Does health insurance cover pregnancy?

Does health insurance cover pregnancy?

The birth of a new baby is a joyful event, and getting the best healthcare is vital. You may be wondering whether you can access private pregnancy care. This guide looks at your options so you can prepare for your new arrival.

Can health insurance cover pregnancy and childbirth?

In short, no, it can’t. Health insurance policies have standard exclusions that typically include pregnancy and childbirth. Generally, health insurers regard pregnancy as a lifestyle choice rather than a medical condition. If you have a straightforward pregnancy and birth, the NHS will take care of your prenatal, labour and postnatal care.

In some circumstances, health insurance will cover conditions related to pregnancy and childbirth but not the pregnancy and labour itself.

Acute conditions

Health insurance covers acute conditions that arise unexpectedly and need treatment to resolve. 

An acute illness is a condition that can be cured with treatment and may not resolve without it. Examples include needing cataract surgery to improve your vision or a knee replacement to treat arthritis. Alternatively, you may need cancer treatment over a longer period. 

By contrast, pregnancy is a natural process that generally reaches its end point without treatment. However, medical intervention could be needed to ensure a safe delivery or to treat pregnancy-related complications.

Planned pregnancy

While unplanned pregnancy occurs, many people decide to start a family and prepare for pregnancy and giving birth. Health insurance typically covers unexpected illnesses and medical conditions; maternity care doesn’t fit that definition.

Preparing for a planned pregnancy can include ensuring you’re healthy before you try to conceive. If you have an existing health insurance policy, you’ll likely have access to well-being tools and services to improve your general health.

However, in some cases, your pre-pregnancy healthcare may involve more in-depth investigations. If your family has a history of a genetic condition that could pass from parent to child, you may want genetic testing to put your mind at ease. Health insurance doesn’t cover pre-pregnancy genetic testing; you’ll need to see your GP for a referral. You’ll need to show a family history of an inherited genetic condition, such as cystic fibrosis, to qualify for testing. The process usually involves counselling before the test and, if necessary, after you receive the results.

Fertility treatment

Sometimes, a planned pregnancy involves fertility treatment, such as IVF. There are strict criteria for treatment via the NHS, and you may spend a long time on an NHS waiting list. Health insurance doesn’t cover fertility treatment for the same reasons it doesn’t provide pregnancy coverage. Insurers regard it as a choice rather than an acute condition.

Private fertility treatment is available, even though your health insurance policy won’t fund it. You can pay for fertility treatment such as IVF in the UK or have treatment overseas.

Can health insurance help with pregnancy complications?

While health insurance doesn’t routinely cover pregnancy, your health insurance policy may cover pregnancy-related complications.

Coverage often includes treatment for pregnancy-related emergencies, such as ectopic pregnancies, miscarriages or abnormal cell growth in the womb. After childbirth, your health insurance may also cover treatment for a retained placenta. Some insurers also provide cover if you have a flare-up of a pregnancy-related condition, as long as the treatment will return you to your previous state of health.

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It’s important to check what’s covered as health insurance differs. Some insurers only cover complications if you’ve had a policy with them for a certain length of time; you may find that your policy covers pregnancy complications if you’re an existing customer but not if it’s a new policy.

Private treatment during pregnancy

While most health insurance doesn’t cover maternity care, pregnant women can still use their health insurance to get private treatment during their pregnancy. Conditions related to the pregnancy generally won’t be covered, but flare-ups could be, as we’ve already mentioned.

Otherwise, being pregnant doesn’t stop you from using your health insurance plan as you usually would. If you become ill or sustain an injury while pregnant, you can contact your insurer to claim treatment if the illness isn’t related to your pregnancy. However, you’ll need to ensure your insurers know you’re pregnant when you claim. Some investigations and treatments can be dangerous for pregnant women, so your doctors must tailor your treatment appropriately. For example, x-rays of your stomach or pelvis may not be suitable. Many painkillers aren’t recommended for use during pregnancy.

In some circumstances, your treatment options may be limited until after you’ve given birth. Cancer during pregnancy is rare, but your treatment plan will need to consider your pregnancy. Surgery and chemotherapy can be possible, but radiotherapy usually has to wait until after your baby’s birth. Your private medical insurance can pay for your cancer treatment. Still, you’ll likely need to consult with your midwife or obstetrician so they can make appropriate decisions about your maternity care.

Private pregnancy care

Health insurance doesn’t provide maternity coverage, but you can still choose to have private healthcare, including a private birth.

Prenatal care and delivery

You can choose whether to receive NHS or private care when pregnant and giving birth. You can also choose between midwife-led or consultant-led care, although your eligibility often depends on your circumstances. For example, if you have gestational diabetes or are expecting twins, you’ll likely need to be monitored by a consultant.

Otherwise, all your prenatal care, including check-ups and scans, can be offered privately in the same way as they would be via the NHS.

Midwife-led care

You can opt for midwife-led care at an NHS hospital, birth centre, or private hospital.

Midwife-led care is typically only available to low-risk and uncomplicated pregnancies. Some services specify a particular age bracket and may not accept you if your BMI is over 30. One of the benefits of private midwife-led care is that you’ll have support from the same team of midwives throughout your pregnancy and birth. In the NHS, prenatal and postnatal care is typically led by community midwives, while the hospital team focuses on the delivery itself. This can mean you may not have met the people who look after you during labour before you get to the hospital.

