Private health insurance: what does it cover?

Many women come to me confused about their private health insurance and what it covers.  There are two types of private insurance: hospital cover and extras cover. 

Hospital cover covers procedures that are performed in hospital.  Hospital cover does not cover the consultations or events leading up to the hospital care admission. 

Extras cover covers things such as dental, optical, physio, dietetics and so on. 

You may have hospital cover on its own; extras cover on its own; or both hospital and extras cover.

When you choose private midwifery care, there are three aspects to your care: pregnancy care, birth care and postnatal care.

Pregnancy care involves consultations.  You are not admitted to hospital, so you cannot claim this aspect of your care through your hospital cover. In stead your midwife will provide you with a receipt for your consultations and Medicare will provide benefits towards the fees that you have paid.

The next part of your care is the birth, which would either take place in your home or in hospital..A few funds will provide benefits for home birth; most will not, and Medicare doesn't either.  Hence, for most families, the cost of the birth itself is met 100% by the family.   Assuming you have private health hospital cover and you give birth in hospital, your health fund will cover the costs for your birth and hospital stay.

The final part of care is the postnatal care, and as with pregnancy care, it concision of consultations.  As you are not admitted to hospital for these appointments, you cannot claim them through your private health insurance.  Rather, Medicare provides benefits towards these services.

Visit my website to learn more about private midwifery care.