When you can claim on your Hospital cover
If you've been on your chosen baby-related Hospital cover for at least 9 months, you can skip this section and jump ahead to Hospitals.
If not, read on to learn about the waiting period situation. Using Pregnancy and birth as an example, waiting periods apply to people who:
- Get Hospital cover for the first time (or after letting their Hospital cover lapse)
- Upgrade to cover that includes Pregnancy and birth (from Hospital cover that didn’t)
- Upgrade to a higher level of cover for Pregnancy and birth (e.g. from 'restricted' to 'covered').
Here, we also discuss waiting periods for Assisted reproductive services and Miscarriage & termination, as we figure it’s important to share this info upfront.
Pregnancy and birth
The waiting period for Pregnancy and birth is 9 months. That means:
- If you just got Hospital cover you won’t be able to claim for any pregnancy-related hospital admissions until the 9 months is up
- If you upgrade to a higher level of cover – you won’t be able to claim your new higher level of benefits for 9 months.
In other words, for 9 months after upgrading:
- From 'not covered' to 'restricted', you won’t be able to claim at all
- From 'restricted' to 'covered', you’ll only be able to claim on your previous (restricted) level of cover.
Given how stressful even minor pregnancy complications can be, you can see why we strongly recommend getting onto your preferred Hospital cover well before you start trying for a baby.
When the waiting period is over
You’ll be covered for the birth of your baby and any hospital admissions for pregnancy-related conditions like:
- Severe morning sickness
- High blood pressure
- Placenta previa (a common condition when the placenta covers the cervix)
- Uncontrolled gestational diabetes
- Iron infusions.
Assisted reproductive services
The waiting period for fertility procedures (e.g. IVF) is either 2 months, or 12 months for members with pre-existing conditions*.
Miscarriage & termination
Miscarriage, or having to terminate a pregnancy, can be highly distressing. While health insurance is the focus here, we’ve included links to medical information and support services at the bottom of the page.
In terms of Hospital cover, Miscarriage & termination of pregnancy is:
- Covered on Top Hospital (Gold), Mid Classic (Silver Plus) and Mid Hospital (Basic Plus)
- Restricted on Basic Hospital (Basic Plus).
There’s a 2-month waiting period, and as we explain in Hospital cover, you can only claim towards inpatient treatment.
Please note that Miscarriage & termination of pregnancy is:
- Not covered on StarterPak (Basic Plus).
Pregnancy loss support
Trusted sources of information and support include:
- Pregnancy, Birth & Baby | 1800 882 436
- Sands Australia| 1300 308 307
- Red Nose Grief and Loss| 1300 308 307
*A pre-existing condition is an illness, ailment or condition where the signs or symptoms of which, in the opinion of a medical practitioner appointed by Nurses & Midwives Health, existed at any time during the 6 months before getting Hospital cover or transferring to a higher level of cover. This rule applies to new members and existing members who are upgrading their level of cover. If you’re new to private health insurance, you’ll have to wait 12 months before you can receive benefits for items or services related to a pre-existing condition. If you change to a higher level of cover, you may have to wait 12 months to receive benefits, including those for services not previously covered. A 12-month waiting period applies to all pre-existing conditions except pregnancy & birth-related services (which is 9 months) and psychiatric, palliative care and rehabilitation (which are 2 months).