Pregnancy, birth and your cover

Helping you minimise your out-of-pocket expenses  

CBHS is committed to helping you manage and minimise your healthcare costs during this important stage of your life. In fact, your peace of mind while you go on this incredible journey, is important to us.

So, we’ve put together a quick guide to help you understand how your health cover works during pregnancy. From waiting periods to information on what you can claim, this article will guide you through some of the things you may need to prepare for.

Here’s how your health cover works during your pregnancy

Waiting periods

All pregnancy and birth services have a 12-month waiting period. So, if your baby’s due date comes before the 12-month waiting period is served, you won’t be eligible to claim on any expenses incurred for the birth or any other pregnancy-related admissions. This waiting period also applies whether you choose a midwife or an obstetrician.

Would you like to have your baby in a private hospital with your own room?

If your answer is ‘yes’, then you’ll need to consider one of the following CBHS products that include pregnancy and birth services.

CBHS will pay benefits towards labour room fees as well as overnight and same day accommodation in either a public or a contracted private hospital.

Would you like to stay in a public hospital as a private patient in a shared room?

If you’re happy to share a room in a public hospital for the birth of your baby, you might like to consider one of the following CBHS policies.

• KickStart (Basic Plus)
• Basic Plus Hospital.

These policies will cover your accommodation and labour room in a public hospital when you’re admitted as a private patient and stay in a shared room.

However, if you choose to have your baby in a private hospital, the benefits won’t cover all hospital costs. This means that you may incur significant out-of-pocket expenses. In a private hospital, CBHS will pay you the minimum of shared room benefits but you won’t receive any benefits for labour room fees.

The following covers don’t include any pregnancy and birth services, so you’ll need to pay for all the costs associated with the pregnancy, birth and delivery.

• Active Hospital (Silver Plus)
• Limited Hospital (Bronze Plus)
• FlexiSaver (Basic Plus).

If you fall pregnant with a Single membership that includes Hospital cover (and pregnancy)…

…you will still be covered however, once your baby is born, you’ll 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.

Choosing between a midwife or obstetrician to deliver your baby

You’re welcome to choose both, however 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. And most private hospitals will only admit you if you have an obstetrician.

Three top ways to keep your out-of-pocket costs down

1. Choose a CBHS-contracted private hospital

A little bit of research can go a long way when it comes to minimising your hospital expenses. Searching for a CBHS agreement hospital near you is a great place to start. Find out what facilities and services are important to you such as breastfeeding classes, an intensive care unit or special care nursery. And try to visit your preferred hospitals to familiarise yourself with what they offer.

2. Select an obstetrician who participates in our Access Gap scheme

Once your GP recommends an obstetrician or you choose your preferred, check to see whether they’re part of the CBHS Access Gap scheme. We partner with Healthshare to help make this process easier for you. Simply pop in your suburb, postcode or preferred hospital to find the right specialist near you. Anaesthetist, assistant surgeon and pathology fees can also be reduced if these professionals participate in our Access Gap Cover scheme.

3. Ask for written quotes from your health professionals

This is a great way to keep up to date with expenses while you’re pregnant. When you go to the first consult with your chosen health professional (obstetrician, anaesthetist etc.), ask for a written quote in advance for pregnancy-related services such as, scans and tests. Quotes are also known as informed financial consent and can give you more transparency about fees and costs. This will help you budget more effectively during your pregnancy.

Did you know?

Private health insurance funds like CBHS are only allowed to cover inpatient services. So, you must be admitted to a hospital to claim benefits.

How do co-payments/excess work?

A daily co-payments or excess payment is designed to help make your premium cheaper. If you have a daily co-payment on your membership, you’ll need to pay the relevant daily co-payment for every day that you’re hospitalised – up to a maximum of six days per person or 12 days per family per calendar year. If your baby needs to be admitted to hospital, you’ll have to pay the relevant daily co-payment unless you’ve reached your family maximum of 12 days.

You won’t have to pay the relevant daily co-payment or excess for your newborn on your membership if you have one of the following covers:

• StepUp (Bronze Plus)
• Comprehensive Hospital (Gold).

The daily co-payment or excess applies for newborns who are admitted to hospital if you have one of the following covers:

• KickStart (Basic Plus)
• Basic Plus Hospital $500 Excess
• Basic Plus Hospital $750 Excess.

Important health cover details to remember once your baby is born

1. Contact CBHS and let us know your baby’s full name, birth date and gender to make sure your newborn is covered under your membership.
   
   
2. If you have single parent or family cover, the waiting periods will be waived for your baby if you let us know about your infant within two calendar months of their birth.
   
   
3. If you’re a parent with singles cover, you can also have the waiting periods waived for your baby if you upgrade to single parent or family cover within two calendar months of your baby’s birth. This change needs to be effective from your baby’s date of birth.

How CBHS health cover can help with your new baby

To help with your new journey as a parent, you can claim benefits towards pre and post-natal care from a midwife or other CBHS recognised providers like Birth Beat and Nourish Baby which is accredited by the Childbirth and Parenting Educators of Australia and the Australian Council of Healthcare Standards. You’ll need to hold  Prestige (Gold) or Top Extras to be eligible.

Will your baby be covered for extra tests or consults after birth?

Your newborn will usually be classed as an outpatient after delivery, so any additional tests or medical consultations won’t be covered by us and may only be eligible for a Medicare rebate. This is because Department of Health rules state that gap medical benefits only apply when the individual is an admitted patient.

Your baby may be considered an admitted patient if the following 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 over nine days old and remains in hospital.