It is important to know what you are expecting from your private health insurance when you are expecting.
Healthcare costs can vary depending on if you choose to be a public patient in a public hospital or a private patient in either a public or private hospital. Your choice will depend on what options are available to you and if you wish to have a private obstetrician.
Pregnancy and birth-related services are covered in both private and public hospitals on some Astute Simplicity Health hospital covers after a 12-month waiting period has been served. Pregnancy and birth-related services, IVF and assisted reproductive services are restricted on some hospital covers.
If you hold extras cover with Astute Simplicity Health you may be able to claim benefit for pre-natal classes. The classes must be provided by a physiotherapist in private practice registered with this fund. For more information, contact Astute Simplicity Health on 1300 090 960.
You are eligible for cover:
  • If you have been covered by a family policy for more than 12 months, you and your baby will be covered, provided your baby is added onto your policy within 30 days of its date of birth.
  • If you have been covered by a single hospital policy for more than 12 months, you will be covered but your baby will not. To cover your baby from birth, you should upgrade your cover to a family policy from the baby’s date of birth. This should be done within 30 days of your baby’s birth date. Astute Simplicity Health will not apply waiting periods to newborns if added within the first 30 days.
  • If you are not currently insured and are already pregnant, you will not be covered for any treatment relating to your pregnancy. You should take out an appropriate private health cover at least three months before you are pregnant so that you serve the 12-month waiting period prior to being admitted for delivery.
  • Premature births or complications arising from pregnancy where a medical practitioner confirms your baby’s expected due date is after the 12-month waiting period will be covered, subject to any excess that applies to your policy.
Do charges apply to my baby?
  • If your baby is healthy, he or she will not be formally admitted to hospital, meaning there are no fees raised for the baby’s stay in hospital.
  • If your baby does need special treatment, they will be admitted to hospital. This means fees will be raised for your baby. If you have taken steps to cover your baby under your policy, Astute Simplicity Health will cover the costs of your baby’s hospital admission (less any excess than many apply to child-dependents on your policy).
  • If you are expecting twins or any multiple births, at least one baby will be admitted to the hospital, even if they are both health. If your policy has no excess or child dependents, you will not be charged an excess to the hospital, even if they are both healthy. If your policy has no excess on child dependents, you will not be charged an excess for the baby’s admission, however fees will be raised for their time in hospital.

You will have to pay for medical services that occur outside hospital, including specialist consultations and obstetrician check-ups. In some cases, a paediatrician will check on your baby’s progress. Unless your baby has been admitted to hospital, the fee for a paediatrician’s visit cannot be claimed on your private health insurance policy. These costs can only be claimed through Medicare.

IVF and assisted reproductive services

If you have held hospital cover with Astute Simplicity Health or joined or transferred from another fund which covered these services, the in-hospital costs associated with IVF and other assisted reproductive services will be covered by Astute Simplicity Health less any excess that applies to your policy, providing you have served a 12-month waiting period.

For tips on avoiding out-of-pocket costs while in hospital, visit our page Going to Hospital.

Want to find out more?

Call today on 1300 090 960