Private Health Insurance Checklist

Starting a family or expanding your family is such an exciting time in your life. Pre-planning this family event relating to your private health insurance is vital, if you wish for your maternity admission to St John of God Hospital Ballarat to be covered by your private health insurance company.

Many people only begin to think about adding maternity cover to their private health insurance policy once they have conceived. Unfortunately, it is then often too late.

Most insurers have a 12-month waiting period before you can claim for maternity or obstetric related services. If you have not served a full 12 month waiting period on your private health insurance policy, you might be disappointed to find you are not covered for birth in a private maternity hospital. 

If you find yourself in the position where baby is due and you have not served waiting periods, you are still welcome to utilise the Maternity services at St John of God Ballarat, but you would need to do so as a self-funded patient.

Waiting periods with private health insurance companies mean, you cannot claim for a particular service until that waiting period has been served.  For maternity or obstetric related care, this is generally 12 months.  

You may have served a 12 month wait by the time your baby is due to be born, however we also need to consider the care you may require leading up to the birth of your baby.

If you require an admission relating to your obstetric care while you are still within the waiting periods, your fund may not cover your antenatal admission. (Antenatal - meaning before birth, during your pregnancy  or relating to your pregnancy)  

It is therefore important to think ahead and investigate your private health insurance options as soon as possible, even if you aren’t planning to conceive for another year.

Private Health Insurance Checklist

Here are some important questions to ask your health fund as you are planning your pregnancy.

Are Maternity/Obstetric services covered in a private hospital on my policy? (If your fund asks you for CMBS item numbers, you can quote 16519 or 16520.)

Some health insurance policies will cover you as a private patient in a public hospital for maternity/obstetric services – but if you are choosing private hospital care for maternity services you would have extensive out of pocket expenses. Do ensure that your policy covers maternity in a private hospital.

Have I served waiting periods for maternity/obstetric services?

This is an important question to ask, because if waiting periods have not been served, there could be significant out of pocket expenses. If you have served your waiting periods, that's great! If not, make sure you write down the date of when they will be served by.

Am I on a single, couples, single-parent or family cover?

Will I have an excess or co-payment to pay for a maternity/obstetric admission?

Knowing this information will give you a better understanding of your out-of-pocket expenses for when baby arrives. Make sure to write down what your excess is and if there are any co-payments, exactly how much they will be.