Planning a family

This guide will show you how to:

  1. understand waiting periods and excesses
  2. choose a cover with pregnancy and birth included
  3. choose between public and private pregnancy care with our pros and cons
  4. know who pays for what
  5. manage private pregnancy costs
  6. get IVF support
  7. find government support for your kids

Two important things before you dive in — these apply to all health funds

Waiting period

A waiting period (including those for pre-existing conditions) of 12 months applies for pregnancy and birth.

Excess

Excesses may apply when you go to hospital, depending on your cover. Peoplecare Gold Hospital cover has three different excess levels to choose from: $750, $500 & $250.

Which hospital cover do I need for pregnancy?

Peoplecare’s Gold Hospital cover. The specific category you’re looking for is called Pregnancy and birth.

Gold Hospital is the highest level of hospital cover in Australia, including all 38 clinical categories. There’s a good reason why Pregnancy and birth generally is only required on Gold Hospital covers, although it can feature on lower levels of cover. Why? To cover your little bundle of joy from any unexpected medical condition they might have to endure, Gold Hospital cover gives you the freedom to seek treatment with your chosen doctor within both public and private hospitals for all 38 clinical categories.

Get a quote

When do I need pregnancy cover?

12 months before the admission for the birth of your baby is the waiting period. We encourage mothers to play it safe with timings. A couple of months up your sleeve to allow for a premature birth could mean the difference between being able to use your hospital cover or not.

How do I use hospital cover to have a baby?

Simply follow the steps in our Going to Hospital Guide. But, in brief, you can choose your obstetrician with your GP.

Do you need private hospital cover to have a baby?

Public versus private for pregnancy care gets passionate responses on either side. We can see why people could be convinced either way.
First we lay out the pros and cons of public vs private and you can make the choice for yourself.

Have a baby through the public system as a public patient

Pros
  • no (or minor) out-of-pocket expenses. Medicare covers the full cost on bulk-billed GPs, ultrasounds, blood tests, your midwives and obstetricians, your hospital stay [1]
  • no waiting periods – if you’re pregnant, the public system will help you
  • public hospitals have higher-end facilities for difficult, high-risk pregnancies and seriously premature babies [2] [3] [4]
  • home birthing and midwifery programs (limited places) [2] [3]
  • if you want a natural birth, the public system with its midwife-led birthing model deliver a higher percentage of babies this way than the private system [2] [5]
Cons
  • No choice in your birth team, you’ll get a team of midwives along with your GP (who you do choose) who’ll take care of you during your check-ups. On the big day, you get whoever is on duty [5] [4]
  • less recovery time in a hospital bed before you’re sent home [5]
  • you’re more likely to share a room after your labour [4]
  • Having to tell different duty staff the same information over and over again each check-up and during your hospital stay [3]
  • You usually end up in a shared ward after your delivery. They can get a bit noisy and your privacy is limited to a thin curtain around your bed. [3]
  • waiting for appointments could be lengthy [3]

Have a baby in a private hospital

Pros
  • Have your own obstetrician with you from the very start to guide you through (not just in labour if something goes wrong like in the public system). [5]
  • Having your own obstetrician might be useful during a complicated pregnancy [6]
  • Shorter appointment waiting times [7] [4]
  • Longer recovery in-hospital before you need to leave [5]
  • Higher chance of getting a private room [5]
Cons
  • Out-of-pocket costs can run into thousands of dollars [5]
  • Having to serve a 12-month waiting period before claiming any pregnancy services [8]
  • There’s a chance you might not get a private room (it depends on availability) [5]
  • Your obstetrician might not be available to attend the labour.
  • That’s worth knowing upfront. [5]
  • If you have severe complications or are quite premature, you might need to transfer to the higher-end facilities at a public hospital such as the Neonatal Intensive Care Unit. [2]

 

Want to learn how to manage your pregnancy costs?

Peoplecare has a Going to Hospital Guide that takes you from Step 1: Visit your GP to Step 7: Check out and Claim. There are plenty of nuggets of wisdom in there that could save you thousands of dollars. Please don’t miss Step 3: Visit your specialist & get an itemised quote.

