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Pregnancy, birth and your cover

Pregnancy is one of life’s exciting milestones. So, it’s natural that you’ll have lots of questions. It can also be a challenging time full of new experiences and feelings. That’s why when it comes to your private health insurance, we want to make sure you know exactly what you’re covered for while you’re pregnant and after you’ve had your baby.

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 joining on Complete Gold Hospital which includes pregnancy and birth services.

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 KickStart (Basic Plus).

This policy 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.

Starter Basic Hospital
Value Bronze Plus
Everyday Silver Plus
Advanced Silver 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.

How do co-payments/excess work?

A daily co-payment 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 Complete Gold Hospital.

The daily co-payment or excess applies for newborns who are admitted to hospital if you have KickStart (Basic Plus).

Important health cover details to remember once your baby is born

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.
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.
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.

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.

Pregnancy FAQs

When is my baby an admitted patient?

Under Commonwealth Department of Health and Family Services rules, we can only pay gap medical benefits for medical services provided to an admitted patient of a hospital. A newborn 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 over nine 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 you can claim expenses through Medicare only. 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.

Does CBHS pay for meals?

Generally, we do not pay for your partner's meals or accommodation while you and your baby are in hospital. Although there are benefits available for Boarder Fees (accommodation only) in some hospitals for specific situations if the boarder also holds Hospital cover with CBHS. However, these benefits are subject to the conditions of the contract that is in place with CBHS. Please contact us 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.

You don’t need to pay the relevant daily co-payment for dependants on your membership if you have Complete Gold Hospital. If you have KickStart (Basic Plus), the daily co-payment applies for dependants on your membership.

For more details 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 or other healthcare professional are covered on Top Extras. The benefit payable is 100% of cost up the overall limit.

To claim for pre/antenatal classes you’ll need to provide CBHS with an official receipt showing the provider's name, nurse's registration number, 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. CBHS will pay you 100% when you're on Top Extras, up to the overall limit.

Note: To claim for pre/antenatal classes the service must not be claimable through Medicare.

To make a successful claim, the pre/antenatal classes must not be claimable through Medicare. You’ll need to provide CBHS with an official receipt showing your healthcare professional’s full name and registration number, dates and cost of each class.

Does CBHS help with lactation classes?

We can help if you have Top Extras cover. Lactation classes come under the midwifery benefit, which entitles you to 100% of the cost up to the overall limit.