haves’ and ‘nice to haves’

With a little bundle potentially entering your life soon, you want the health protection you need without wasting money on novelty extras. Overall you want mum and bub to be looked after before, during and after birth.

This is where it really pays to shop around to find the best health insurance policy catering for you and your individual circumstances and needs. For example, pregnancy massage may seem like a luxury inclusion for some but to others with chronic muscular issues it could be a must. Make a list of what is essential to your coverage needs and look at what you can do without – everyone will be different.

Restrictions, extras and limits to consider

Here are some other important things to consider when choosing the best private health insurance for your pregnancy:

5. Waiting periods

In Australia, all health funds have a strict 12 month waiting period for obstetric services, meaning you need to have held this level of cover for a year before you’re admitted to hospital in order to be covered.

6. Infertility treatment and IVF

Treatments for infertility, including in-vitro fertilisation (IVF), are not automatically covered by policies for natural birth and obstetrics and policies that do include these treatments will only cover certain parts such as hospital admissions. The waiting times to qualify for these benefits can also vary across policies from 12 months to three years.

7. Dental work after pregnancy

When you consider pregnancy hormones can lead to dental problems in some women such as gum disease and increased risk of tooth decay, it is important to know what level of dental cover the policy includes.

How to save yourself money and make the most of your coverage

You might find it difficult to really haggle the price of your health insurance down but there are ways to make sure you are getting the cover you need.

  • Join a health fund with basic hospital cover before your 31st birthday to avoid paying the Lifetime Health Cover loading.
  • Look closely at the fine print and only pay for what you need at this stage in your life.
  • Compare several policies before choosing one. There are companies that conduct bulk comparisons of policies but be aware of their motives for favouring certain providers.
  • Don’t be fooled into thinking you need cover for all the extras offered and be realistic about what you are likely to make claims for.
  • You can lower the premium you pay now if you choose to pay a higher excess or co-payment when the time calls for you to be admitted to hospital.
  • Regularly review your policy because the market is constantly changing.



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