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.

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 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?

Depending on your answer, you might want to consider the cover suggested below. 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

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?

CBHS will not pay for a Home Birth 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.

Click here to search for a hospital near you.

The costs involved in pregnancy cover

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.

To find specialists who are part of CBHS' Access Gap Cover Scheme, check out our Healthshare search.

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.

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.

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.

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.

Baby and your health cover

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. 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 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.

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