Planning for pregnancy?

No, they’re not. To ensure your little one is included in your hospital cover, please call us as soon as possible after they’re born to add them. If you’re on a singles policy, you’ll need to add your baby to your cover within two months of their birth to avoid them having to serve all applicable waiting periods. If you are on a couples or family policy, you have 12 months, but it’s a good idea to ring and add your baby ASAP so you don’t forget. If the baby is added within these timeframes, then your baby will only need to serve waiting periods that haven’t yet been served. If your baby is not added within the required timeframes, you will be responsible for any costs associated with their hospital admissions.

If you’re planning on starting or extending your family, it’s important to know there is a 12-month waiting period for pregnancy and birth services on hospital cover. This means you’ll need to have had pregnancy and birth services included on your hospital cover for at least 12 months before we’ll pay towards any hospital admissions related to your pregnancy and birth. Remember babies can come early, so take this into account when you start planning your family.

If you’re joining Medibank from another Australian health fund, you may not need to re-serve waiting periods for services you’ve already served.³

Before you go to hospital, ask each specialist and your hospital for a written breakdown of all the costs so that you can understand and agree to it before you receive any treatment. This is known as ‘Informed Financial Consent’. The breakdown should list the fees for each specialist involved in your treatment – for example, your obstetrician and anaesthetist if you have one – and any other related costs.

The only way to know for sure is to ask each doctor upfront if they’ll participate in Medibank’s GapCover for each claim as part of your treatment. You can search for doctors who have previously participated in Medibank’s GapCover at medibank.com.au/provider or call us on 132 331. GapCover doesn’t cover all medical services, and specialists can choose whether or not to participate in GapCover for part, or all of your treatment. So even if a doctor has participated in GapCover before, you’ll need to check that they’ll do it in each case. If you’re being treated by more than one doctor (e.g. obstetrician and anaesthetist), you’ll need to check that each individual doctor will participate.

GapCover doesn’t apply to pathology and radiology services, out-of-hospital medical services and services not included under your policy. GapCover also doesn’t apply to things such as any applicable excess payment and per-day payment. You may still have out-of-pocket costs. See your Member Guide for more information.

Although private health insurance will pay benefits towards the in-hospital services you receive during your pregnancy, you may still have out-of-pocket expenses to pay.

For inpatient medical services, Medicare pays 75% of the Medicare Benefits Schedule (MBS) fee for your obstetrician, anaesthetist and any other doctors, as well as any diagnostics billed with an MBS item number (e.g. x-rays or lab tests) while you’re admitted to hospital. Medibank pays the remaining 25% of the MBS fee (as long as you’ve served any relevant waiting periods).

Keep in mind that some doctors charge rates that are higher than the MBS fee for a particular service. When this occurs, you’ll have to pay the difference — this is known as the ‘gap’. You can reduce or eliminate these out-of-pocket expenses by choosing doctors who agree to participate in Medibank’s GapCover.

Another consideration is what hospital you attend. Medibank has arrangements with most private hospitals and day surgeries in Australia — these are known as Members’ Choice hospitals. You’ll generally get better value if you go to one of these providers. If you’re treated at a non-Members’ Choice private hospital, we’ll generally pay lower benefits and you may incur significant out-of-pocket expenses. Where you’re treated as a private patient in a public hospital, we’ll pay benefits towards overnight and same day accommodation in a shared room.

You may also have out-of-pocket expenses for any services your baby receives. Generally, a healthy newborn isn’t separately admitted to hospital as an inpatient (this is because the baby comes under the mother’s admission). Because the baby isn’t an inpatient, it’s important to be aware that any treatment, tests or doctor’s visits (e.g. a pre-release check-up by a paediatrician) are outpatient services, for which Medibank doesn’t pay any benefits. This means you’ll only be eligible to claim a Medicare rebate for those services and may have out-of-pocket expenses.

We recommend that you talk to your obstetrician, the hospital and Medibank about what costs you can expect and how you can reduce them.

For more on this topic read our article: Understanding the Costs of Having a Baby