Health insurance when you're planning kids

Planning to have a child?

Whether it's your first or your fifth child, you have a busy and exciting time ahead of you. The last thing you want to do is worry about medical bills and quality of care, so it's a good idea to get your health insurance sorted out well in advance.

Why do I need private health insurance?

Private health care is the best way to ensure top quality care in a private hospital of your choice, with the obstetrician of your liking. You can even get your own private room in some cases. With private health insurance, you get all the benefits of private health care without the great whacking bill at the end:

A national study published in the Medical Journal of Australia showed that there are benefits to both mothers and babies born in private hospitals:

• babies born in private hospitals were less likely to need resuscitation at birth or admission to intensive care
• women giving birth in public hospitals had more than twice the rate of severe perineal tearing
• babies born in public hospitals were more than twice as likely to require high-level resuscitation at birth
• Low Apgar scores (indicating possible health problems) and intensive care admission were also more common in babies born in public hospitals
• neonatal death rates were 1 in 1000 in private hospitals and 3 in 1000 in public hospitals

Having a new baby can be stressful and expensive enough without having to worry about these sorts of concerns. The best thing you can do for yourself and your partner is to get private health cover to see you through this time. But you'll need to plan ahead and act early, because birth-related services generally require a 12 month waiting period before the benefits become available to you. That means you need to either join or upgrade to a health plan that covers birth-related services, and pay your health insurance premium for 12 months before you can claim those benefits.

I already have private health insurance...

For those who already have private health insurance, a simple phone call to your health fund or checking your policy papers will show whether you have cover for birth-related services. If you have a budget health cover or a singles health cover only, chances are you may need to upgrade your health insurance to include these services, which will require a 12 month wait. If you do have birth-related services as part of your health cover, check the conditions and benefits that you're entitled to.

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I'm new to private health insurance

If you don't have health insurance yet but want to get cover for the birth of your child, make sure you take out a health plan that covers you for birth-related services. Because you have to wait 12 months before you're eligible to claim on birth-related services, consider getting other features that you can use more immediately, including extras like dental, optical and physiotherapy, to make the most of your cover. Read our introduction to health insurance and our tips to save on health insurance for more information.

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How to choose your health insurance policy

When choosing your private health insurance policy to prepare for a new child, there are two features that you need to consider. These are:

1. Pregnancy and birth related services: This relates to antenatal care, delivery and post-natal care.

2. Assisted reproductive services: This refers to services and treatment for conception other than by natural means, including artificial insemination, IVF (in vitro fertilisation), GIFT (gamete intrafallopian transfer) and ICSI (intracytoplasmic sperm injection).

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What does private health insurance cover?

Having private health insurance means that your health fund covers:

• your choice of private hospital (provided you have private hospital cover) and doctor
• hospital accommodation, labour ward, delivery suite or birth centre costs (depending on the plan, you could even have your own private room) 
• surgery-related expenses including operating theatre and intensive care if it is required
• medical costs including fees for your doctor, obstetrician, anaesthetist and paediatrician if required
• the cost of drugs supplied as part of your hospital treatment
• other therapies like physiotherapy, when they are associated with your delivery and provided by the hospital. These other therapies may also be covered as part of your Extras cover, if you choose it.

However, keep in mind that some doctors charge above the Medicare Benefit Schedule, so there may be a gap. Unless your health fund has a gap plan, or your doctor has an agreement with your health fund, that gap could be payable out of your pocket. Before treatment is administered, find out if the doctor you choose is covered by your health fund's no gap scheme so you're not left unexpectedly out of pocket. Read more about the Gap

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Cover for your baby

In order to ensure that your new bundle of joy is covered from the time of their birth, make sure that you upgrade from singles or couples cover to family or single parents cover at least two months before the birth, regardless of whether or not the birth is premature.

The health insurance premium for family cover is the same as couples cover, so the sooner you do it, the better.

You can compare prices for private health insurance policies for families on moneytime today.

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