Navigating Pregnancy Health Insurance Waiting Periods

Learn more about pregnancy waiting periods in private health insurance and what to avoid with Savvy
Published on February 27th, 2024
  Written by 
Adrian Edlington
Adrian Edlington is PR & Communications Manager at Savvy. With a keen interest in personal finance, car loans, the mortgage industry, cost of living pressures, electric vehicles and renewable technology, Adrian's research includes conducting primary data surveys and analysis of up-to-the-minute secondary Australian data sources. His work on behalf of Savvy has been featured on ABC.net.au The Conversation, the Sydney Morning Herald, AFR, News.com.au, The Age, Herald Sun, Adelaide Now, SBS On The Money, 7News, Car Expert, Which Car, Drive.com.au and more. In his spare time, Adrian enjoys mountain biking and business podcasts.
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Bill Tsouvalas
Bill Tsouvalas is the managing director and a key company spokesperson at Savvy. As a personal finance expert, he often shares his insights on a range of topics, being featured on leading news outlets including News Corp publications such as the Daily Telegraph and Herald Sun, Fairfax Media publications such as the Australian Financial Review, the Seven Network and more. Bill has over 15 years of experience working in the finance industry and founded Savvy in 2010 with a vision to provide affordable and accessible finance options to all Australians. He has built Savvy from a small asset finance brokerage into a financial comparison website which now attracts close to 2 million Aussies per year and was included in the BRW’s Fast 100 in 2015 as one of the fastest-growing companies in the country. He’s passionate about helping Australians make financially savvy decisions and reviews content across the brand to ensure its accuracy. You can follow Bill on LinkedIn.
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Kate Browne

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Kate Browne
Kate Browne is Compare Club's Head of Research and Insights. She has almost two decades of experience in the media as a managing editor, news editor, investigative journalist and broadcaster. She has worked at Yahoo Finance, Finder, CHOICE and the ABC and has written for dozens of publications including the Sydney Morning Herald, the Sun Herald, The Age, news.com.au, the Sunday Telegraph, The Big Issue, Sunday Life and Kidspot. She was also one of the writers and presenters of ABC TV's top-rating consumer affairs show The Checkout which ran for six seasons.
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Starting a family is one of the biggest steps you can take in life, so it’s important to be prepared for whatever curveballs life can throw at you. That’s why, when it comes to your private health insurance, being aware of the waiting period for pregnancy-related claims is essential before you begin making any big plans. Learn all about pregnancy in health insurance and what you need to know right here with Savvy today!

Be of the waiting period for pregnancy coverage aware

The maximum waiting period for pregnancy-related claims as part of a hospital cover policy is 12 months. This is mandated by the Federal Government, meaning no private health insurer can enforce a waiting period longer than this for obstetrics.

It applies to those purchasing a health insurance policy for the first time as well as individuals and couples who are upgrading from a lower level of cover, such as basic or bronze hospital cover, to one including pregnancy protection, typically gold cover.

It's important to be aware of this waiting period and plan accordingly, especially if you're considering starting your family in the near future, to ensure your pregnancy cover is in place when you need it.

Premature births within the waiting period won’t be covered

It's also essential to understand that premature births, like any other birth, occurring within the waiting period for pregnancy coverage won’t be covered by your private health insurance.

This means that if you give birth prematurely before the waiting period has elapsed, you may be responsible for covering private hospital medical expenses out of pocket or have to go through the public system, which is still a viable option for many parents.

If you're concerned about the potential for premature birth, it’s important to line up the required insurance well in advance of the potential for pregnancy.

Pregnant woman graphic

Not all IVF and assisted reproductive treatments are covered

Assisted reproductive technology (ART) such as in vitro fertilisation (IVF) is an increasingly popular way to open doors for parents who may find conceiving naturally more difficult.

Indeed, according to a study by the University of New South Wales, one in 18 children born in Australia in 2021 were conceived through ART treatments.

While assisted reproductive services are listed as a minimum requirement on gold hospital cover policies on the PrivateHealth website, not all treatments will be covered by your insurance.

Services which are conducted as an outpatient (that is, outside a hospital setting) aren’t covered by hospital insurance. This means that consultations, ultrasounds and scans performed without you being admitted to hospital won’t be covered.

Additionally, to be eligible for the benefits available under your private health insurance policy, you must serve a waiting period of at least 12 months before your fertility treatment begins.

Switch to a family or single parent policy before you give birth

If you're currently covered under a singles or couples health insurance policy and are planning to start or expand your family, it's important to switch to a family or single parent policy before giving birth.

These policies can provide coverage for both you and your newborn, where they otherwise wouldn’t be under your current policy. By switching to a family policy before giving birth, you can avoid potential gaps in coverage and ensure that your child is covered for a range of medical needs should they arise.

Dependents can typically be added to a family or single parent policy for free, so switching from your previous policy may not end up costing you much more than you were previously paying (unless you’re upgrading your cover).

According to Kate Browne Head of Research & Insights at Compare Club;

“Health insurance is a really complex product and it can be easy to take out the wrong kind of cover, and end up paying for something that won't give you good value. If you are thinking about taking out private health insurance one the best ways to make sure you are getting the cover that you need is to speak to a health insurance expert who can not only run you through a range of options and insurers as well as explaining what the waiting periods will be and what you can expect.

And don't be afraid to ask lots of questions - not only of your health insurer but of all the specialists you are seeing, having a baby can be an expensive exercise so it's good to know what kind of costs you are in for so you can get prepared financially and emotionally well before the time comes.”

Hospital cover waiting periods don’t need to be re-served on new policies

When switching health insurance providers, it's important to note that waiting periods for hospital cover generally don’t need to be re-served on new policies. This means that if you've already served waiting periods for hospital treatment under your current policy, you won't have to serve them again if you switch to a new one.

However, waiting periods for new or upgraded services will still apply, so it's essential to review the details of your new policy carefully. Additionally, if you’ve taken a significant break in your coverage, your insurer may require you to re-serve your obstetrics waiting period.

Private health insurers set their own extras waiting periods

Extras cover, which includes services such as antenatal and postnatal classes, psychology and physiotherapy, comes with waiting periods which can be set by private health insurers. This means that waiting periods can vary between insurers and may differ depending on the specific service being claimed.

When purchasing extras cover, it's essential to review the waiting periods set by your insurer for different pregnancy services so you can be clear on what is and isn’t covered and how far in advance of giving birth you need to lock it in.

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This guide provides general information and does not consider your individual needs, finances or objectives. We do not make any recommendation or suggestion about which product is best for you based on your specific situation and we do not compare all companies in the market, or all products offered by all companies. It’s always important to consider whether professional financial, legal or taxation advice is appropriate for you before choosing or purchasing a financial product.

The content on our website is produced by experts in the field of finance and reviewed as part of our editorial guidelines. We endeavour to keep all information across our site updated with accurate information.

Savvy is partnered with Compare Club Australia Pty Ltd (AFS representative number 001279036) of Alternative Media Pty Ltd (AFS License number 486326) to provide readers with a variety of health insurance policies to compare. Savvy earns a commission from Compare Club each time a customer buys a health insurance policy via our website. We don’t arrange for products to be purchased from these brands directly, as all purchases are conducted via Compare Club.

Savvy’s comparison service is provided by Compare Club. Compare Club compares selected products from a panel of trusted insurers and does not compare all products in the market.

Any advice presented above or on other pages is general in nature and doesn’t consider your personal or business objectives, needs or finances. It’s always important to consider whether advice is suitable for you before purchasing an insurance policy.

For any further information on the variety of insurers compared by Compare Club or how their business works, you can read their Financial Services Guide.


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