[baileybunny]

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??

[mez70]

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..


This post has been edited by mez70: 08/01/2012, 01:08 PM

[geishagirl]

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

[mez70]

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.

[pinkelephant]

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.

[futureself]

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.

[StudyMum]

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.

This post has been edited by StudyMum: 08/01/2012, 05:19 PM

[Dylan's Mummy]

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.

[Bluenomi]

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.

[SeaPrincess]

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