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Private health insurance maternity checklist

03 July 2019 Blog
Starting a family or expanding your family is an exciting time in your life. Pre-planning your private health insurance is vital, to ensure your private health insurance covers your maternity admission. Our General Manager of Health Funding, Strategy and Performance Cathy Ryan shares her checklist of questions to ask your health fund.

Planning a baby

Planning for a baby should include whether you want to purchase health insurance including maternity cover.

It’s an important decision and it needs to be made at least 12 months before your baby is due. By planning ahead and taking out private hospital insurance as early as possible, you will have served any waiting period and need not worry.

If you wait until you conceive before upgrading your insurance, you may find that you will not be able to choose maternity care in a private hospital.

You can still receive care at one of our private hospitals, as a self-funded patient, even if your waiting period is not over or if your private health insurance does not cover maternity care. You will likely have extensive out-of-pocket costs, so it is best to call the hospital direct to find out what to expect.

So what to ask your private health fund?

Are maternity/obstetric services covered in a private hospital on my policy?

This is the most important question to ask. Make sure you are clear if your fund covers you and your baby’s care in a private hospital..

The new health insurance classifications means you should ask the health fund if they have a Gold or Silver Plus product that covers everything necessary so you can have your baby in a private hospital.

If you have an existing health insurance policy, ask if you can add maternity cover.

If your fund asks you for an ‘item number’ (Medicare number), you can quote 16519 or 16520.

Have I served waiting periods for maternity/obstetric services?

You may find that you and your baby are already covered under your existing health insurance policy. 

If you have upgraded your policy then understanding your waiting period is an important question to ask. If you have served your waiting periods, that's great. If not, make sure you write down the date when they will be served. If your waiting periods have not been served, you have significant out of pocket expenses to pay.

Am I on a single, couples, single-parent or family cover?

Your health fund may require you to upgrade your cover to include your baby. If you are on a single/couples cover, make sure to ask when it may be time to consider upgrading to family or single parent cover to ensure your baby is covered as well as you.

Will I have an excess or co-payment to pay for a maternity/obstetric admission?

Knowing this information will give you a better understanding of your out-of-pocket expenses for when your baby arrives. Make sure to write down what your excess is and if there are any co-payments, exactly how much they will be.

If my baby is admitted to a special care nursery for medical care at birth, will I be charged an excess or co-payments apply for my baby to be admitted to hospital?

Again, this is another important question to help understand the possible out-of-pocket expenses that you may incur.

Some health funds have different rules about whether your baby will be covered or not, this is a good question to ask so you have a better understanding when planning out of pockets expenses.or when to make sure you change to a single parent or family cover

Other helpful tips

Change of name

Another very important factor as a privately insured maternity patient to consider is ensuring that your name in consistent in three places:

  • on your Medicare Card
  • on your health fund insurance policy
  • on your hospital record.

If you recently married or have changed your surname, check that your name is listed the same way in these three places.

Choosing a private obstetrician

One of the benefits of choosing a private maternity care, is that you are cared for by one of our obstetricians who is accredited to work at our hospitals. You can choose an obstetrician by browsing our find a doctor search and asking your GP for a referral.

Final considerations

  • Medicare covers the costs of common tests such as an ultrasound or blood tests.
  • Your hospital insurance only pays for services provided while you’re admitted in hospital. You can claim any medical services (such as doctor visits from Medicare. You should ask your specialist for a list of charges so you understand what you can expect to pay and what part Medicare covers. .
  • You may have other out-of-pocket expenses relating to your anaesthetist or paediatrician as well as for medication issued on discharge from hospital. Speak to your obstetrician about any likely charges.
Cathy Ryan - Group General Manager Health Funding, Strategy & Performance
Cathy Ryan is the Group General Manager Health Funding, Strategy and Performance at St John of God Health Care and has more than 10 years' experience in this role.