What if I’m having a baby?
Pregnancy’s an exciting time, but also full of questions. Between
the internet and everyone’s “helpful” advice, it can be a bit of an
information overload. We want to make this time as easy as
possible, so we’ve put together all the FAQs we get – from before
bubs is born to when you leave hospital.
Before your baby is born
First things first...
Let’s think about your level of cover. The most important thing to
keep in mind is waiting periods. If you’re new to health insurance
or upgrading your cover, pregnancy and birth related services
have a 12 month waiting period. This means you’ll need to think
about your level of cover before you get pregnant.
You’ve got two options for having your baby in hospital:
Premium Hospital
If you’d rather go to a private hospital, you’ll need our Premium
Hospital cover. You’ve got the option of no excess, a $250 excess
or a $500 excess with this cover.
Mid Hospital
If you’re happy to go to a public hospital as a private patient, this
cover is for you. You’ll have a $500 excess, which is halved when
you’re admitted to a public hospital (so it’ll only be $250 when
you’re admitted to have your baby). If you’re admitted to a
private hospital to have your baby you’ll have large out-of-pocket
costs.
There’s no cover for pregnancy or birth related services with our
Basic Hospital cover.
There are also some out-of-hospital services (like pre/post-natal
classes) that are only covered by extras. For these services, you’ll
also need our High, Premium or Gold Extras cover.
What if I have a midwife deliver
my baby instead of an obstetrician?
You can have both if you like, but you can
only claim for one while you’re in hospital.
If you have an obstetrician
While you’re in hospital, Medicare will cover
75% of the scheduled fee, and we pay the
remaining 25%.
It’s important to know that doctors and
hospitals can charge above the scheduled
fee, and anything over it is your
out-of-pocket cost. Your doctor should let
you know about any out-of-pocket costs
before you go to hospital.
If you have a midwife
If you have your baby in hospital using a
midwife, Medicare will cover 75% of the
scheduled fee and we pay the remaining
25%. In most cases, Medicare will cover the
cost of a midwife if you have your baby in a
public hospital. Most private hospitals will
only admit you if you have an obstetrician.
Having your baby at home using a midwife
is an outpatient service, which means you’ll
need to have High, Premium or Gold Extras
to receive a benefit.
Whether you choose a midwife or an
obstetrician, there’s a 12 month waiting
period for these services.
Can I claim on birthing classes or pregnancy aids?
These can be claimed if you’ve got High, Premium or Gold Extras cover.
Ante/post-natal services are out-patient services and need to be provided
by a physio, chiro, registered nurse, midwife and/or childbirth educator.
What are the waiting
periods?
There is a 12 month wait on these services if you’re new to or have just
upgraded your cover.
Who covers the cost of my obstetrician appointments?
These appointments are paid for by you and Medicare. Your obstetrician will tell you
how they’ll bill you – either as a lump sum or charge per visit. If your obstetrician
charges more than what Medicare pays you will have out-of-pocket costs (known as
a gap payment). If you’re going to have out-of-pocket costs, your doctor should tell
you exactly what they will be (this is called Informed Financial Consent).
All pregnancy & birth
related services have a 12
month waiting period. This
means that if you’re
already pregnant when
you take out hospital cover,
you and your baby won’t
be covered - either for the
birth or any hospital
admissions while you’re
pregnant.
1800 808 690
Want more info? Give us a buzz!
What am I covered for during my hospital stay?
Are there any other costs I should expect?
When you’re admitted to hospital, you’ll generally have a few
different bills.
Hospital bills
These include things like accommodation and theatre fees. We
pay these bills for you if you have Premium or Mid Hospital cover.
Medical bills
These are for specialists who see you while you’re in hospital, like
obstetricians and anaesthetists. Between us and Medicare, you’ll
be covered for the full Medicare Scheduled Fee for these bills (as
long as you have Premium or Mid Hospital cover and have served
your waiting periods, of course).
