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 or $500

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. After birth, add your little bundle of joy to your Gold Hospital cover within 1 year to avoid any waiting periods and have the widest coverage for 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 private 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 (with a private midwife)

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 choosing an obstetrician and which hospitals they use. Once you know this, use Peoplecare’s hospital search to see if we have an agreement to pay that hospital (if not, give us a buzz to chat it through as these costs can 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 in this IVF guide. The clinical category on hospital cover that you need is called Assisted reproductive services.

Starting point

Your doctor is the best person to help you. Normally, IVF is the last step before you’ve tried out other proven (cheaper and easier) options. We know it can be stressful, not to mention expensive.

Which cover do you need?

You need to spend at least 12 months on a hospital cover to serve your waiting period with the clinical category called Assisted reproductive services, which includes benefits for IVF including:

  • retrieval of eggs or sperm
  • In vitro Fertilisation (IVF)
  • Gamete Intra fallopian Transfer (GIFT)

Peoplecare’s Gold Hospital cover includes Pregnancy and birth and Assisted reproductive services.

Will I have to pay IVF out-of-pocket costs?

Yes, 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 those.

If you’re not sure, give us a buzz and we’ll help you work through it. If you want the info now, we also have a very useful Going to Hospital Guide to read.

Is there a way to save on out-of-pocket costs?

Yes, there is!

Peoplecare’s Access Gap scheme works with your specialists to give you low or no gap payments. We have an Access Gap agreement with over 36,000 doctors, but it’s up to the doctor on a case-by-case basis whether they’ll take part. Ask your doctor whether they’ll participate in Access Gap for your services whilst in hospital. If they do, they’ll bill us directly and you won’t have to worry about a thing.

Learn more about Access Gap.

Who pays for assisted reproductive services?

IVF Service Peoplecare Medicare  You
Gold Hospital Cover Extras Cover
Hospital excess payment
on your cover
No No No Yes
Retrieval of eggs* In a public or private hospital No Yes Yes
Embryo transfer* In a public or private hospital No Yes Yes
Frozen embryos* In a public or private hospital No Yes Yes
Nasal sprays and pessaries No Benefits available for pharmacy items above PBS cost No Yes
Storage fees No No No Yes

*Medicare will cover 75% of the Medicare Scheduled Fee for these services, and Peoplecare will cover the remaining 25%. Anything beyond the Medicare Scheduled Fee will be an out-of-pocket cost.

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 they need a Special Care Nursery or Intensive Care Unit there. You’ll need to add your bub within 12 months 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.