View Going to Hospital Guide

 

Who pays what...

Service

Peoplecare

Medicare

You

Hospital cover

Extras Cover

Pregnancy & birth-related services while you’re admitted to hospital:

  • accommodation
  • theatre fees
  • specialist fees during the birth

Gold Hospital - Yes

No

Yes

 

Your excess, additional services, incidental fees, and any gap.

Out-patient appointments (things like standard doctors’ appointments, scans and tests)

No

No

Up to 85% of the Medicare Scheduled Fee

Any gap between what Medicare pays & what the doctor charges

Home birth

No
  • Premium Extras - Yes
  • High Extras - Yes
  • Mid Extras - No
  • Simple Extras - No
No Yes

Ante/post-natal services

 No
  • Premium Extras - Yes
  • High Extras - Yes
  • Mid Extras - No
  • Simple Extras - No
 No  Yes

Pregnancy aids (if provided by a physio)

 No
  • Premium Extras - Yes
  • High Extras - Yes
  • Mid Extras - No
  • Simple Extras - No
 No  Yes

IMPORTANT: There could be out-of-pocket costs on any of these services that you’ll need to pay for yourself. Your doctor and other providers should tell you about any out-of-pocket costs that you’ll have (this is called Informed Financial Consent). If you’re not sure, read our Going to Hospital Guide or give us a buzz and we’ll help you work through it.

Please also keep in mind that there can be excesses and limits on any of these services, depending on your level of cover.

 

 

Going private tip: Talk to your GP about which hospital your obstetrician works. Once you know this, use Peoplecare’s hospital search to see if we have an agreement to pay that hospital (if not, you’ll have to pay these expenses yourself and that could be mighty expensive).

Need help conceiving?

We have all the in vitro fertilisation information you need about how to claim and what your benefits are. Read our IVF fact sheet.

After delivery

Why is it important to add your baby to your cover straight away?

Just in case your little bundle of joy comes early in a private hospital and it needs a Special Care Nursery or Intensive Care Unit there. You’ll need to add your bub to your Gold Hospital cover to claim the full value of what is very expensive care, often rising to “tens of thousands of dollars.” [8]

Government support available

From maternity leave to family tax benefits to childcare subsidies, there may be payments that you might be able to claim along with your new baby.

Visit Services Australia’s Having a Baby guide for more details.

References:

  1. Moneysmart, "Having a baby," [Online]. Available: https://moneysmart.gov.au/having-a-baby.
  2. Choice, "Do you need health insurance to have a baby?," 14 October 2019. [Online]. Available: https://www.choice.com.au/babies-and-kids/getting-ready-for-baby/planning-for-baby/articles/health-insurance-for-pregnancy-and-birth.
  3. S. McCulloch, "Belly Belly," 31 May 2018. [Online]. Available: https://www.bellybelly.com.au/birth/how-much-does-it-cost-to-give-birth-in-australia/.
  4. The Women's, "Pregnancy care & birthing options," [Online]. Available: https://www.thewomens.org.au/health-information/pregnancy-and-birth/now-you-are-pregnant/pregnancy-care-birthing-options.
  5. S. Rogers-Anderson, "Kidspot," 29 July 2015. [Online]. Available: https://www.kidspot.com.au/birth/labour/preparing-for-labour/should-you-give-birth-in-a-public-or-private-hospital/news-story/2e2abbb72df69a1497c64552817e7db9.
  6. N. Tovey, "Kidspot," 7 May 2018. [Online]. Available: https://www.kidspot.com.au/health/family-health/mums-health/the-lessons-i-learnt-about-health-insurance-as-a-firsttime-mum/news-story/681d337786751e570418c67973b0669a.
  7. S. McCulloch, "Belly Belly," 5 June 2018. [Online]. Available: https://www.bellybelly.com.au/birth/australia-public-private-birth-centre-home/.
  8. Commonwealth Ombudsman, "Obstetrics and Pregnancy," [Online]. Available: https://www.ombudsman.gov.au/publications/brochures-and-fact-sheets/factsheets/all-fact-sheets/phio/obstetrics.