What if I’m having a baby?Pregnancy’s an exciting time, but also full of questions. Between the internet and everyone’s “helpful” advice, it can be a bit of an information overload. We want to make this time as easy as possible, so we’ve put together all the FAQs we get – from before bubs is born to when you leave hospital.

Before your baby is born

Who covers the cost of my obstetrician appointments?

Can I claim on birthing classes or pregnancy aids?

What if I have a midwife deliver my baby instead of an obstetrician?

What are the waiting periods?

First things first...

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Let’s think about your level of cover. The most important thing to keep in mind is waiting periods. If you’re new to health insurance or upgrading your cover, pregnancy and birth related services have a 12 month waiting period. This means you’ll need to think about your level of cover before you get pregnant.

You’ve got two options for having your baby in hospital:

Premium HospitalIf you’d rather go to a private hospital, you’ll need our PremiumHospital cover. You’ve got the option of no excess, a $250 excess or a $500 excess with this cover.

Mid HospitalIf you’re happy to go to a public hospital as a private patient, this cover is for you. You’ll have a $500 excess, which is halved when you’re admitted to a public hospital (so it’ll only be $250 when you’re admitted to have your baby). If you’re admitted to a private hospital to have your baby you’ll have large out-of-pocket costs.

There’s no cover for pregnancy or birth related services with our Basic Hospital cover.

There are also some out-of-hospital services (like pre/post-natalclasses) that are only covered by extras. For these services, you’ll also need our High, Premium or Gold Extras cover.

All pregnancy & birth related services have a 12 month waiting period. This means that if you’re already pregnant when you take out hospital cover, you and your baby won’t be covered - either for the birth or any hospital admissions while you’re pregnant.

You can have both if you like, but you can only claim for one while you’re in hospital.

If you have an obstetricianWhile you’re in hospital, Medicare will cover 75% of the scheduled fee, and we pay the remaining 25%.

It’s important to know that doctors and hospitals can charge above the scheduled fee, and anything over it is your out-of-pocket cost. Your doctor should let you know about any out-of-pocket costs before you go to hospital.

If you have a midwifeIf you have your baby in hospital using a midwife, Medicare will cover 75% of the scheduled fee and we pay the remaining 25%. In most cases, Medicare will cover the cost of a midwife if you have your baby in apublic hospital. Most private hospitals will only admit you if you have an obstetrician.

Having your baby at home using a midwife is an outpatient service, which means you’ll need to have High, Premium or Gold Extras to receive a benefit.

Whether you choose a midwife or anobstetrician, there’s a 12 month waiting period for these services.

These can be claimed if you’ve got High, Premium or Gold Extras cover. Ante/post-natal services are out-patient services and need to be provided by a physio, chiro, registered nurse, midwife and/or childbirth educator.

There is a 12 month wait on these services if you’re new to or have just upgraded your cover.

These appointments are paid for by you and Medicare. Your obstetrician will tell you how they’ll bill you – either as a lump sum or charge per visit. If your obstetrician charges more than what Medicare pays you will have out-of-pocket costs (known as a gap payment). If you’re going to have out-of-pocket costs, your doctor should tellyou exactly what they will be (this is called Informed Financial Consent).

What’s a gap payment?

What about any tests during pregnancy?

What if I have an epidural? How much will that cost me?

The big arrivalWhat is an excess? Will my baby or I have one?

What am I covered for during my hospital stay?Are there any other costs I should expect?

What if my baby comesearly?

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When you’re admitted to hospital, you’ll generally have a fewdifferent bills.

Hospital billsThese include things like accommodation and theatre fees. Wepay these bills for you if you have Premium or Mid Hospital cover.

Medical billsThese are for specialists who see you while you’re in hospital, likeobstetricians and anaesthetists. Between us and Medicare, you’llbe covered for the full Medicare Scheduled Fee for these bills (aslong as you have Premium or Mid Hospital cover and have servedyour waiting periods, of course).

Doctors and hospitals can charge above the Medicare ScheduledFee, and anything above it is your out-of-pocket cost. You shouldbe told about any out-of-pocket costs you’ll have before beingadmitted to hospital (this is called Informed Financial Consent).

Additional service billsThese are for extra services like TV, a double bed, extra meals, etc.while you’re in hospital. You pay the full cost of these extras.

It’s important to remember that there can be other out-of-pocketcosts when you go to hospital, even if you’ve got top hospitalcover. They can be:

• Your excess (if you have one)

• Pharmacy items that you’re given to take home with you (which you might be able to claim separately if you’ve got extras cover)

The best way to avoid out-of-pocket shocks is to give us a buzz ifyou’ve got a hospital stay coming up!

A gap payment is the difference betweenthe Medicare fee and what your doctoractually charges. Peoplecare offers theAccess Gap scheme, which aims to giveyou low or no gap payments. We have anAccess Gap agreement with over 30,000doctors, but it’s up to the doctor on acase-by-case basis whether they’ll takepart or not.

Ask your obstetrician whether they’ll takepart in Access Gap for your appointments.If they do, they’ll bill us directly and youwon’t have to worry about a thing (exceptyour new arrival, of course).

Tests during your pregnancy are usuallydone by your doctor or at a privateclinic (not as an in-patient in hospital),which means they can only be claimedthrough Medicare. These tests will usuallyhave out-of-pocket costs.

If you’re admitted to hospital to havetests, we’ll be able to pay a benefit(along with Medicare).

There might be some tests you canclaim through extras cover (if you haveit), so give us a buzz if you have any teststhat you can’t claim through Medicare.

An excess is the amount you’ve agreed to pay if you’re admitted to hospital. Lots of people choose to have an excess on their hospital cover so their membership payments are lower.

