What's covered under pregnancy and birth related services?
What maternity services are covered?
Hospital costs:
If your hospital cover includes pregnancy and birth, with no restrictions or exclusions, you’re fully covered for:
accommodation charges
theatre charges
labour ward charges
when you are admitted as a private patient to any of our contracted hospitals or a public hospital.
Check your product guide to see if any restrictions and exclusions apply to your cover.
Medical costs:
Inpatient medical services provided by your obstetrician, gynaecologist, anaesthetist, or other specialist medical practitioner are covered when you are admitted to hospital, except where exclusions apply. Medicare pays 75% of the Medicare Benefits Schedule (MBS) fee for eligible inpatient services, and we pay the remaining 25%. If you are charged more than the MBS fee, you will be out of pocket for this additional amount unless billed under Access Gap Cover. You may also be out-of-pocket for pathology and radiology. You will be out-of-pocket for any incidentals such as phone calls, meals for your partner, and television hire, as well as any medications not directly related to your hospitalisation.
Waiting periods
There is a twelve-month waiting period for all pregnancy and birth if you are:
a new member
upgrading your existing policy
transferring from another fund, unless you already served the full waiting period for these services under your previous cover.
Hospital visits before or after the delivery
Current legislation prevents us from paying any benefits for appointments with your obstetrician, gynaecologist, or other specialist, including scans and doctors’ management fees except while you are a hospital inpatient. Medicare will usually pay a benefit for these services.
Length of hospital stay
Each of our contracted hospitals defines its own standard length of stay for admission to give birth, so please check directly with the hospital. If your stay is extended for a valid medical reason, we will pay accommodation benefits.
Cover for your baby
Children are covered under a single parent policy or family policy only.
If you already have one of these policies, your newborn child is immediately covered and deemed to have served the same waiting periods as the adult member with the longest period of cover. You’ll need to contact us to add the baby to your policy.
If you’re on a couples policy or single policy, you’ll need to:
transfer to a family policy or single parent policy within three months of your baby’s birth
pay the additional premium from the date of the baby’s birth.
Multiple births
Your theatre charges and labour ward charges are already covered, and we will pay the hospital’s additional accommodation charges for your second and subsequent babies.
Home birth
We can only pay benefits under your hospital cover when you are admitted to hospital, so home births are not included. However, depending upon the level of extras cover you’ve chosen, you may be eligible to receive benefits for some pregnancy and birth–related services, such as pre-natal consultations with a registered midwife in private practice. See your product guide for details.
Paediatrician fees
If there are no medical complications your newborn won’t be admitted as an inpatient. We are therefore unable to pay benefits relating to paediatric services while your baby is in hospital with you, including any charges for the pre-release checkup.
However, if there is a medical reason for your baby to be admitted at the time of birth, you can claim benefits for pediatrics and other eligible services for the duration of your baby’s stay in hospital.
We do not pay a benefit for visits to the paediatrician after discharge. Medicare will usually pay a benefit on these services.
Ante and postnatal physiotherapy
Ante and postnatal physiotherapy is not covered under your hospital policy. If you have extras cover, you may be able to claim a benefit for ante or postnatal classes conducted by a registered physiotherapist in private practice. Check your product guide to see if you are eligible.
Childbirth education classes
Many private and public hospitals run childbirth education classes. You may be able to claim a benefit for these if you have extras cover which includes the Health and Wellbeing benefit. Check your product guide to see if you are eligible.
Pregnancy cover for dependants
If your daughter is a dependant on your policy she is covered for all the pregnancy and birth-related benefits outlined above, assuming it's included on your cover and provided she has served the waiting periods.
However, your daughter’s baby will not be eligible for benefits under your cover. To ensure her baby is covered from birth, your daughter will need to:
transfer to family policy or single parent policy in her own name within three months of the baby’s birth
pay the additional premium from the date of the baby’s birth.
