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Health insurance and pregnancy | What you need to know

08 October, 2018
Baby's coming, and you need to know your cover

Family matters

Pregnancy is an exciting time, and you're sure to have lots of questions!

At CBHS, we are committed to providing exceptional member service and helping members manage and minimise health-care costs during pregnancy and birth. We want to make this time as easy as possible, so this article will guide you through some of the things you may need to prepare for throughout each stage of your pregnancy.

What are the waiting periods?

All Pregnancy related services have a 12-month waiting period. This means that if you are already pregnant when you take out hospital cover you, either for the birth or any admissions whilst you are pregnant.

The 12 month waiting periods also applies if you upgrade your cover to a higher level.


Let’s think about your level of health cover

The most important thing to keep in mind when looking at health insurance is waiting periods. This means you’ll need to think about your level of cover before you get pregnant.


Would you rather go to a private hospital and have a private room?

If the answer is yes, then you will need to consider one of the following CBHS products that include pregnancy related services – where CBHS pays benefits towards labour room fees and overnight and same day accommodation in either a public or private hospital.:

  • Prestige
  • Comprehensive Hospital
  • StepUp


Are you happy to go to a public hospital as a private patient in a shared room?

If the answer is yes, then consider one of the following CBHS Products. These products provide restricted pregnancy related cover –They will cover your accommodation and labour room in a public hospital as a private patient in a shared room. If you choose to be treated in a private hospital, the benefits paid will not cover all hospital costs and are likely to result in significant out-of-pocket expenses. In a private hospital, CBHS will pay minimum shared room benefits and no benefits are payable for labour room fees:

  • Limited Hospital
  • KickStart
  • Basic Hospital


Do any covers exclude pregnancy completely?

Yes - some cover excludes pregnancy related services – where CBHS pays no benefits at all and therefore you will need to pay for all costs associated with the pregnancy, birth and delivery.

Your hospital options:

  • Active Hospital
  • Flexi Saver


Choosing a hospital

If you're choosing a private hospital, pick a CBHS contracted hospital to help keep your costs down.  Do your research to find out what facilities and services are important to you (e.g. breastfeeding classes, an intensive care unit or special care nursery). Arrange a visit to the hospitals you're considering familiarising yourself with what they offer.

Click here to search for a hospital near you


What are the doctors costs?

Private Health Insurance Funds are only permitted to cover inpatient services. This means you need to have been admitted to a hospital for the benefit to be paid.

During pregnancy, you are likely to have many outpatient appointments (when you are not admitted to hospital), including scans, tests, and visits with your obstetrician/GP. Private Health Insurance Funds are not able to provide benefits for these appointments.

It is important to note that you may experience out of pocket costs for medical treatment from your obstetrician, anaesthetist, assistant surgeon and pathology fees. Obtain a quote (known as Informed Financial Consent) from your obstetrician so you are aware of the charges payable throughout your pregnancy.


Keeping costs to a minimum

It is important to request an informed financial consent or a written quote in advance when first consulting with your chosen health professional. This means more transparency about fees and costs, which will allow you to budget more effectively during your pregnancy.


Choosing a Doctor

Speak with your GP about recommending a good obstetrician. BHS has partnered with Healthshare to empower our members to make the best possible health choices.

Healthshare can help you find the right specialist near you, and let you know if they participate or have participated in CBHS Access Gap Cover. Anaesthetist, assistant surgeon and pathology fees can also be reduced if these professionals participate in the Access Gap Cover Scheme.

Healthshare can be found by following this link:


Co-payments / excess

If you have a daily co-payment on your membership, you will need to pay the relevant daily co-payment each day that you are hospitalised up to a maximum of 6 days per person or 12 days per family per calendar year. If your baby needs to be admitted to hospital, you will be required to pay the relevant daily co-payment unless you have reached your family maximum of 12 days.

You will not be required to pay the relevant daily co-payment for your newborn on your membership if you have StepUp, Comprehensive Hospital or Limited Hospital covers. If you have Kickstart or Basic Hospital 500, the daily co-payment or excess applies for newborn’s who are admitted to hospital.


What if I have a midwife deliver my baby instead of an obstetrician?

You can have both if you like, but you can only claim for one while you’re in hospital.

In most cases, Medicare will cover the cost of a midwife if you have your baby in a public hospital. Most private hospitals will only admit you if you have an obstetrician.

Whether you choose a midwife or an obstetrician, there’s a 12-month waiting period.


Can I claim for a Home Birth?

CBHS will not pay for a Home Birth on any level of cover.


What happens if I have Hospital cover that includes pregnancy, but I become pregnant while I am on a Single membership?

 If you have a Single membership, you will still be covered during your pregnancy and at the birth of your baby. Once your baby is born, you will need to upgrade to a Family or Single Parent membership to ensure coverage for the baby. This is particularly important if your baby is admitted to hospital.


What is Birth Beat?

If you hold CBHS Prestige or Top Extras you have access to pre and post-natal care from a midwife or other CBHS recognised provider.

Birth Beat is one of our health management programs. It is a 100% online childbirth education course. Delivered by a registered midwife and CBHS-recognised provider, it’s packed with tips to prepare you for birth and parenthood.  Follow this link for more information


After Baby is born

Don’t forget to contact CBHS after the arrival of your baby. You will need to provide us with basic information such as the baby’s full name, date of birth and gender so that you can ensure that they are covered under your CBHS membership.

Families with single parent or family cover will have waiting periods waived for the baby if they let us know about the new baby within two (2) calendar months of the birth. If you are a parent with singles cover, you can also have waiting periods waived for the baby if you upgrade to single parent or family cover within two (2) calendar months after the baby is born. This change needs to be effective from your baby’s date of birth.


Status of baby

Your new baby will usually be classed as an outpatient after delivery, so any additional tests or medical consultations will not be covered by CBHS and may only be eligible for a Medicare rebate.

This is due to rules by the Department of Health, which state that gap medical benefits apply only when the individual is an admitted patient.

However, your baby may be considered an admitted patient if any of following circumstances apply:

  • Your baby is admitted to an approved neo-natal intensive care facility (Special Care Nursery)
  • Your baby is a second or subsequent child born as a twin or in another multiple birth situation
  • Your baby is more than 9 days old and remains in hospital.


Any other questions?

Please contact us if you have any questions - we are here to help you. Call 1300 654123 or email help@cbhs.

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