Baby Hints & Tips

Private Health And Child Birth – What’s Covered and What If Something Goes Wrong?

PLEASE NOTE: this article is not financial advice. Please speak to your financial advisor or private health care provider with direct questions related to insurance cover for your family.

There are limits to private health and child birth, just like any other insurance policy. If you are taking out private health cover for your pregnancy and soon-to-be born baby, there’s a lot you need to know before you commit. Arranging private health insurance for your baby as soon as you find out you are pregnant will still have limitations as to what you can claim for.

Private Health And Child Birth


It is vital to understand what is covered with private health and child birth before you commit to an insurance policy for your pregnancy.

The following information is a guide. It is strongly advised that you speak to a qualified professional related to your individual insurance needs.

Child birth care providers and places

As an Australian, you are entitled to free birth care in a public hospital because pregnancy and child birth is covered by Medicare. However, there are alternatives to the public system if you prefer private obstetric care for your child’s birth.

  • Public hospital – A public hospital will offer both private and shared rooms for recovery after the birth of your baby. Care in the lead up to your child’s birth can be via your GP or the hospital’s midwives and obstetricians.
  • Birth centre – Birth centres are often associated with lower-risk pregnancies when minimal medical intervention is required at birth. Care at a birth centre is provided by midwives and only when complications arise would you be transferred to a public hospital.
  • Planned homebirth – Homebirths are only available in certain states. This option is usually reserved for women who require minimal medical care, with midwives and doulas on hand to support you at the time of birth
  • Private hospitals – Should you take out private health for child’s birth, you have the option of birthing at a private hospital. Private hospitals for child birth would require pre-advanced planning and you would choose one private obstetrician to support your birthing journey.

The types of birth care in the private and public system will differ from state to state. Some private obstetricians use public hospitals whereas others may only attend private birth centres and clinics. Discuss the best options for the birth of your baby with your local GP first and contact your health insurance provider well in advance to establish what is covered should you choose to go private.

When should you arrange private health cover for your child?

If you are taking out private health cover for your child’s birth, be aware of your insurance policy’s conditions.

Some private health care providers will have waiting periods. What does an insurance waiting period mean? That claims on an insurance policy cannot be processed before a certain period-of-time after you initiated your cover. Typically, private health insurance will require a 12-month waiting period for pregnancy and child birth cover. This means you ought to consider taking our private health cover for your baby prior to falling pregnant. Consider this if you are trying to conceive and would prefer to birth at a private hospital.

Should you choose to opt for private obstetric care during your pregnancy and child birth, ask your preferred insurance provider about the options available for family cover. Make these enquiries as soon as you know you would like to start a family.

Private health insurance cover for your unborn child

Usually, private health policies will require you to list your baby on your insurance policy prior to the birth in the event of a high-risk situation or complication.

A healthy baby may be added on to your policy after he or she is born. However, for high-risk situations it would be necessary for a baby to be listed prior to his or her arrival otherwise you may not be able to claim on your policy.

An example of this would be when a newborn baby arrives early and is admitted to a special care unit. Your private health fund may not cover the costs if you have not previously listed your baby on your family’s insurance policy.

It is unfortunate and probably not something you want to think about, but sometimes things can go wrong with pregnancies and child birth. It is important to know that claims on private health and child birth are very difficult (sometimes impossible) to claim for when complications occur without adequate medical insurance cover.

Premature babies born before 32 weeks

Special care for premature babies (those born before 32 weeks) or babies who are very unwell are generally transferred to a special care unit. A baby arriving before 32 weeks will be transferred to a large hospital’s Neonatal Intensive Care Unit (NICU). The cost of a baby’s care in a large hospital’s NICU will be covered by Medicare.

Premature babies born between 32 – 37 weeks

If a premature baby arrives between 32 and 37 weeks, there are special care facilities available in private hospitals, but such care will incur fees. Your private health insurance cover for your birth and child’s may only come into play if you have organised your private health fund to cover your baby prior to his or her birth.

Upgrading your insurance cover for private health and child birth

Private health cover is not limited to child birth, so you may already have access to health insurance. That said, even if you already have private health cover in place, it is it important to discuss upgrade options with your provider to include your baby. Make enquiries with your insurance provider as soon as you decide to start a family. Then you know your options prior to conceiving and understand what you need to do to make sure your pregnancy and birth is covered by your private health insurance provider.

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