Finding out you’re pregnant, and preparing for a baby, is an exciting and intense time. Amongst the excitement, though, practical and financial decisions need to be made, such as suitable health insurance. Understanding your pregnancy and birth cover  is important in planning your pregnancy journey. This factsheet explains HCi pregnancy cover and how it may help with some of your expenses.

Pregnancy related services are not included for extras and other hospital cover. So, we recommend checking your policy for pregnancy cover before pregnancy, where possible.

You can view full Product Summaries in our resources section or contact us to discuss upgrading your cover.

Why have pregnancy cover?

Health insurance for pregnancy and birth (obstetrics) gives you peace of mind. It can provide important financial support throughout pregnancy, delivery, and any related hospital treatment whilst giving you more choice over your care.

Hospital cover including pregnancy gives you

• more hospitals to choose for the birth
• a private room in hospital (subject to availability of course)
• an option for specialist care rather than a GP or midwife
• choice of obstetrician for continuity of care
• a potentially longer stay in hospital after the birth.

Waiting periods for pregnancy cover

To be eligible for obstetrics and pregnancy cover, you need to have had appropriate hospital cover for at least 12 months prior to your hospital admission for the birth or a pregnancy related treatment.

Waiting periods apply for planned caesarean (C-section), induced labours, miscarriages and terminations, as well as spontaneous births.

So, we will not pay any pregnancy related claims for treatments carried out before the 12 months waiting period is finished. If you’re unsure of your eligibility, please contact us before going to hospital.

When baby arrives early

It is important to note that waits apply to the date you are admitted to hospital, not your due date. If the baby is born within 12 months of cover starting, claims will not be paid regardless of when the baby was due.

Likewise, admissions for pregnancy related conditions are only covered if waits were served prior to that admission.

What is covered for pregnancy?

HCi hospital cover (Gold or Silver Plus Advantage) may help with eligible inpatient hospital costs. This can include:

• accommodation and hospital staff costs
• delivery suite and/or theatre fees
• medications and supplies used during labour
• obstetrician and anaesthetic (if required) fees, up to the Medicare Benefit Schedule amount

HCi extras cover may help with costs of physiotherapy, optical care, dietary advice, podiatry help, remedial massage, and dental care during pregnancy, although not specifically for pregnancy. Medically necessary aids^ such as custom made pregnancy related compression garments and a TENS machine, may be covered under some extras policies.

Important notes:

• Standard waiting periods and pre-existing condition rules apply.
• Excess payments may apply if this is your first hospital admission for the calendar year– call us or log into OMS to check your excess.
• Out-of-pocket costs may still arise (eg if your provider or hospital doesn’t have an agreement with HCi or charges above the Medicare schedule).
• The hospital will generally bill us directly, so you won’t need to make claims. If you do pay for any eligible service, simply upload the receipt in OMS for us to assess your claim.

Inpatient vs Outpatient – what’s the difference?

Like other treatments and procedures, pregnancy cover depends on whether you are an inpatient or outpatient. So it’s important to know the difference.

• Inpatient: services when you are formally admitted to hospital, such as for delivery.
• Outpatient: treatments or services done outside of a hospital admission, such as antenatal checkups/appointments and ultrasounds.

Our outpatient costs factsheet explains the difference in greater detail.

What’s not included in pregnancy cover?

HCi hospital cover does not cover:

• out-of-hospital services such as antenatal consultations, whether routine or with specialists (endourologist, cardiologist, etc)
• tests as an outpatient like ultrasounds, blood tests, foetal monitoring or genetic testing (Medicare may assist with some of these)
• out-of-pocket costs or “gaps” charged by doctors or hospitals above the set benefit amount.
• your obstetrician’s management fee
• childbirth classes or post-partum exercise classes
• lactation consultant fees.

Does Medicare help with pregnancy costs?

Medicare covers some of the costs associated with pregnancy. However, rebates often do not cover the full cost, so members should expect to pay some gap fees.

You can receive care in a public hospital at no cost under Medicare. Birthing centres and private hospitals will have costs, some of which may be covered by Medicare and HCi.

A Medicare rebate may apply for:

• consultations with midwives and obstetricians, including via telehealth
• certain diagnostic tests and scans (ultrasounds, blood tests, etc)
• some immunisations˜ and prescribed medications
• pregnancy counselling
• gestational diabetes testing

Cover for the baby

Generally, a newborn is in hospital with the mother rather than a separate admission. This means that costs for hospital accommodation and routine care (such as an initial health check, Vitamin K testing and audiology screening) are included as part of the mother’s care.

If your baby requires the special care nursery or any additional extra support (such as phototherapy or a neonatologist visit), they will be admitted in their own right. Claims for these costs are covered only if the baby was added to the policy prior to birth.

Find out more about cover for your baby in our ‘adding a baby to your HCi policy’ factsheet.

Remember to add your baby to your Medicare card, too. Medicare may help with costs of any neonatal care your baby may need, as well as things like vaccinations and routine GP check-ups.

Helpful tips for pregnancy cover

✔  Contact HCi early – we can help you understand (and maybe adjust) your cover and avoid surprises. And we can add baby to ensure they are covered from birth.

✔  Talk to your doctor/clinic – if you’re planning private hospital care, it’s a good idea to ask your obstetrician, anaesthetist and hospital for a written estimate of costs. This ensures you have provided Informed Financial Consent.

✔   Budget for out-of-pocket costs (even with Medicare and HCi cover). Ask your treating doctor if they will treat you under HCi’s Access Gap Cover (AGC). AGC arrangements can help minimise your out of pocket expenses.

* HCi Gold, Silver and Bronze hospital cover will help with hospital costs if you unfortunately are admitted for a miscarriage or termination.
^ Medically necessary aids generally require a medical eligibility declaration – see our factsheet for details.
˜ Learn about immunisation for pregnancy from the Department of Health, Disability and Ageing.

 Pregnancy related information to read