Pregnancy and birth

CBHS is dedicated to helping you minimise your out-of-pocket expenses during every stage of your pregnancy.

Are you thinking of starting a family? 

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

CBHS-Pregnancy-2At 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 page will guide you through some of the things you may need to prepare for throughout each stage of your pregnancy.

Planning for your pregnancy

If you are thinking about getting pregnant, there are a number of things you can do to get prepared. Check out Pregnancy, Birth and Baby for some great advice and tips on getting ready for your pregnancy and the birth of your baby.

Making sure you're covered

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. If you’re new to health insurance or upgrading your cover, pregnancy and birth related services will have a 12 month waiting period. 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:

  • 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:
  • Limited Hospital
  • KickStart
  • Basic Hospital

CBHS-Pregnancy-1Please note that if you attend a Private hospital for pregnancy related services you will have significant out of pocket expenses.

Please note that Pregnancy related services are an Exclusion under FlexiSaver.

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 and your baby won’t be covered, 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.

Choosing a hospital

Speak with your GP about choosing a hospital, and recommending a good obstetrician. Do your research to find out what facilities and services are important to you (eg breastfeeding classes, an intensive care unit or special care nursery).

If you're choosing a private hospital, pick a CBHS contracted hospital to help keep your costs down Click here to search for a hospital near you. 

Arrange a visit to the hospitals you're considering to familiarise yourself with what they offer.

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.

Costs?

CBHS is dedicated to helping you minimise your out-of-pocket expenses associated with the birth of your baby.

CBHS-Pregnancy-3

Here’s a quick overview of the costs associated with having your baby in a private hospital:

If you have hospital cover that includes pregnancy and have served your waiting period, many of your inpatient (while you are admitted to hospital) hospital costs will be covered. It is important to note that you may experience out of pocket costs for medical treatment from your obstetrician therefore it is advised that you consult with your obstetrician on the proposed costs associated with your pregnancy and the birth of your baby.

Private health insurance cannot cover outpatient costs (when you are not admitted to a hospital). Medicare will pay a certain amount and you’ll need to pay for the remainder yourself.

It’s important to know that most of your antenatal appointments with your private obstetrician/midwife and medical tests and scans during your pregnancy will be as an outpatient and therefore won’t be covered by CBHS but are eligible for rebates from Medicare.

Your outpatient costs can vary greatly depending on how much your obstetrician charges so it’s important you give your agreement to these costs (preferably in writing) upfront. This is referred to as receiving Informed Financial Consent.

Check with your obstetrician about whether they will be willing to participate i CBHS’s Access Gap Cover Scheme, as this can help you reduce your out-of-pocket expenses. Anaesthetist, assistant surgeon and pathology fees can also be reduced if these professionals participate in the Access Gap Cover Scheme.

After Baby is born

Once your baby has been born, there are some steps that you will need to take to ensure that your baby is covered under your private health insurance policy. You will also need to ensure that you claim for your baby’s medical expenses, so that you are not more out-of-pocket than you need to be. Please refer to the section below on the ‘Status of baby’ to see if you are eligible to claim for these medical services.

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 as long as 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 sole 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.

Hospital expenses

Remember to claim for medical expenses after your baby is born. If your doctor participates in the Access Gap Cover Scheme, he or she should bill CBHS directly for in-hospital costs. If the bill is sent to you, forward it to us and we will process it for you. If your doctor does not participate in the Access Gap Cover Scheme, you must take the bill to Medicare and claim through Medicare first.

You can find out more about the Access Gap Cover Scheme and participating doctors here. To find out more about Medicare coverage for pregnancy, the birth of your baby, including current Medicare Safety Net thresholds and the Extended Medicare Safety Net, please visit the Medicare Safety Net page.

CBHS-Pregnancy-4

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.

Pregnancy FAQ’s

  • When is my baby an admitted patient?

    Under rules set down by the Commonwealth Department of Health and Family Services, the payment of gap medical benefits is restricted to medical services provided whilst an admitted patient of a hospital.

    A new born baby is classified as an admitted patient when one or more of the following criteria apply;

    • The baby is admitted to an approved neo-natal intensive care facility
    • The baby is the second or subsequent born in a multiple birth situation (i.e. Twins, triplets etc)
    • The baby is more than 9 days old while still in hospital

    If none of these criteria are met, your baby is not classified as an admitted patient for gap medical purposes and expenses can only be claimed through Medicare. (It is required that you indicate that your baby was not classified as admitted patient). You will be eligible for 85% of the schedule fee through Medicare. No further benefits are available from CBHS.

  • Does CBHS pay for meals?

    Generally, when mother and baby are in hospital, CBHS do not pay for the partner's meals or accommodation. Although there are benefits available for Boarder Fees (accommodation only) in some hospitals for specific situations, these benefits are subject to the conditions of the contract that is in place with CBHS. Please contact CBHS for further information.

  • What is my daily co-payment?

    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.

    If you have LiveLife and StepUp package cover, the daily co-payment is waived for dependant children on your membership up to 12 years of age.

    From January 1st, 2015 you will not be required to pay the relevant daily co-payment for dependant children on your membership if you have LiveLife, StepUp, Comprehensive Hospital or Limited Hospital covers. If you have Kickstart or Basic Hospital 500, the daily co-payment or excess applies for dependant children on your membership.

    For further clarification on Daily Co-Payments, contact Member Care on 1300 654 123.

  • Does CBHS pay for pre/antenatal classes?

    Pre/antenatal classes provided by a Physiotherapist are covered on Top Extras, and Prestige and LiveLife package cover. The benefit payable is 70% of cost, up to a maximum of $105.00 per confinement.

    To claim for pre/antenatal classes CBHS require an official receipt showing the provider's name, qualifications, dates and cost of each class.

    Pre/antenatal classes provided by a registered nurse or midwife are covered under the midwifery limit on Top Extras, and Prestige and LiveLife package cover. The benefit payable is 70% of cost, up to a maximum of $500.00 per confinement.

    To claim for pre/antenatal classes provided by a registered nurse or midwife must not be claimable through Medicare. CBHS require an official receipt showing the midwife's full name and nurse’s registration number, dates and cost of each class.

  • Can CBHS help with lactation classes?

    CBHS can help if you have Top Extras, Prestige or LiveLife package cover. Lactation classes come under the midwifery benefit, which entitles you to 70% of the cost up to a maximum of $500 per confinement.

    To claim for lactation classes the service must not be claimable through Medicare. CBHS requires an official receipt showing the midwife's full name, nurse’s registration number and date and cost of each consultation.

More information

The information provided on this page is intended as general information only. If you have any specific questions about your cover, co-payments or any other element of your membership in regards to your pregnancy, feel free to contact us for more information. 

The links below provide useful information about your child’s development and changes to your body:

Our friendly team is pleased to answer your queries and provide you with information to minimise and manage your out-of-pocket expenses during pregnancy and birth. Contact us on 1300 654 123 or send an email to help@cbhs.com.au to find out more.