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Private Health Waiting Periods


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14 replies to this topic

#1 baileybunny

Posted 08 January 2012 - 12:58 PM

I was just curious, as most private health funds have a 12 month waiting period for pregnancy/obstetric benefits-

what happens say if I signed up for private health now, then in 3 months time got pregnant, meaning the due date would be somewhere around mid-Jan 2013 (meaning I would have served the 12 month waiting period based on the due date).

Lets say bub did not go 40/41 weeks but instead decided it was time to come at 30 or even 35 weeks.

Would this mean I would not get private health cover, because I would not have reached the waiting period when bubs was born, or because the 40 week due date was past the 12 month waiting period I would be covered?

I hope that all makes sense...just something I was thinking about. Ideally I suppose people would generally line up their private health cover that includes pregnancy maybe 18 months before they expected their baby to be born just to be on the safe side??

#2 mez70

Posted 08 January 2012 - 01:07 PM

To be blunt YOU would not be covered until the 12 waiting period has been served even if bubs was due after that date but came early... Some funds may pay a benefit if bubs was born prem but I certainly would not be relying on that occuring as the 12 mth is a Govt legislated rule that health funds need to stick to. If the bubs was admitted in it's own right and you had family coverage the BABY and babys costs alone would be covered.

The other thing to remember is any hosp during pregnancy will not be covered so if you have really bad morning sickness and need to be admitted, or complications requiring hosp bed rest that will not be covered either..

Edited by mez70, 08 January 2012 - 01:08 PM.


#3 geishagirl

Posted 08 January 2012 - 01:16 PM

La trobe have a 9 month wait period. Not true that 12 months is government legislated.

#4 mez70

Posted 08 January 2012 - 03:18 PM

Unless there have been changes to the National Health act or what ever it was called in the past few years it used to be 9 months and there were way to many borderline cases. It then got changed out to 12 mths to avoid this scenario. From memory Funds were able to pay Private Patient Public Hosp benefits between 9 and 12 mths so there could be fine print in Latrobe's coverage or if they are paying after 9 mths they are walking a fine line. Basically when I was in the PHI field we always said 12 mths ... Two years is often a benefit limitation on lower dollar coverages. If you are thinking of having kids and using PHI you need to get you covered ASAP to start serving your wait times, you can always add dH once you get the BFP or in the first few mths of pregnancy as most funds require membership to be a family one Prior to bubs birth for bub to be covered.


#5 pinkelephant

Posted 08 January 2012 - 04:41 PM

Hi OP

I'm with HCF and when I was asked this question they told me that they go by the due date of the baby, so if you do have bubs early you are still covered.  Best to ring around a few PHI's and ask them.

#6 Futureself

Posted 08 January 2012 - 04:46 PM

Perhaps it depends on your fund - mine goes by the due date and if early, an authorising letter from the OB was needed stating the due date in order to be covered. If Private is important to you then I would get it ASAP to ensure you're covered, not just for the birth but other benefits like fertility treatments if needed, acupuncture, pregnancy massage etc which are a great benefit of PHI too.


#7 StudyMum

Posted 08 January 2012 - 05:19 PM

I'd say that it must be ok after 9 months as I am with one of the major health funds that has a 12 month obstetric waiting period and I fell pregnant (a surprise baby!) about a month after we got new insurance. When I rang up to cancel my insurance (as I was contemplating a change to Latrobe as they honor any waiting period already served and have a 9 month waiting period) my current insurer changed my waiting period to 9 months. I'd say it is at the discretion of the insurer if they insure you after 9 months.

Edited by StudyMum, 08 January 2012 - 05:19 PM.


#8 Dylan's Mummy

Posted 12 January 2012 - 01:22 PM

I work for a health fund.  With us, as long as the baby is due on or after the date that the 12 month waiting period ends, we will cover it.  We do request an EDC (estimated date of confinement) certificate and make a determination about it and this can be done before the baby is born.  You'll need to contact your fund to see what their policy is.

