Planning a family

If you are planning a family and would like to be covered for pregnancy and birth related services in a private hospital with the obstetrician of your choice, you will need to make sure you have an appropriate level of Hospital cover. Since there is a nine month waiting period for these benefits, you will need to sign up (or upgrade your existing membership) well before you decide to fall pregnant.

Your Hospital cover only covers treatments you receive during your hospital admission, which means that any out-of-hospital medical expenses incurred throughout your pregnancy (scans, obstetrician appointments, blood tests etc.) will not be covered by your private health insurance.

You can check to see if any costs are covered by Medicare as you may become eligible for additional benefits with the Medicare Safety Net, which is designed to help families and individuals with high out-of-pocket costs associated with out-of-hospital Medicare Benefits Schedule (MBS) services.

Once you meet the Medicare Safety Net threshold, you may be eligible for additional Medicare benefits for out-of-hospital MBS services for the rest of the calendar year.

You can register for the Medicare Safety Net so Medicare can track your out-of-hospital, out-of-pocket expenses and advise you when you are nearing the threshold.

For more information, please read the Pregnancy Guide or contact Medicare.

Choose the right level of cover

  • Top Hospital - Nil, 300, 500

Note: There is a nine month waiting period for pregnancy and birth related services, so make sure you have held Top Hospital cover well before you start trying to conceive.

Choose an Obstetrician

Your GP can provide you with a list of obstetricians in your area and once you have made your selection, you should check that the hospital you plan to deliver your baby in holds an agreement with Teachers Health Fund or you may find yourself with significant out-of-pocket expenses.

Ask about Access Gap Cover and get a quote

Your obstetrician can provide you with a quote so that you are fully aware of the charges you will incur throughout your pregnancy.

Remember that any service you receive when you are not admitted to hospital may only be partially covered by Medicare.

You can also ask your obstetrician if they will bill you under the Access Gap Cover scheme, a billing scheme that aims to reduce or eliminate out-of-pocket expenses associated with doctor and specialist services received in hospital.

Doctors may choose to participate in AGC on a patient-by-patient basis, so you should discuss this option with your doctor to potentially eliminate or reduce any out-of-pocket expenses.

Don’t forget to add your new baby to your health cover within two months of the birth so that all waiting periods can be waived.