An excess is only paid once per adult in a financial year, so no matter how many times you’re admitted in that year you’ll only have to pay your excess once. If you’re admitted to a public hospital or day stay facility, your excess is halved (and in these cases you’ll need to pay the other half of your excess if you’re admitted a second time).

And there’s no excess for kids under 21, so you won’t have to pay any additional excess for bubs.

Epidurals are included in your anaesthetist’s bill, which we will pay towards. Like all medical bills, Medicare pays 75% of the Medicare Scheduled Fee and we pay the remaining 25%.

If your anaesthetist charges more than the Medicare Scheduled Fee you’ll have some out-of-pocket costs and your anaesthetist should tell you what they’ll be.

If you’ve served your 12 monthperiod, you’ll be covered for the birth of your baby no matter when they arrive (as long as you’ve got Mid or Premium Hospital cover).

If you haven’t served your 12 month waiting period, you and your baby won’t be covered.

What about any tests that my baby has during the hospital stay?

When your baby’s home

What if my baby needs special care?

What about anypost-natal check-upswith my doctor?

When should I add my baby to my Peoplecare membership? And how do I do this?

What about any post-natal classes?

All info is based on the 12 month waiting period for pregnancy & birth related services.If you haven’t served this waiting period, you won’t be covered for these services.

1800 808 690Want more info? Give us a buzz!

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Unless your baby’s admitted to special care (and we hope they’re not!) they’re not considered an in-patient, so any tests or doctor visits can only be claimed through Medicare.

If your baby is admitted to special care, we’ll be able to pay towards their tests and doctor visits (as long as you’ve served your 12 month waiting period).

Babies are usually admitted to a public hospital if they need special care, which means they’re covered by Medicare. Ifyour baby is admitted to a private hospital, we’ll be able to cover them as soon as you add them to your membership (as long asyou’ve got Mid or Premium Hospital cover and have served your 12 month waits).

To make sure everyone’s covered, it’s best to let us know within 30 days of bub’s birth. We know how busy having a newborn can be though, so as long as you let us know within 12 months of the birth your baby won’t have to serve any waiting periods (as long as you’ve served yours).

You can let us know about your new arrival by phone, email or by updating your membership online at peoplecare.com.au/oms.

If you’re adding your baby to your membership after 3 months from their birth, bub will be covered from the date they’re added (not their date of birth) and will need to serve waiting periods if you haven’t served yours.

If you’re on a family membership and you add your baby within 3 months of their birth, they’ll automatically be covered with no excess or waiting periods (as long as you’ve served yours).

If you’re on a couple membership and you add your baby within 3 months of their birth, you’ll automatically move to a family membership. There’ll be no difference to your membership payments and your baby will be covered with no excess or waiting periods (as long as you’ve served yours).

If you’re on a single membership you’ll need to upgrade to a family or single parent family membership within 3 months of your baby’s birth. This will increase your membership payments, but once you’ve paid the difference your baby will be covered with no excess or waiting periods (as long as you’ve served yours).

If you’re moving to family or single parent family membership, you might have to make a back-payment to cover your baby within the first three months. Please note that we can’t back-date cover after 3 months from their birth.

Make sure you also let Medicare know you have a new addition to your family. This will make sure everything runs smoothly if your bub needs to make a visit to the hospital for any reason.

These can be claimed ifyou’ve got High, Premiumor Gold Extras cover.

Post-natal classes areout-patient services andneed to be provided bya physio, chiro, registerednurse, midwife and/orchildbirth educator.

Once you’ve taken yourbaby home, check-upswith your doctor arecovered by Medicare only.

Who pays what...

^R – this is a restricted service under Mid Hospital cover, which means you’re covered as a private patient in a public hospital only. If you’re admitted to a private hospital for pregnancy or birth related services under this level of cover, you’ll have large out-of-pocket costs.

ServicePeoplecare

Medicare YouHospital cover Extras cover

Pregnancy & birth-related services while you’re admitted to hospital (these are things like accommodation, theatre fees, doctors’ and specialists’ services during the birth, etc.)

Public hospitalas a publicpatient

Your excess if you’ve got one,additional services, incidental fees, etc.

Pregnancy & birth-related services outside of hospital (things like standard doctors’ appointments, scans and tests)

Up to 85% of the Medicare Scheduled Fee

Any gapbetween whatMedicare pays & what thedoctor charges

Home birth

Ante/post-natal services

Pregnancy aids (if provided by a physio)

IVF services (see IVF Fact Sheetfor more info)

Up to the Medicare Scheduled Fee

PremiumHospital

MidHospital

BasicHospital

PremiumHospital

MidHospital

BasicHospital

Premium ExtrasHigh ExtrasMid ExtrasBasic ExtrasGold ExtrasSilver ExtrasBronze Extras

IMPORTANT: There could be out-of-pocket costs on any of these services that you’ll need to pay for yourself. Your doctor and other providers should tell you about any out-of-pocket costs that you’ll have (this is called Informed Financial Consent). If you’re not sure, give us a buzz and we’ll help you work through it.

Please also keep in mind that there can be restrictions, excesses and limits on any of these services, depending on your level of cover.

Premium ExtrasHigh ExtrasMid ExtrasBasic ExtrasGold ExtrasSilver ExtrasBronze Extras

Premium ExtrasHigh ExtrasMid ExtrasBasic ExtrasGold ExtrasSilver ExtrasBronze Extras

Premium ExtrasHigh ExtrasMid ExtrasBasic ExtrasGold ExtrasSilver ExtrasBronze Extras

Premium ExtrasHigh ExtrasMid ExtrasBasic ExtrasGold ExtrasSilver ExtrasBronze Extras

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