Newborn health insurance
If you’re a new or expectant parent, you may be wondering about how your changing family impacts your health insurance. Learn more about covering newborns on health insurance.
Health insurance for your newborn and growing family
Starting or growing your family is an exciting time, but it can also be overwhelming. Scans, appointments, organising your birthing plan, trying to follow mysterious cot assembly instructions (none of which is covered by private health insurance) – there’s a lot going on. Amongst the joyful chaos, you might also be wondering what’s next for your health insurance.
GMHBA has been helping growing families for decades, and one thing we’ve found is that getting private health insurance for newborns – either by adding a newborn to your health insurance, buying a new policy or upgrading your existing one (which may attract extra costs or waiting periods) – can really help with peace of mind. It’s just one less thing to worry about.
It’s important to remember that having an existing private health insurance policy doesn’t mean your baby will automatically be covered. You have to add that layer of protection by adding your newborn to your family health insurance or changing your cover to accommodate your growing family.
In this article, we’re going to run through how the whole process works to get private health insurance for yourself and your newborn, or add a newborn to your existing GMHBA policy. We promise it’s easier than building a cot.
Getting cover for your newborn
While private health insurance for newborns isn’t a necessity, it can be a smart investment for peace of mind.
If you do decide to get health insurance for your baby, it’s important to find the right cover for you and your family. That generally means looking at factors like your budget, lifestyle, and the unique healthcare needs of babies.
Comprehensive cover for newborns with GMHBA
The good news is, GMHBA has a number of different health insurance policies that can cover your newborn, including plenty of options for families and single parents, so you can find the cover that best suits your needs.
How to choose the right cover for your baby
There are a bunch of factors to consider prior to adding your newborn to your cover. Are you looking for your baby and family to be covered for extras, now or in the future? How much are you looking to spend on premiums? What level of hospital cover do you want?
Think of it this way: your hospital insurance is your traditional insurance. It’s the cover you hope you never have to use, but it’s there if you need it. With extras cover, it all depends on what you think your baby or family is likely to use or need.
When it comes to your health insurance cover, it’s important to consider:
- Hospital cover inclusions: Our hospital policies rise in tiers, from Basic through to Gold. At the base level, you have our Basic Plus Starter Hospital, which will cover your child for things like tonsils, adenoids and grommets in a private hospital. Make sure you carefully read the hospital service inclusions, exclusions, restrictions and waiting periods of the various policies – that’ll help you make an informed decision.
- Hospital networks: GMHBA has agreements with a wide range of private hospital networks throughout Australia, which provide members who hold a private hospital policy with cover for accommodation and a range of services, subject to the level of cover of the hospital policy you take out. Browse the full map here.
- Extras benefits: To access extras benefits, also known as ancillary or general treatment, you’ll need to take out extras cover. This also rises in tiers, low, medium and high, and it can either be combined with a hospital policy or taken out as a standalone policy. Many parents on a family or single parent policy use extras for postnatal support, including remedial massage, chiropractors, counselling, acupuncture, and lactation consultants (subject to the level of cover you choose). As your child grows, you may be able to claim on their dental, optical, speech therapy needs and more, depending on your level of cover.
- Premiums: Different levels of cover can impact premiums. The trick is to find a balance that works with your budget and lifestyle. The best place to start is to get a quote.
How to add your baby to your existing GMHBA policy
If you have existing private health insurance through GMHBA and you want to add your newborn to your health cover, it’s important to be aware that this may change the membership ‘class’ of your policy, or require a new policy product altogether. This can come with additional costs and potential waiting periods depending on your current membership type.
It can get a bit complicated, so we’d recommend giving us a call on 1300 382 160 to discuss your specific circumstances, prior to the birth of your baby.
Once you have contacted us and confirmed you have the right level of cover to suit your needs, you can follow the below steps to add your newborn to your health insurance when the big day arrives.
- Register your newborn with Medicare.
- Call GMHBA on 1300 382 160 to add your newborn to your health insurance policy. If your baby needs to go into the Neonatal Intensive Care Unit (NICU) in a private hospital, we suggest calling and adding them as soon as you can. Only the main policy holder can add new members or make changes to the cover, unless you have already completed a Spouse Authority form for the second adult on your policy. You can contact GMHBA to do this at any time.
- Pay any additional premium cost (if applicable).
- Your baby is included on the policy as long as the policy remains active, up until the age of 21.
Waiting periods
Whether waiting periods apply for your newborn will depend on a range of factors, such as whether you’re new to private health insurance, an existing GMHBA member, have recently changed your cover and when you added your baby to your cover. Please contact us to discuss your individual circumstances, ideally prior to the birth of your baby.
Pregnancy waiting periods
For hospital cover with pregnancy, which includes the mother’s hospital stay after birth, the waiting period is 12 months. This means you should be looking to purchase hospital cover that includes the clinical category pregnancy and birth around 3-4 months before getting pregnant. Note that we measure this by the estimated due date you were provided by your obstetrician or midwife, so if the baby arrives early and the waiting period hasn’t been served, we just confirm the date the baby was due to arrive (you’ll just need a letter from them that confirms the due date).
