Understanding the costs of having a baby

What your health insurance pays for when it comes to pregnancy.

Written by Editor Medibank

Having a baby is a joyful time. There is a lot to get excited about, but there’s also a lot to plan for and consider, including the financial implications of bringing a little person into the world. We know that the costs of having a baby in a private hospital can be complicated to understand, and we want to provide you with as much information as possible so you know what to expect.

Your hospital costs when having a baby can be broken down into services you receive when you are admitted (in-hospital and medical treatment), and services you receive as an out-patient (out-of-hospital medical services or extras treatment).

In-hospital and medical treatment costs for having a baby

In-hospital treatment refers to all the services you receive when you are admitted to hospital to have your baby. If your cover Includes private obstetrics, and you’ve served your waiting period, Medibank will pay benefits towards your care in a private hospital.

Ask for Informed Financial Consent

Informed Financial Consent is a way for you to find out exactly how much your in-hospital treatment will cost, so that you can agree to it before it happens. Before you are admitted to hospital, your doctor or obstetrician should provide a breakdown of all out-of pocket costs you are likely to incur during the hospital admission. Make sure that you obtain an Informed Financial Consent and agree to it before you finalise your choice of hospital and obstetrician.

How to reduce your out-of-pocket expenses for pregnancy

To help reduce out-of-pocket expenses for our members, Medibank has entered into agreements with a number of private hospitals across Australia as part of our Members’ Choice network. This means that by visiting a Members’ Choice hospital you’ll get better value for money compared to a non-Members’ Choice private Hospital.

How do I find out which hospitals are part of Medibank Members’ Choice?

To find a Members’ Choice hospital visit

It’s important to be aware that Medibank’s agreements with Members’ Choice hospitals are subject to change.

Ask about our GapCover Scheme

Our GapCover Scheme has been designed to minimise your out-of-pocket expenses. When you go to hospital, there is usually an extra amount between the fee your doctor charges you and the total benefits you receive from Medicare and us. The GapCover scheme can help close this gap amount. To find out more please call us on [132 331](tel: 132331).

How do I find out which doctors are part of Medibank’s GapCover Scheme?

To find a GapCover Scheme hospital visit
It’s important to be aware that it is up to the provider whether they want to participate in GapCover and their decision can be made on a case-by-case basis. Please contact your provider to discuss this prior to seeking treatment.

Ensure your newborn is covered for in-hospital treatment

Generally, a healthy newborn is not admitted to hospital as an inpatient. Because the baby is not an in-patient, 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 cannot pay any of these benefits. This means you will only be eligible to claim a Medicare rebate for those services and may incur out-of-pocket expenses.

In some cases, a newborn may need to be admitted to hospital in their own right, e.g. if they require treatment in a special care nursery or an intensive care unit. To make sure your newborn is covered in the event you need these services, we strongly advise you to add your baby to your membership from their date of birth. If a newborn is not added within Medibank’s required timeframes (2 months from date of birth), you will be responsible for any costs associated with their admission.

Out-of-hospital costs and extras treatment

Out-of-hospital/extras treatments are services you receive as an out-patient, e.g. ultrasounds and scans. All private health insurance funds, including Medibank, are not permitted to pay out-of-hospital medical services when a Medicare rebate applies. The table below shows what Medibank can pay benefits towards and any costs you may incur during your pregnancy journey.

Listen now for tips on choosing the right cover for mums-to-be.

Written by Editor Medibank

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