Doctors and hospitals can charge above the Medicare Scheduled
Fee, and anything above it is your out-of-pocket cost. You should
be told about any out-of-pocket costs you’ll have before being
admitted to hospital (this is called Informed Financial Consent).
Additional service bills
These are for extra services like TV, a double bed, extra meals, etc.
while you’re in hospital. You pay the full cost of these extras.
It’s important to remember that there can be other out-of-pocket
costs when you go to hospital, even if you’ve got top hospital
cover. They can be:
• Your excess (if you have one)
• Pharmacy items that you’re given to take home with you (which
you might be able to claim separately if you’ve got extras cover)
The best way to avoid out-of-pocket shocks is to give us a buzz if
you’ve got a hospital stay coming up!
What’s a gap payment?
A gap payment is the difference between
the Medicare fee and what your doctor
actually charges. Peoplecare offers the
Access Gap scheme, which aims to give
you low or no gap payments. We have an
Access Gap agreement with over 30,000
doctors, but it’s up to the doctor on a
case-by-case basis whether they’ll take
part or not.
Ask your obstetrician whether they’ll take
part in Access Gap for your appointments.
If they do, they’ll bill us directly and you
won’t have to worry about a thing (except
your new arrival, of course).
What about any tests during
pregnancy?
Tests during your pregnancy are usually
done by your doctor or at a private
clinic (not as an in-patient in hospital),
which means they can only be claimed
through Medicare. These tests will usually
have out-of-pocket costs.
If you’re admitted to hospital to have
tests, we’ll be able to pay a benefit
(along with Medicare).
There might be some tests you can
claim through extras cover (if you have
it), so give us a buzz if you have any tests
that you can’t claim through Medicare.
The big arrival
What is an excess? Will my baby or I have one?
An excess is the amount you’ve agreed to pay if you’re admitted to
hospital. Lots of people choose to have an excess on their hospital
cover so their membership payments are lower.
An excess is only paid once per adult in a financial year, so no matter
how many times you’re admitted in that year you’ll only have to pay
your excess once. If you’re admitted to a public hospital or day stay
facility, your excess is halved (and in these cases you’ll need to pay
the other half of your excess if you’re admitted a second time).
And there’s no excess for kids under 21, so you won’t have to pay
any additional excess for bubs.
What if I have an epidural? How much will that cost
me?
Epidurals are included in your anaesthetist’s bill, which we will
pay towards. Like all medical bills, Medicare pays 75% of the
Medicare Scheduled Fee and we pay the remaining 25%.
If your anaesthetist charges more than the Medicare Scheduled
Fee you’ll have some out-of-pocket costs and your anaesthetist
should tell you what they’ll be.
What if my baby comes
early?
If you’ve served your 12 month
period, you’ll be covered for the
birth of your baby no matter when
they arrive (as long as you’ve got
Mid or Premium Hospital cover).
If you haven’t served your 12
month waiting period, you and
your baby won’t be covered.
1800 808 690
Want more info? Give us a buzz!
What about any tests that my baby has during the
hospital stay?
Unless your baby’s admitted to special care (and we hope
they’re not!) they’re not considered an in-patient, so any tests
or doctor visits can only be claimed through Medicare.
If your baby is admitted to special care, we’ll be able to pay
towards their tests and doctor visits (as long as you’ve served
your 12 month waiting period).
What if my baby needs special
care?
When your baby’s home
Babies are usually admitted to a public
hospital if they need special care, which
means they’re covered by Medicare. If
your baby is admitted to a private hospital,
we’ll be able to cover them as soon as you
add them to your membership (as long as
you’ve got Mid or Premium Hospital cover
and have served your 12 month waits).
When should I add my baby to my Peoplecare membership?
And how do I do this?
To make sure everyone’s covered, it’s best to let us know within 30 days of
bub’s birth. We know how busy having a newborn can be though, so as
long as you let us know within 3 months of the birth your baby won’t have
to serve any waiting periods (as long as you’ve served yours).