#9 Bluenomi

Posted 12 January 2012 - 01:28 PM

Also check the fine print. Some funds have a 12 month waiting period but that is for a private patient in a public hospital. A private hospital sometimes has a 24 months waiting period.

#10 SeaPrincess

Posted 12 January 2012 - 01:35 PM

QUOTE (mez70 @ 08/01/2012, 11:07 AM) <{POST_SNAPBACK}>
The other thing to remember is any hosp during pregnancy will not be covered so if you have really bad morning sickness and need to be admitted, or complications requiring hosp bed rest that will not be covered either..


This is a really good point. I spent a total of nearly a month in hospital with 3 separate admissions while pg with DS2, all of it well before his due date - PHI paid out $500/day just in accommodation, and where we were living at the time, I definitely wouldn't have wanted to be in a shared room in the public system.  While you hope nothing will go wrong, you can't rely on that.

R

#11 Roselet

Posted 13 January 2012 - 08:34 PM

Definitely a read the fine print issue. I did loads of research when I was looking at changing funds and some definitely allowed the 12 months to be due date and still covered you if you were prem. But I'm pretty sure that wasn't true of all funds.
Good luck wtih your research.

#12 baileybunny

Posted 14 January 2012 - 08:07 AM

QUOTE (mez70 @ 08/01/2012, 01:07 PM) <{POST_SNAPBACK}>
The other thing to remember is any hosp during pregnancy will not be covered so if you have really bad morning sickness and need to be admitted, or complications requiring hosp bed rest that will not be covered either..


I never thought of this,,thanks for bringing it to mind. I wonder then if you could get admitted at a public hospital for things like premature labour, morning sickness etc, even if you weren't registered/booked in with the public hospital...and then only use your private hospital/ob or go there if you know you are definitely covered and had now exceeded the waiting period...?

#13 chookymonster

Posted 17 January 2012 - 09:35 PM

QUOTE (baileybunny @ 14/01/2012, 09:07 AM) <{POST_SNAPBACK}>
I never thought of this,,thanks for bringing it to mind. I wonder then if you could get admitted at a public hospital for things like premature labour, morning sickness etc, even if you weren't registered/booked in with the public hospital...and then only use your private hospital/ob or go there if you know you are definitely covered and had now exceeded the waiting period...?


I don't know if that would work but if you do that, you will not be seeing your private OB, and they might not have a full history of your pregnancy so, if you have early complications, not sure if you want to risk that?

#14 stella777

Posted 19 January 2012 - 01:56 PM

Hi OP
as PP's have said it is best to check with the fund you are with. I was initially with MBF and they only covered from the day the baby was actually born (not the expected due date). I ended up switching to Medibank Private as they would cover me from the expected due date as long as the doctor could provide proof that the baby arrived before it's due date. I was in your hypothetical situation, with twins due only a few weeks after I had served my waiting period, and as I knew there was a high probability they may arrive early I switched. As long as you have held equal obstetric cover in the fund you are with and the fund you are moving to, all waiting period times carry over to the next fund if you know what I mean

#15 brizvegas

Posted 20 February 2012 - 11:15 PM

QUOTE (StudyMum @ 08/01/2012, 05:19 PM) <{POST_SNAPBACK}>
I'd say that it must be ok after 9 months as I am with one of the major health funds that has a 12 month obstetric waiting period and I fell pregnant (a surprise baby!) about a month after we got new insurance. When I rang up to cancel my insurance (as I was contemplating a change to Latrobe as they honor any waiting period already served and have a 9 month waiting period) my current insurer changed my waiting period to 9 months. I'd say it is at the discretion of the insurer if they insure you after 9 months.


Can I ask StudyMum which major fund you were with? I'm with MedibankP and am only 2 wks short and they won't cover me. Latrobe will cover me but I'm finding no many OBs have arrangements with them and there is a big gap that I'll need to pay.  Thanks for any info you can provide.




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