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Starting a family is one of the biggest steps you can take in life, so it’s important to be prepared for whatever curveballs life can throw at you. That’s why, when it comes to your private health insurance, being aware of the waiting period for pregnancy-related claims is essential before you begin making any big plans. Learn all about pregnancy in health insurance and what you need to know right here with Savvy today!
Be aware of the waiting period for pregnancy coverage
The maximum waiting period for pregnancy-related claims as part of a hospital cover policy is 12 months. This is mandated by the Federal Government, meaning no private health insurer can enforce a waiting period longer than this for obstetrics.
It applies to those purchasing a health insurance policy for the first time as well as individuals and couples who are upgrading from a lower level of cover, such as basic or bronze hospital cover, to one including pregnancy protection, typically gold cover.
It's important to be aware of this waiting period and plan accordingly, especially if you're considering starting your family in the near future, to ensure your pregnancy cover is in place when you need it.
Premature births within the waiting period won’t be covered
It's also essential to understand that premature births, like any other birth, occurring within the waiting period for pregnancy coverage won’t be covered by your private health insurance.
This means that if you give birth prematurely before the waiting period has elapsed, you may be responsible for covering private hospital medical expenses out of pocket or have to go through the public system, which is still a viable option for many parents.
If you're concerned about the potential for premature birth, it’s important to line up the required insurance well in advance of the potential for pregnancy.
Not all IVF and assisted reproductive treatments are covered
Assisted reproductive technology (ART) such as in vitro fertilisation (IVF) is an increasingly popular way to open doors for parents who may find conceiving naturally more difficult.
Indeed, according to a study by the University of New South Wales, one in 18 children born in Australia in 2021 were conceived through ART treatments.
While assisted reproductive services are listed as a minimum requirement on gold hospital cover policies on the PrivateHealth website, not all treatments will be covered by your insurance.
Services which are conducted as an outpatient (that is, outside a hospital setting) aren’t covered by hospital insurance. This means that consultations, ultrasounds and scans performed without you being admitted to hospital won’t be covered.
Additionally, to be eligible for the benefits available under your private health insurance policy, you must serve a waiting period of at least 12 months before your fertility treatment begins.
Switch to a family or single parent policy before you give birth
If you're currently covered under a singles or couples health insurance policy and are planning to start or expand your family, it's important to switch to a family or single parent policy before giving birth.
These policies can provide coverage for both you and your newborn, where they otherwise wouldn’t be under your current policy. By switching to a family policy before giving birth, you can avoid potential gaps in coverage and ensure that your child is covered for a range of medical needs should they arise.
Dependents can typically be added to a family or single parent policy for free, so switching from your previous policy may not end up costing you much more than you were previously paying (unless you’re upgrading your cover).
According to Kate Browne Head of Research & Insights at Compare Club;
“Health insurance is a really complex product and it can be easy to take out the wrong kind of cover, and end up paying for something that won't give you good value. If you are thinking about taking out private health insurance one the best ways to make sure you are getting the cover that you need is to speak to a health insurance expert who can not only run you through a range of options and insurers as well as explaining what the waiting periods will be and what you can expect.
And don't be afraid to ask lots of questions - not only of your health insurer but of all the specialists you are seeing, having a baby can be an expensive exercise so it's good to know what kind of costs you are in for so you can get prepared financially and emotionally well before the time comes.”
Hospital cover waiting periods don’t need to be re-served on new policies
When switching health insurance providers, it's important to note that waiting periods for hospital cover generally don’t need to be re-served on new policies. This means that if you've already served waiting periods for hospital treatment under your current policy, you won't have to serve them again if you switch to a new one.
However, waiting periods for new or upgraded services will still apply, so it's essential to review the details of your new policy carefully. Additionally, if you’ve taken a significant break in your coverage, your insurer may require you to re-serve your obstetrics waiting period.
Private health insurers set their own extras waiting periods
Extras cover, which includes services such as antenatal and postnatal classes, psychology and physiotherapy, comes with waiting periods which can be set by private health insurers. This means that waiting periods can vary between insurers and may differ depending on the specific service being claimed.
When purchasing extras cover, it's essential to review the waiting periods set by your insurer for different pregnancy services so you can be clear on what is and isn’t covered and how far in advance of giving birth you need to lock it in.
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Written by 
Reviewed by
Reviewer
Bill Tsouvalas
Commentary by
Guest Contributor
Kate BrowneFact checked
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