You can let us know about your new arrival by phone, email or by
updating your membership online at peoplecare.com.au/oms.
What about any
post-natal classes?
If you’re adding your baby to your membership after 3 months from their
birth, bub will be covered from the date they’re added (not their date of
birth) and will need to serve waiting periods if you haven’t served yours.
These can be claimed if
you’ve got High, Premium
or Gold Extras cover.
If you’re on a family membership and you add your baby within 3 months
of their birth, they’ll automatically be covered with no excess or waiting
periods (as long as you’ve served yours).
If you’re on a couple membership and you add your baby within 3 months
of their birth, you’ll automatically move to a family membership. There’ll be
no difference to your membership payments and your baby will be
covered with no excess or waiting periods (as long as you’ve served yours).
If you’re on a single membership you’ll need to upgrade to a family or
single parent family membership within 3 months of your baby’s birth. This
will increase your membership payments, but once you’ve paid the
difference your baby will be covered with no excess or waiting periods (as
long as you’ve served yours).
Post-natal classes are
out-patient services and
need to be provided by
a physio, chiro, registered
nurse, midwife and/or
childbirth educator.
What about any
post-natal check-ups
with my doctor?
If you’re moving to family or single parent family membership, you might
have to make a back-payment to cover your baby within the first three
months. Please note that we can’t back-date cover after 3 months from
their birth.
Once you’ve taken your
baby home, check-ups
with your doctor are
covered by Medicare only.
All info is based on the 12 month waiting period for pregnancy & birth related services.
If you haven’t served this waiting period, you won’t be covered for these services.
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Make sure you also let Medicare know you have a new addition to your
family. This will make sure everything runs smoothly if your bub needs to
make a visit to the hospital for any reason.
1800 808 690
Want more info? Give us a buzz!
Who pays what...
Service
Pregnancy & birth-related
services while you’re admitted
to hospital (these are things
like accommodation, theatre
fees, doctors’ and specialists’
services during the birth, etc.)
Peoplecare
Hospital cover
Premium
Hospital
Mid
Hospital
Basic
Hospital
Extras cover
Premium Extras
High Extras
Mid Extras
Basic Extras
Gold Extras
Silver Extras
Bronze Extras
Pregnancy & birth-related
services outside of hospital
(things like standard doctors’
appointments, scans and
tests)
Medicare
Public hospital
as a public
patient
You
Your excess if
you’ve got one,
additional
services,
incidental fees,
etc.
Any gap
Up to 85% of the between what
Medicare
Medicare
Scheduled Fee
pays & what the
doctor charges
Premium Extras
High Extras
Mid Extras
Basic Extras
Gold Extras
Silver Extras
Home birth
Bronze Extras
Ante/post-natal services
Premium Extras
High Extras
Mid Extras
Basic Extras
Gold Extras
Silver Extras
Bronze Extras
Pregnancy aids (if provided by
a physio)
Premium Extras
High Extras
Mid Extras
Basic Extras
Gold Extras
Silver Extras
Bronze Extras
Premium
Hospital
Mid
IVF services (see IVF Fact Sheet
Hospital
for more info)
Basic
Hospital
Premium Extras
High Extras
Mid Extras
Basic Extras
Gold Extras
Silver Extras
Bronze Extras
Up to the
Medicare
Scheduled Fee
^R – this is a restricted service under Mid Hospital cover, which means you’re covered as a private patient in a public hospital only. If you’re admitted to a
private hospital for pregnancy or birth related services under this level of cover, you’ll have large out-of-pocket costs.
Please also keep in mind that there can be restrictions, excesses and limits on any of these services, depending on your
level of cover.
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IMPORTANT: There could be out-of-pocket costs on any of these services that you’ll need to pay for yourself. Your doctor
and other providers should tell you about any out-of-pocket costs that you’ll have (this is called Informed Financial
Consent). If you’re not sure, give us a buzz and we’ll help you work through it.