Private health insurance for women’s health

Gold hospital cover (and some lower tier ‘plus’ policies) can include benefits for pregnancy and birth-related services, like contributing towards the cost of private inpatient hospital care during your pregnancy, accommodation, labour ward costs and doctors’ fees. While hospital insurance doesn’t cover consultations before you’re admitted to hospital as a patient, you can claim a portion of these costs through Medicare.

When you give birth in a private hospital, you can choose your own obstetrician, see the same doctor throughout your pregnancy and recover in a private room (if available). Women treated in a private hospital also get to spend more time on average recovering in hospital before they have to go home.³

There is a 12-month waiting period before you can claim on inpatient hospital expenses relating to pregnancy and birth-related services, so it’s vital to take out cover before you start trying if you want your health fund to contribute towards your private care.

You can also access many valuable out-of-hospital health services for your pregnancy through an eligible extras cover. This includes birthing and breastfeeding classes, pre- and postnatal midwife visits and sleep settling consultations. Physiotherapy is another helpful extras service for women who have experienced pregnancy complications resulting in back pain, pelvic pain or incontinence.

If you have a hospital insurance policy that includes assisted reproductive services, you may be able to claim a benefit on inpatient treatment to help you fall pregnant such as in vitro fertilisation (IVF) and gamete intrafallopian tube transfer (GIFT).

If you have a genetic condition that you’re concerned about passing on to your children, you may be able to receive genetic testing to assess the genetic makeup of your embryos before they’re implanted for conception.

There’s also a 12-month waiting period you’ll have to serve before you can claim on these services, so make sure you take out cover well before you plan on trying for a child.

If you’re not planning on having a child or are finished having children, there are other benefits of private health insurance that you might be interested in. For example, certain extras policies will pay a benefit towards some of the cost of prescribed contraceptives for a medical purpose from a pharmacy. This is beneficial if you require a more expensive contraceptive that isn’t on the government’s Pharmaceuticals Benefits Scheme (PBS).

Termination of pregnancy is also an option available to women through private health insurance. However, the specific laws surrounding termination of pregnancy do differ between states, so you’ll want to discuss your specific circumstance with your general practitioner, as you may need the approval of a second doctor, depending on your circumstances.⁴

While the public health system does provide cancer treatment, a private hospital policy means you can:

• Avoid public waiting lists
• Choose your preferred doctor if they’re available on your treatment dates
• Be treated in a private room (if one’s available).

Some cancers are specific to or generally far more common in women, including cervical cancer, ovarian cancer and breast cancer.

The level of health insurance you may require is influenced by which part of the body is affected by cancer. The higher tiers of hospital cover (i.e. Silver and Gold) are generally the best options for peace of mind when it comes to including cancer treatments in your policy, as they include any area of the body that may be impacted.

Yes, you can still get cover if you’ve been diagnosed with a pre-existing health condition, and your coverage will not cost more because of it. However, you’ll typically have a 12-month waiting period before you can claim on inpatient hospital treatment relating to your pre-existing condition.

Waiting periods for hospital insurance are set by the Australian Government and vary depending on the treatment. These waiting periods are the same across all health insurance providers, regardless of sex.

Waiting periods for extras cover vary between insurers and will generally be 2 months, 6 months or 12 months, depending on the treatment. Some services, like hearing aids, may attract even longer waiting periods, so read your policy document carefully.

If you’re moving from a single policy to a single parent policy or family policy, there will be a price increase.

The good news is that adding dependent children to your existing family policy doesn’t cost extra. Although, you may need to pay more for adult dependants who aren’t studying.

Dependants can typically be insured up to 21 to 25, depending on the health fund and whether your child is studying, employed full-time or married. This is up to the insurer, who can implement their own age range from 18 to 31.

If you want to buy health insurance to help cover medical expenses, there are a few factors that might impact your decision on when you should take out cover:

• Age-Based Discounts. Introduced by the Australian Government in 2019, the age-based discount applies to adults aged 18 to 29. Should the insurer offer the discount (which is optional), you could save anywhere from 2% to 10% depending on your age when you take out an eligible product.
• Lifetime Health Cover (LHC) loading. If you take out hospital cover by 1 July following your 31st birthday and maintain cover, you’ll avoid paying more via the LHC loading.

These initiatives are designed to encourage Australians, whether they’re men or women, to take out health insurance earlier in life.

There are also other incentives for cover, such as:

• The Private Health Insurance Rebate, which helps reduce the cost of your insurance for eligible members
• The Medicare Levy Surcharge (MLS) is an extra cost payable at tax time if you don’t have private health insurance and earn above $97,000 as a Single or $194,000 as a Couple/Family.