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Home » Understanding Health Insurance » Planning a family

Planning a family

If you would like to be covered for pregnancy and birth related services in a private hospital and with an Obstetrician of your choice you need to take out an appropriate level of private Hospital cover or upgrade your existing membership well before you are pregnant.

Your private Hospital cover kicks in once you are admitted into hospital. You need to be aware that the out-of-hospital medical expenses incurred throughout your pregnancy (scans, obstetrician appointments, blood tests etc) will not be covered by your private health insurance cover – although they may be covered to some extent by Medicare.

You may also become eligible for additional Medicare benefits with the Medicare Safety Net.The Medicare Safety Net is there to help you. It provides families and individuals with financial assistance for high out-of-pocket costs for out-of-hospital Medicare Benefits Schedule (MBS) services. Once you meet a Medicare Safety Net threshold, you may be eligible for additional Medicare benefits for out-of-hospital MBS services for the rest of the calendar year.

Register for the Medicare Safety Net so Medicare can track your out-of-hospital, out-of-pocket expenses and advise you when you are nearing the threshold.

More information about the Medicare Safety Net.

Please take the time to read through the Pregnancy Guide.

  • Choose the right level of cover

    Tip – there is a 9 month waiting period for pregnancy and birth related services. So make sure you have held either of these levels of Hospital cover well before you start trying to conceive.

  • Choose an obstetrician

    Speak to your GP who will be able to provide you with a list of Obstetricians in your area. After you select your obstetrician, check with us that the hospital you plan to deliver your baby at holds an agreement with Teachers Health Fund. If it doesn’t you might find yourself significantly out-of-pocket.

  • Ask about Access Gap Cover and get a quote

    Ask your Obstetrician for a quote so you are fully aware of the charges throughout your pregnancy. Remember that any service received when you are not admitted to hospital may only be partially covered by Medicare.

    While you are discussing costs, ask your Obstetrician if he/she will bill you under Access Gap Cover.Access Gap Cover (AGC) is a billing scheme that aims to reduce or eliminate out-of-pocket expenses to members for doctor and specialist services received in hospital. Doctors may choose to participate in AGC on a patient by patient basis, so you should discuss this with your doctor.

    More about AGC for services received when you are admitted to hospital to give birth. This may help you eliminate or reduce any out-of-pocket expenses.

Wishing you all the very best on the birth of your baby. Your pregnancy should be an enjoyable experience.

After the baby arrives and you have settled in, you will need to add your baby to your cover within two months of the birth so all waiting periods can be waived.

Related Resources

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Your Rebate

All Australian residents, who are entitled to Medicare, are able to claim an income tested rebate on their private health insurance; would you like to apply your rebate?

For individuals earning between $88,001 - $102,000 (or $176,001 - $204,000 for families*).
*For families with children, the thresholds are increased by $1,500 for each child after the first.

How rebate tiers workX

Most Australians with private health insurance currently receive a rebate from the Australian Government to help cover the cost of their premiums. The private health insurance rebate is income tested. The table below details the different rebate amounts and Medicare Levy Surcharge levels.

The rebate applies to hospital, general treatment and ambulance policies. It does not apply to overseas visitors cover. The rebate levels applicable for 1 July 2013 to 30 June 2014 are:

Singles
Families
≤$88,000
≤$176,000
≤$88,001-102,000
≤$176,001-204,000
≤$102,001-136,000
≤$204,001-272,000
≤$136,001
≤$272,001
Rebate
< Age 6530%20%10%0%
Age 65-6935%25%15%0%
Age 70+40%30%20%0%

Single parents and couples (including de facto couples) are subject to family tiers. For families with children, the thresholds are increased by $1,500 for each child after the first. http://www.privatehealth.gov.au/healthinsurance/incentivessurcharges/insurancerebate.htm