Pregnancy & Birth

Is there a waiting period for pregnancy cover?

• Yes, pregnancy and birth has a 12 month waiting period for anything inpatient related. This means you must have served your 12-month waiting period by the time your baby is born.

Can the waiting period be waived?

• No, waiting periods can’t be waived. That’s why getting onto the right cover early can make a real difference. If you’re unsure where you’re at, or want help understanding your options, we’re always happy to talk it through with you.

What if my due date is after my waiting period, but my baby comes before?

• We know babies don’t always arrive exactly on schedule. If your due date is close to the end of your waiting period, it’s a good idea to chat with us early so you understand how your cover works and what to expect based on your individual circumstances.

We have hospital cover that pays benefits towards services and treatment provided in hospital during pregnancy, childbirth and following delivery.

This includes accommodation as a private patient in a private or public hospital (shared room only in a public hospital) and any fees for the labour ward, theatre or intensive care.

It also includes benefits towards inpatient medical services. Medicare pays 75% of the Medicare Benefits Schedule (MBS) fee for your obstetrician, anaesthetist and other doctors, as well as any diagnostics (e.g. x-rays or lab tests) while you’re admitted to hospital, while ahm pays the remaining 25% of the MBS fee. It’s important to understand that some doctors and providers charge above the MBS fee and when this occurs you’ll have to pay the difference – this is known as the ‘gap’.

If an excess applies to your cover, you’ll need to pay this, any personal expenses like additional meals for your partner or any other expenses not covered by our agreement with the hospital, as well as any pharmaceuticals (including drugs issued on discharge) not covered by our agreement with the hospital.

Some doctors and providers charge fees for inpatient medical services that are higher than the Medicare Benefits Schedule (MBS) fee. When this happens, you’ll have to pay the difference- this is known as the ‘gap’. You may be able to reduce the gap by choosing doctors who agree to participate in ahm’s GapCover scheme for each claim as part of your treatment.

For more information on GapCover refer to What is GapCover? or Member Guide(opens in a new tab).

Also, private health insurers are not permitted to pay benefits towards outpatient services (when you or your newborn are not admitted to hospital). While you may be eligible to claim a Medicare rebate, you may have out-of-pockets for the outpatient appointments you’re likely to have during pregnancy such as scans, tests, and visits with your obstetrician/GP. Also, healthy newborns are generally not admitted to hospital after the birth so there may also be outpatient appointments for your baby too, for example with a paediatrician. If your baby is admitted to hospital as an inpatient, it’s important to contact us as soon as possible to add them to your cover so they can be entitled to any benefits under your hospital policy. You can read more about this below.

This can be a little confusing, so contact us(opens in a new tab) for more information.

Informed Financial Consent is your right to know how much your treatment costs before you go to hospital. You can ask your doctor or obstetrician to provide a breakdown of the out-of-pocket costs you are likely to incur during your hospital admission.

For more, read our guide to informed financial consent

Is my baby included in my health insurance?

Your baby isn’t automatically added to your cover when they’re born. You’ll need to contact us as soon as possible to add them.

• If you’re on a single cover, you’ll need to change to a family or single parent family cover within two months of your baby’s birth.
• This change takes effect from your baby’s date of birth, and any difference in premiums applies from that date.
• If you add the baby as above, they will only need to serve waiting periods not already served by the Principal Member.

If you already have a family or single parent family cover when your baby is born you still need to add your baby to your policy, but you have up to 12 months to do this. So long as your membership existed at your baby’s date of birth, the same waiting period rules apply.

If your baby needs hospital treatment

In most cases, a healthy newborn isn’t separately admitted to hospital as an inpatient. This is because the baby usually comes under the mother’s hospital admission.

A baby is generally only admitted as an inpatient if:

• they need care in a special care nursery or intensive care unit, or
• they’re a second or subsequent baby in a multiple birth.

If your baby is admitted to hospital as an inpatient, it’s important to contact us as soon as possible to add them to your cover so they can be entitled to any benefits under your hospital policy.

What about doctors who see my baby in hospital?

If a doctor or paediatrician visits your baby in hospital, their service is usually billed as an outpatient service. In these cases, benefits are generally only payable by Medicare, not ahm.

However, if a paediatrician’s visit is billed as an inpatient service for an included item, and your baby has been admitted to hospital as an inpatient, ahm may pay benefits towards the visit, in line with your level of cover.

What if you have twins or multiple births?

If you have twins or more than one baby:

• You won’t be charged hospital accommodation for the first baby, unless one or more babies are admitted as an inpatient.
• You will be charged hospital accommodation for your second and any additional babies, so it’s important to make sure they’re added to your policy from birth.

Do babies have an excess or daily charge?

Your hospital excess and/or daily charge may apply for the mother and any babies who are admitted as inpatients, up to the applicable limit. Check your product guide to understand what limits apply to your cover.