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We can help you minimise your out-of-pocket expenses during every stage of your pregnancy.
We are committed to helping you manage and minimise health-care costs during this important stage of your life. We want to make this time as easy as possible, so this article guides you through some of the things you may need to prepare for throughout each stage of your pregnancy.
HOW YOUR HEALTH COVER WORKS WITH YOUR PREGNANCY
What are the waiting periods?
All Pregnancy related services have a 12-month waiting period. This means that if your baby’s due date is before serving the 12-month waiting period you won’t be eligible for benefits, either for the birth or for any pregnancy related admissions whilst you are pregnant.
The 12 month waiting periods also applies if you upgrade your cover to include pregnancy.
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 CBHS products above that include pregnancy related services. We pay benefits towards labour room fees and overnight and same day accommodation in either a public or a contracted private hospital.
- Prestige (Gold)
- Comprehensive Hospital (Gold)
- StepUp (Bronze Plus)
Are you happy to go to a public hospital as a private patient in a shared room?
Depending on your answer, you might want to consider one of the policies above. These provide restricted pregnancy related cover. They 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 will not cover all hospital costs and are likely to result in significant out-of-pocket expenses. In a private hospital, we will pay minimum shared room benefits and no benefits are payable for labour room fees:
- KickStart (Basic Plus)
- Basic Plus Hospital
Do any covers exclude pregnancy completely?
These exclude pregnancy related services. We pay no benefits so you would need to pay for all costs associated with the pregnancy, birth and delivery:
- Active Hospital (Silver Plus)
- Limited Hospital (Bronze Plus)
- FlexiSaver (Basic Plus)
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.
Can I claim for a home birth?
We don’t pay for home births on any level of cover.
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.
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.
THE COSTS INVOLVED IN PREGNANCY COVER
Choosing a doctor
Speak with your GP about recommending a good obstetrician. We partner with Healthshare to help you choose.
Healthshare can help you find the right specialist near you, and let you know if they participate in or have participated in our Access Gap Cover scheme. Anaesthetist, assistant surgeon and pathology fees can also be reduced if these professionals participate in our Access Gap Cover scheme.
Find specialists who are part of our Access Gap Cover scheme on Healthshare.
What are the doctor’s costs?
Private health insurance funds are only allowed to cover inpatient services. This means you must be 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 cannot pay benefits for these appointments.
You may have 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.
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 have to pay the relevant daily co-payment unless you have reached your family maximum of 12 days.
You will not have to pay the relevant daily co-payment for your newborn on your membership if you have StepUp (Bronze Plus), Comprehensive Hospital (Gold) covers. If you have Kickstart (Basic Plus), Basic Plus Hospital 500 or Basic Plus Hospital 7500, the daily co-payment or excess applies for newborns who are admitted to hospital.
Keeping costs to a minimum
Ask for a written quote in advance (this is informed financial consent) at your first consult with your chosen health professional. This means more transparency about fees and costs, which will allow you to budget more effectively during your pregnancy.
After baby is born
Don’t forget to contact us after the arrival of your baby. You will need to give us basic information such as the baby’s full name, date of birth and gender to ensure they are covered under your CBHS membership.
If you have single parent or family cover waiting periods will be waived for the baby if you 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 of your baby’s birth. This change needs to be effective from your baby’s date of birth.
BABY AND YOUR HEALTH COVER
What is Birth Beat?
If you hold CBHS Prestige (Gold) or Top Extras you can claim benefits towards pre and post-natal care from a midwife or other CBHS recognised provider, including Birth Beat.
Birth Beat is a 100% online childbirth education course. Delivered by a registered midwife and CBHS-recognised provider, it’s packed with tips to help prepare you for birth and parenthood. For more information, visit the Birth Beat website.
Status of baby
Your new baby 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.
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 nine days old and remains in hospital
What is Nourish Baby
Nourish Baby is an Australian online provider of antenatal and early parenting education and support anytime and anywhere.
All courses are delivered by qualified antenatal and early parenting health professionals who are deeply passionate about supporting parents through pregnancy, birth and the first 3 years of their child's life.
Recommended by obstetricians, midwives and child health nurses across Australia, Nourish is accredited by the Childbirth and Parenting Educators of Australia and the Australian Council of Healthcare Standards.
For more information, visit the Nourish Baby website.
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 classed as an admitted patient for gap medical purposes and expenses can only be claimed through Medicare. (You must indicate that your baby was not classed as an admitted patient). You will be eligible for 85% of the schedule fee through Medicare. No further benefits are available from CBHS.
Generally, when mother and baby are in hospital, we 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 us for further information.
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 (Gold)* and StepUp (Bronze Plus) 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 are not be required to pay the relevant daily co-payment for dependant children on your membership if you have LiveLife (Gold), StepUp (Bronze Plus) or Comprehensive Hospital (Gold). If you have Kickstart (Basic Plus), Basic Plus Hospital 500 or Basic Plus Hospital 750 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.
*LiveLife(Gold) is a closed product and no longer available.
Pre/antenatal classes provided by a physiotherapist are covered on Top Extras, and Prestige (Gold) and LiveLife (Gold) package cover. The benefit payable is 70% of cost, up to a maximum of $105.00 per confinement.
To claim for pre/antenatal classes we need 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 (Gold) and LiveLife (Gold) package cover. The benefit payable is 70% of cost, up to a maximum of $500.00 per confinement.
To make a successful claim the pre/antenatal classes must not be claimable through Medicare. We need an official receipt showing the midwife's full name and nurse’s registration number, dates and cost of each class.
We can help if you have Top Extras, Prestige (Gold) or LiveLife (Gold) 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. We need an official receipt showing the midwife's full name, nurse’s registration number and date and cost of each consultation.