To be covered for having a baby, your Phoenix Health hospital cover will need to include Pregnancy & Birth, and the delivery of your baby will need to be after you’ve served the 12-month waiting period.

What happens if your baby comes early and you’re still within your waiting periods? If you are still within your waiting periods on the day you give birth, as long as the estimated date of delivery of your baby is after your waiting periods are up, then you’ll be covered by your Private Health Insurance. We’ll just need something in writing from your Obstetrician stating the estimated delivery date to confirm this.

What happens if you need a little extra help starting your family? Assisted Reproductive Services, including IVF, is covered separately to Pregnancy & Birth, so to be able to claim these services, you’ll need to make sure they are also included in your level of hospital cover, and you‘ve served the waiting periods.

Understanding waiting periods can be complex – the best and easiest way to understand them is to give us a buzz on 1800 028 817 or email [email protected] We will confirm with you all the technical health insurance stuff.

Pregnancy & Birth and Assisted Reproductive Services are covered under Phoenix Health Gold levels of hospital cover as well as Silver Plus Content Hospital.

There’s nothing more personal than your health and the health of your family, and as such where you give birth is a truly personal decision. So, do you go Private or Public?

One of the biggest advantages of choosing to be a private patient for the birth of your child, is you’ll get to see the same obstetrician throughout your pregnancy. It is also highly likely you’ll have a private room after the birth, and you’ll get to stay longer in hospital – giving you that added level of support, which is certainly comforting as you navigate those early days together with your baby.

We’ve put together the table below, to help you understand the difference between being a Private or Public patient, so you can make the best decision for you.

Private Patient
Public Patient
Waiting Periods
12 months
Practitioner Obstetrician or Midwife in a private practice of your choice Doctor or Midwife assigned to you by the public hospital – and might someone different at each visit
Antenatal Appointments Check-ups in private rooms Check-ups as an out-patient at hospital or with a GP
Fees payable by you prior to the admission for delivery The cost of appointments with your Specialists, tests and scans (may be partly funded by Medicare) and any out of pocket gaps your Specialists may charge Generally, none.
However, if your doctor doesn’t bulk bill or you have non-standard scans or tests, you will have additional costs to pay
Hospital You can choose a Private or Public Hospital. You may even choose a birthing centre Public Hospital
Room at Hospital You can stay in a private room – where one is available Shared Room in a Public Hospital
Birth Attendance Obstetrician, Midwives and Anaesthetist (if required) Public or Community Midwives and hospital Doctor if needed
Length of Stay Generally, 3-5 nights Generally, 1-3 nights
Hospital Accommodation Covered by private health insurance – you may have a hospital excess to pay (Depending on your level of cover) Covered by Medicare
Additional Fees payable by you Doctors’ fees above the Medicare Benefit Scheduled Fee (MBS) (See Section 1.5), your hospital excess (if you have one), personal items like newspapers, TV, pharmaceuticals provided on discharge or unrelated to the birth Likely none

Yes, you can choose your own Private Hospital! Phoenix Health has agreements with over 550 hospitals around Australia – so as long as your preferred hospital is on our list, you’ll be covered. It’s easy to check if the hospital of your choice is an Agreement Hospital Click Here

Yes, having the choice of who treats you is one of the biggest advantages of holding Private Health Insurance – after all it’s who you’re trusting with your health.

But how do you choose your Obstetrician? Maybe a friend has recommended someone, or you’ve found a Obstetrician through your own research. If you’re still looking, you can use our find a provider tool to find a Specialist or Obstetrician in your local area Click Here. You’ll also be able to see if the Obstetrician uses Access GAP Cover – which can reduce some of your out-of-pocket expenses for the delivery of your baby (See Section 1.8)

One thing to keep in mind is most Obstetricians only work out of certain hospitals, so you’ll need to have a discussion with them about where they practice and if it’s the hospital you have chosen.

The Medicare Benefit Schedule Fee (MBS) is a guideline fee the Government have set for doctors to charge for all medical procedures; think of it like a recommended retail price.

Phoenix Health and Medicare can only pay a benefit up to 100% of the MBS. Doctors will charge you whatever price they deem reasonable for your treatment and we have no say in how much or little they charge you. If your Obstetrician charges over the MBS, then the amount above the MBS fee will be an out-of-pocket expense that you will need to pay. This out-of-pocket may be reduced or removed if your Obstetrician elects to use our Access Gap Cover. (See Section 1.8)

Yes, by choosing to be a Private Patient for the birth of your child you will have out-of-pocket expenses.

On your first visit to your Obstetrician, they should supply you with what is known as Informed Financial Consent which in a nutshell is the list of the fees and costs they will be charging you for your treatment. Some of these fees will be partially covered by Medicare and some will be partially covered by Phoenix Health and Medicare. (See Section 1.7)

There will be charges for scans and antenatal appointments during your pregnancy that you won’t be able to claim through private health insurance. You should be able to claim a portion of these fees back through Medicare.

Once you’re booked in for the delivery of your baby, the hospital you have chosen will also advise you of any out-of-pocket expenses related to your hospitalisation (usually just your excess). You will not see a bill for the Hospital Accommodation, Theatre Fees or Labour Ward fees as the hospital will bill us directly for them.

If you have not served your waiting periods on the day your baby arrives then you will not be able to claim anything on your Private Health Insurance, this will mean you have significant out-of-pocket expenses

Informed Financial Consent is the list of fees and charges your Obstetrician will billing you for the management and delivery of your child.

The table below is an example of what may be contained in your Obstetrician Informed Financial Consent. Obstetricians all have different charges and fees, so if there is something on your Informed Financial Consent that you are unsure about either have a chat with your Obstetrician or give us a buzz on 1800 028 817.

Service Type Claimable Through How much is covered
Antenatal visits Medicare 85% of the MBS fee
Pregnancy Management Fees Medicare 85% of the MBS fee
Hospital Admission while pregnant Medicare & Phoenix Health 100% of the MBS fee
Delivery Fee Medicare & Phoenix Health 100% of the MBS fee

Anaesthetist or other Specialist Doctors fees are claimable if you’re admitted to hospital as in-patient, you’ll be covered for 100% of the MBS fee, anything above that much like your Obstetrician charges will be an out-of-pocket expense.

Remember Health Insurance can only pay a benefit towards Doctors’ or Specialists fees if you’re admitted to hospital as an in-patient. If you’re not admitted as an in-patient it will be billed as an outpatient service and likely to be partially covered through Medicare only. (See Section 2.2)

Access Gap Cover is an agreement between Phoenix Health and an Obstetrician or other Specialist Doctor, where Phoenix Health agrees to pay a higher benefit to the Obstetrician, and in return the Obstetrician limits the out-of-pocket to $800 or in some cases removes it altogether.

Access Gap

*Please Note – Access Gap only reduces or eliminates the out-of-pocket expenses for the Obstetricians and/or Anaesthetists for the actual delivery of your baby, it does not apply to any other out-of-pocket expenses

Access Gap Cover is available to any Obstetrician, however it is completely up to them to use it or not. Often, they assess the use of Access Gap on a case by case and patient by patient basis – so where they may use Access Gap for you, they may not for another one of their patients.

We recommend having a chat to your Obstetrician on your first visit and ask them if they will use the Access Gap Cover Scheme for you.

The Bumps and Bubs Program is designed to support you from the time you learn you’re expecting through the first three years of your baby’s life. We want you to feel confident and supported, so you can get back to enjoying the moment with your little one.

To learn more or enrol in the program simply Click Here