Health Insurance doesn’t play a massive role in the early stages of your pregnancy – as during this time, most of the treatments and bills you receive will be for out-patient services, and not claimable through your private health insurance. You should check these bills with Medicare though as you may receive a benefit through them.

In-patient services are received whilst you’re admitted into hospital.
If you’re admitted as a private patient, as long as the treatment you receive is included with your Hospital Cover, then you will be able to claim up to the Medicare Benefit Schedule Fee (MBS). (See Section 1.5).

For example, when you go to hospital for the delivery of your baby, you’ll be admitted as an in-patient, so any treatment you receive during that admission (as long as they are Medicare recognised) will be considered an in-patient service and will be claimable under private health.

Out-Patient services are treatments received outside of a hospital admission.
Any treatments you receive as an out-patient are not claimable under private health. Out-patient services are generally claimable through Medicare.

For example, during your pregnancy you’ll have numerous check-ups with your Doctor and or Midwife, as well as blood tests and scans. Unless you have been admitted to hospital as an inpatient, these services will be considered out-patient.
Did you know… that if you ever need to go to the emergency room of a private hospital, any services you receive will be considered out-patient services and will not be claimable through Private Health Insurance. This includes if there is a facility fee charged – this will become your out-of-pocket cost.

During your pregnancy you’re likely to lose count of the number of check-ups, blood tests and scans you’ll have – so it’s important to know what you can and can’t claim through your private health.

Any scans or tests you have in the Doctor’s rooms, or at a pathology centre are considered an out-patient service and are not claimable on your Phoenix Health cover. You should receive a benefit through Medicare though, so if you receive an invoice, get in touch with them.

Should you need to have any pathology tests (including blood tests etc) done whilst you’re admitted to hospital for the birth of your baby, these will be covered under your hospital cover as you’ll be considered an in-patient.

Depending on your level of Extras cover, you may be able to claim on and treatments that will help support your health throughout your pregnancy and birth journey.

Physiotherapy may help to improve back and neck pain as well as assist in maintaining and improving pelvic floor and abdominal strength.
Massage, Chiropractic and Acupuncture may help to improve back pain and assist in posture.

Dietician services can assess your medical dietary needs and can help with common pregnancy matters like Gestational Diabetes, lactation issues, nausea and weight management.

If you don’t have Extras cover, most general extras only have a 2-month waiting period, so you may be able to claim for services like those above sooner. To find out more about Phoenix Health Extras and how to claim, Click Here

As a Phoenix Health member you get exclusive access to the Phoenix Health Rewards which has special online offers and discounts, including 10% off at Amcal Pharmacies online – so you can stock up on those pre-natal vitamins and nappies. Start saving now! Just log in to your Online Member Services Click Here and then click on Phoenix Health Rewards. If you have the Phoenix Health App you can get to your rewards program there too!