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Midwifery care also allows you to have your baby at a birth centre rather than a hospital. All midwife-led services will help you to make choices about giving birth. However, private midwives can often dedicate more time to these discussions. Private services also offer helplines so you can call for advice 24/7.

Consultant-led care

As the name suggests, consultant-led care is supervised by an obstetrician. It’s typically required in high-risk pregnancies, but you can choose a consultant-led birth if you want to have your baby in a hospital and enjoy the additional reassurance of a supervising doctor.

Your antenatal checks and scans will be with a midwife, the same as they are with midwife-led care. Private consultant-led packages include non-surgical interventions such as forceps or ventouse when giving birth, which aren’t always included with midwife-led care. If you want an elective c-section for medical reasons or because of complications with previous births, your care will need to be supervised by a consultant.

Birth choices

When you have private maternity care, you can choose between a hospital birth or giving birth in a birth centre.

Birth centres

Birth centres provide midwife-led care, so they’re only suitable for low-risk pregnancies. Birth centres typically offer a home-from-home atmosphere and are more likely to have facilities such as birthing pools to assist during labour. They treat giving birth as a normal process that doesn’t need medical supervision. Birthing mums typically report feeling more relaxed and able to cope with labour and have a lower likelihood of needing an assisted birth, such as a forceps delivery.

Hospital options

The benefits of giving birth in a private hospital are similar to other types of private healthcare. Many private hospitals have hotel-style facilities, luxury dining options and an en-suite bathroom. You’ll also benefit from relaxed visiting hours, and your partner will likely be able to stay overnight with you and your newborn baby. You’ll typically be in a maternity ward with other mums and babies in an NHS hospital. This can mean more noise and less space for your partner to stay with you. Some maternity hospitals even include a celebratory afternoon tea in your package.

In a hospital, you’ll also have access to neonatal and emergency services if needed, and you can have an epidural if you want one.

How much does private antenatal care and birth cost?

Most private hospitals will provide a fixed price quote for your antenatal care and giving birth. Costs vary depending on your location, your chosen private hospital, and your decisions about giving birth. Some elements aren’t included in your quote. For example, your package can include all your antenatal care and delivery fees but not obstetrician fees or anaesthetist charges, even if you’ve opted for a c-section.

Other costs depend on how the birth goes. Your chosen package may include a one or two-night stay after you give birth, and you can add an additional night. However, if your delivery becomes prolonged, you may have a hefty bill for an extra night or a caesarean birth. Some private hospitals also add delayed discharge fees, which can be as much as £100 per hour.

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Private postnatal care

After giving birth, you’ll spend some time in the hospital so the medical staff can check that you and your newborn baby are both healthy and ready to go home. You can relax in a private room when you choose a private birth. Postnatal services vary between hospitals, but most women will receive support to establish breastfeeding if needed and have physiotherapy to aid their physical recovery.

Some hospitals also have a private nursery to care for your baby overnight while you rest. You’ll usually need to pay an additional charge for this service.

Once you’ve returned home after giving birth, your baby will need check-ups to check their hearing and ensure they’re gaining weight appropriately. They’ll also have a heel prick test. This blood test checks for serious inherited or congenital health conditions.

You’ll also have a postnatal examination to check your recovery. Private postnatal care packages can include these checks; you can also add postnatal care to your antenatal care and delivery. Alternatively, you can return to the NHS and receive care from your GP and community midwives.

Is health insurance worth having during pregnancy?

While health insurance doesn’t include pregnancy cover, we think it’s still worth having. Private medical insurance gives you access to high-quality private healthcare for illnesses and injuries that arise before, during, and after pregnancy.

However, you’ll only be covered for pregnancy-related conditions in specific circumstances, for example, if you experience a miscarriage or retained placenta after giving birth. If your medical needs are complex, you may need to manage a pre-existing condition alongside symptoms arising from pregnancy. This may make it more difficult for insurers to determine what’s covered or excluded.

One of the advantages of health insurance is that it comes with a range of services and information to help you improve your health and well-being. Even if your policy doesn’t cover pregnancy, you can still access information about common conditions and ways to live a healthy lifestyle.

Looking after your family

Health insurance can help you look after your growing family by allowing you to add your children to the policy. Some insurers pay a cash ‘baby bonus’ when you have a baby or adopt a child under one, as long as you’ve had the policy for at least ten months. (We’ll let you do the maths on that one.)

Family health insurance is often cheaper than an individual policy, but it’s worth comparing quotes to see what coverage is available and how much you’ll pay. Many insurers allow you to add multiple children to your policy but only pay for the first one. Insurers also have different age limits. Many classify a child as someone under 20. However, Freedom Health Insurance covers your children up until they’re 25, with newborns covered from the day they’re born.

Get in touch

At MyTribe, we put you in touch with specialist, regulated brokers who’ll give you advice tailored to your circumstances to help you find the best health insurance plan for your needs. We also create guides so you can learn more about your options.

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Disclaimer: This information is general and what is best for you will depend on your personal circumstances. Please speak with a financial adviser or do your own research before making a decision.