Your health insurance may not cover you if your baby is born early

Ombudsman warns new mums of private health cover loopholes.

Health insurance is one of the things you need to think about well ahead of time if you’re planning to have a baby. After all, the last thing you want to worry about during a sleepless night is an expensive hospital bill.

Health insurers clamp down on new mums

The Private Health Insurance Ombudsman warns that while insurers used to be flexible if a baby was born early, this rarely occurs now.

Parents should be aware:

  • There will be a 12-month waiting period: If possible, take out a policy well ahead of getting pregnant.
  • The waiting period applies to the date you’re admitted to hospital for the birth.
  • You won’t be covered if you have a premature birth within the waiting period or even if you give birth only a few days before the end of the waiting period.
  • Mothers have been given the wrong advice by health insurers and expected they would be covered as long as the waiting period was served by the expected date of the birth of their baby.

    Different rules for baby

    So that your baby is covered you need to upgrade your policy to a family policy. If you have a normal birth and your baby is healthy, they usually won’t get admitted to hospital, so you may not need cover for them.

    But if your baby is born early, has any health issues or you have twins, they may need to get admitted to the special care nursery or intensive care. This can cost thousands of dollars.

    Parents should be aware:

    • Most funds require that you update your policy to a family policy one to three months before the birth of your baby.
    • Some funds may require you to upgrade your policy as early as 12 months prior to birth.
    • Children are covered for free: family policies are not more expensive than couple policies. However, if you’re a single parent you will pay more for a single parent policy than for a single policy.
    • Look for a policy that does not charge an excess for your baby, many insurers offer policies that only charge the excess for adults.


    • Look for a top cover private health insurance policy that does not apply the excess to children.
    • Take out private health insurance well ahead of getting pregnant.
    • Check with your health insurer how soon you need to upgrade to family cover so that your baby is covered.
    • Once you’re pregnant, check whether you have served the waiting period.
    • If you give birth before the waiting period is up, consider going to a public hospital as a public patient. Don’t worry, Australia has a world-class health system and public hospitals have excellent birthing facilities.

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