Also, it’s important to note, with GMHBA, pregnancy cover is only available on gold levels of hospital cover. That’s our top tier. All private health funds have to follow the same rules for clinical categories.
What will GMHBA pay hospital benefits towards for newborns?
When a baby is born, if all goes to plan, they are not actually admitted as a patient. The admission for the birth is paid under the parent’s policy, provided they have the right level of hospital cover.
It’s important to note that if the baby does end up being admitted to hospital as a private patient, they will need to be added to the parent’s policy. GMHBA’s hospital cover will pay benefits subject to the hospital inclusions on the policy.
It can also cover things like ambulance fees if there’s an emergency (subject to level of cover and type of ambulance trip) and could reduce wait times by choosing to be treated in a private hospital as a private patient if your child needs elective surgery.
For more details on what we do and do not pay benefits towards, read our Important Information Guide.
Private health insurance doesn’t cover routine check-ups (GP or outpatient Medicare consultations) or most vaccinations (as these are already subsidised by the PBS).
Any specialist visits that don’t require a hospital stay will also go through Medicare, which will cover 85% of the MBS schedule fee that’s set by the government (unless you’ve already reached the safety net). You'll pay the remaining 15%.
You may also pay more if your doctor charges more than the MBS fee. This is known as a gap or out of pocket cost. GMHBA can't pay the gap in accordance with government legislation – it’s not just a GMHBA thing.
GMHBA + Baby program
We’ve partnered with Nourish Baby to provide specialised support for members during pregnancy and early parenting.
To support more parents and our littlest GMHBA members, the GMHBA + Baby program is available on all levels of GMHBA hospital cover (from Basic through to Gold tiers). You’ll just need to have held hospital cover with us for at least 2 months to be eligible.
The program covers:
- Pregnancy health, labour and birth preparation
- Lactation, feeding support and personalised sleep program from birth to age 3
- Personalised sleep and settling telephone support from birth to age 3
- Emotional health and wellbeing
- First aid and CPR for babies and toddlers
- Baby and toddler development and growth
- Parenting and relationships
You’ll be in good hands - Nourish Baby are the only online antenatal classes accredited by the Childbirth and Parenting Educators of Australia and the Australian Council of Healthcare Standards. They’re also recommended by COPE: Centre of Perinatal Excellence.
How to get started
If you're thinking of joining, here's all the information you need to get started.
You can speak to a friendly member of our team to get a personalised quote, or get a quote online. You can also visit us in person to discuss your options if you’re located near a GMHBA branch.
We’ll walk you through the various policy options, to make sure you get the right level of health cover for you – and your newborn. It’s generally best to do this before the birth, but honestly it’s never too late to protect your family with private health insurance.
For existing GMHBA members, the process is even simpler. Just contact us or add a new person in your member area. We can talk you through any new waiting periods or price changes associated with insuring your baby, or quickly add your newborn to your existing eligible health insurance policy.
If you are the main policy holder and your partner is contacting us, you will need to provide us with spouse authority first so that they are able to make changes to the policy. You can do this at any time.
Frequently Asked Questions
While babies – like all other Australians – don’t necessarily need private health insurance, it’s a great way to ensure peace of mind. Especially when it comes to hospital stays. For example, if your baby needs a medical procedure, electing to be treated as a private patient in a private hospital can reduce wait times and give you more choice when it comes to picking your own specialists.
You can take out a new policy to cover your baby and family, or your newborn can be added to your existing GMHBA policy. This may involve upgrading your cover to a Single Parent or Family policy, depending on your circumstances.
Your newborn will be covered as long as the policy remains active, up until the age of 21. Between the ages of 21 and 25, cover will depend on whether they’re a full-time student or apprentice. If they’re doing any sort of full-time study, we’ll cover your child up until their 25th birthday.
If you earn above the family income threshold, you may be liable to pay the Medicare Levy Surcharge. If you have hospital cover, you may be exempt from MLS as long as all dependants are also covered on your policy. So it’s generally a good idea to add your newborn to your policy. It's always best to check your personal circumstances with a tax professional.
No. Newborns are not automatically covered for private health insurance, even if you already have a policy. You’ll need to add them manually, either by taking out a new policy and including them on it, or by adding them to your existing GMHBA policy.
Of course! Private health insurance really gives you the luxury of choice. You can still get all the benefits of Medicare – and, indeed, a lot of newborn care is still managed through Medicare, whether you have private health insurance or not – but you also get all the benefits of the private system.
Babies who are born prematurely, or those who are very unwell, might need care in a Neonatal Intensive Care Unit (NICU).
- If you’re a public patient in a public hospital, most of these costs are covered by Medicare.
- If you’re a private patient, and you have a pre-term baby within the 12-month pregnancy and birth waiting period, your baby would be covered as long as private hospital cover was held by the mother/parent at least 2 months prior to admission. The baby would need to be added to the parents cover and the due date confirmed by a letter from your obstetrician or midwife. It’s important to note that, if they are admitted to hospital, your baby would only be covered for the same clinical categories as the parent/s policy. If your baby is admitted to NICU for a clinical category that is not covered by the parent/s policy, you may incur out of pocket costs.