There are a million ways to make your mini-me.

No, they’re not. To ensure your little one is included in your Hospital cover, please call us as soon as possible after they’re born to add them. If you’re on a singles policy, you’ll need to upgrade to a single parent or family policy and add your baby to your cover within two months of their birth to avoid them having to serve all applicable waiting periods. If you are on a couples or family policy, you have 12 months. If the baby is added within these timeframes, then your baby will only need to serve waiting periods that haven’t yet been served. If your baby is not added within the required timeframes, you will be responsible for any costs associated with their hospital admissions during the relevant waiting period.

Your baby will only be covered once you add them to your policy. If your baby is admitted to a private hospital and they haven't been added, you have the option of backdating your policy to cover the hospital admission but only if your baby is admitted during the 2 or 12 month timeframe referred to above.

Before you go to hospital, ask each specialist and your hospital for a written breakdown of all the costs so that you can understand and agree to it before you receive any treatment. This is known as ‘Informed Financial Consent’. The breakdown should list the fees for each specialist involved in your treatment – for example, your obstetrician and anaesthetist if you have one – and any other related costs.

GapCover is a medical gap scheme that aims to reduce or eliminate our members’ out-of-pocket medical expenses for a hospital stay. The only way to know if your doctor will participate is to ask upfront if they’ll participate in Medibank’s GapCover for the birth. You can search for doctors who have previously participated in Medibank’s GapCover at medibank.com.au/provider or call us on 132 331. GapCover doesn’t cover all medical services, and specialists can choose whether to participate in GapCover for part, or all of your treatment. So even if a doctor has participated in GapCover before, you’ll need to check that they’ll do it for your case. If you’re being treated by more than one doctor (e.g. obstetrician and anaesthetist), you’ll need to check that each individual doctor will participate.

GapCover doesn’t apply to pathology and radiology services, out-of-hospital medical services and services not included under your policy. GapCover also doesn’t apply to things such as any applicable excess payment and per-day payment. You may still have out-of-pocket costs. The maximum member out of pocket on GapCover claims is $500 per account. See your Member Guide for more information.

Although private health insurance will pay benefits towards the in-hospital services you receive during your pregnancy if you have Gold Hospital cover with Pregnancy and Birth and have served the relevant waiting periods, you may still have out-of-pocket expenses to pay.

For inpatient medical services, Medicare pays 75% of the Medicare Benefits Schedule (MBS) fee for your obstetrician, anaesthetist and any other doctors, as well as any diagnostics billed with an MBS item number (e.g. x-rays or lab tests) while you’re admitted to hospital. Medibank pays the remaining 25% of the MBS fee (as long as you’ve completed any relevant waiting periods).

Keep in mind that some doctors and diagnostic providers charge rates that are higher than the MBS fee for a particular service. When this occurs, you’ll have to pay the difference — this is known as the ‘gap’. You can reduce or eliminate these out-of-pocket expenses by choosing doctors who agree to participate in Medibank’s GapCover.

Another consideration is what hospital you attend. Medibank has arrangements with most private hospitals and day surgeries in Australia — these are known as Members’ Choice hospitals. You’ll generally get better value if you go to one of these providers. If you’re treated at a non-Members’ Choice private hospital, we’ll generally pay lower benefits and you may incur significant out-of-pocket expenses. Where you’re treated as a private patient in a public hospital, we’ll pay benefits towards overnight and same day accommodation in a shared room.

You may also have out-of-pocket expenses for any services your baby receives. Generally, a healthy newborn isn’t admitted to hospital as an inpatient. Because the baby isn’t an inpatient, it’s important to be aware that any treatment, tests or doctor’s visits (e.g. a pre-release check-up by a paediatrician) are outpatient services. This means you’ll only be eligible to claim a Medicare rebate for those services (not benefits under your hospital cover) and may have out-of-pocket expenses.

We recommend that you talk to your obstetrician, the hospital and Medibank about what costs you can expect and how you can reduce them.

For more on this topic read our article: Understanding the Costs of Having a Baby