Does Health Insurance Cover Pregnancy?

Roman Danaev

19 December 2024

Pregnancy is an exciting time, and getting the right care is key for both you and your baby. Of course, the NHS provides free care for mothers and babies before and after birth, but many parents also turn to their health insurance for extra support during pregnancy. If you’re wondering whether your insurance covers pregnancy, this guide will help you understand your options.

What Is Maternity or Pregnancy Health Insurance?

Most regular health insurance plans don’t cover routine pregnancy care, such as ultrasounds, childbirth, or postnatal care. Maternity insurance, however, is specifically designed to cover these key areas — supporting you through pregnancy, delivery, and recovery afterwards.

Can Regular Health Insurance Cover Pregnancy and Childbirth?

Health insurance doesn’t cover pregnancy or childbirth as standard. Most policies exclude these, viewing pregnancy as a natural life event rather than a medical condition. If your pregnancy and birth are uncomplicated, the NHS will take care of your prenatal care, labour, and postnatal support.

Some health insurance plans offer financial support through a cash payout, known as a pregnancy benefit. This is usually given as a bonus per policy. For your growing family, some plans can also provide a cash sum for every child born. To claim the pregnancy benefit, you just need to notify your insurer after the baby is born.

To receive this cash benefit, your health insurance policy needs to be active for a certain period before you get pregnant. This waiting time (or qualifying period) is the gap between when you start the policy and when you conceive — a few weeks, months, or even years. The longer this period, the higher the cash benefit might be.

Acute Conditions vs. Pregnancy

Health insurance is primarily designed to cover acute conditions — issues that arise suddenly and require immediate medical attention. These are health conditions that can be treated or resolved with specific interventions, such as surgeries, hospital stays, or medication.

Pregnancy, on the other hand, is different. For most women, the body progresses through the stages of pregnancy without the need for medical intervention. It’s not seen as an illness or condition that requires immediate treatment.

Complications and Pregnancy-Related Issues

Complications andpregnancy-related conditions refer to any health problems that come up during pregnancy and require extra care beyond the usual check-ups. Even though pregnancy is a natural process, complications can happen that affect the health of both the mother and the new baby. These can range from common issues like gestational diabetes or high blood pressure to more serious conditions that may need medical treatment, such as preeclampsia or ectopic pregnancies.

Health insurance offers coverage for pregnancy complications because these are seen as medical conditions that need attention. This type of health cover can include hospital stays, medications, tests, and other treatments needed to keep both mother and baby safe. What’s covered varies depending on the plan, but most will cover conditions that need medical care, like preterm labour or infections.

Planning for Pregnancy

When you’re planning a pregnancy, health insurance generally isn’t involved. However, some insurance plans do offer wellness programmes to help you stay healthy before conception. These might include nutrition advice or fitness support, which are helpful as you prepare for pregnancy.

More specialised services, like genetic testing for inherited conditions, are usually not covered by insurance.

If there’s a family history of something like cystic fibrosis, you might want to consider testing to understand any potential risks. For this kind of testing, you’ll typically need a referral from your general practitioner. They’ll review your family medical history and decide if testing is necessary.

Fertility Treatment

Fertility treatments, like IVF, are also not covered by most health insurance policies. Private healthcare providers view fertility treatments as a personal choice, not a medical necessity, so they won’t fund them. If you choose private fertility treatment, you’ll need to pay for it out of pocket.

The NHS offers fertility treatments, so they can help. Just know that they come with strict eligibility requirements and long waiting lists.

Private Maternity Care

Health insurance typically doesn’t cover maternity care as standard, but you can still choose private options for the best experience during your pregnancy and delivery.

Prenatal Care and Delivery

When it comes to pregnancy, you have choices. You can go through the NHS, or you can opt for private care, whether it’s led by a midwife or a consultant, depending on what suits you best. If your pregnancy is considered high-risk — for example, you have gestational diabetes or are expecting twins — consultant-led care is the recommended option. All your prenatal care, such as appointments and ultrasounds, can be done privately if you prefer.

Midwifery Care

Midwifery care is available at both NHS and private hospitals, as well as birth centres, and is the common choice for low-risk pregnancies. One of the advantages of private midwife care is the continuity — you’ll have the same team of midwives supporting you from pregnancy through to birth. In NHS care, different midwives handle your prenatal, postnatal, and delivery care, which means you may not meet the people who will be looking after you during labour until you’re at the hospital.

Private midwives also tend to have more time to discuss your birth plan and answer questions. Many private services offer 24/7 helplines for extra reassurance whenever you need it.

Consultant-Led Care

Consultant-led care is overseen by an obstetrician and is typically needed for high-risk pregnancies. However, you can also choose this option if you simply want the added reassurance of having a doctor supervising your birth. While your antenatal care and scans will still be handled by midwives, consultant-led packages include extra services, such as non-surgical interventions like forceps or ventouse, should you need them.

If you’re considering a C-section, elective or due to complications, your care will need to be consultant-led.

Birth Choices

With private maternity care, you have more control over where and how you give birth. Whether you opt for a hospital or a birth centre, you’ll be able to choose what feels best for you.

Birth centres are ideal for those with low-risk pregnancies who want a relaxed, home-like setting. These centres include features like birthing pools and focus on treating birth as a natural process. Many women find the environment less stressful, which can reduce the chances of needing interventions like forceps or ventouse.

Private hospitals offer a more luxurious experience, with amenities like hotel-style rooms, en-suite bathrooms, and gourmet meals. You’ll also benefit from greater privacy, more flexible visiting hours, and the reassurance that your partner can stay with you and your newborn. Most importantly, private hospitals provide access to emergency care and neonatal services if needed, along with options for pain relief such as an epidural.

Private Postnatal Care

After giving birth, you’ll stay in the hospital for a while so doctors can make sure both you and your baby are healthy before going home. If you’ve chosen a private birth, you’ll enjoy the comfort of a private room. Most hospitals offer breastfeeding support and physiotherapy to help with recovery.

Some hospitals also provide private nurseries for your baby to stay in overnight, so you can rest — though this comes with an extra fee.

Once you’re home, your baby will have check-ups to monitor their weight, hearing, and overall health, including a heel prick test for certain conditions. You’ll also have your own postnatal check-up. Private postnatal care packages include these services, or you can choose to care through your GP and community midwives.

How Much Does Private Antenatal Care and Birth Cost?

Most private hospitals offer a fixed price for antenatal care and delivery, but the cost varies depending on the hospital, your location, and the choices you make about your birth plan. But not everything is included in the quoted price. For example, your package may cover antenatal care and delivery, but it might not include anaesthetist or obstetrician fees.

There are also extra costs to consider, depending on how the birth goes. Your package might include a one or two-night stay after delivery, with the option to add an extra night if needed. However, if the birth takes longer than expected or you need a C-section, you could be charged for additional nights.

How Does Being Pregnant Affect My Health Insurance Policy If I’m Already Covered?

Being pregnant usually doesn’t have a major impact on your existing health insurance policy.

If there are any pregnancy-related complications that affect your health, your insurance should cover certain treatments. For instance, pregnancy-related emergencies like ectopic pregnancies or abnormal cell growth, as well as complications after childbirth, such as a retained placenta, might be included. If you have a pre-existing condition that flares up during pregnancy, your insurance may also cover private treatment, as long as it’s focused on returning you to your usual health.

Bear in mind that pregnancy itself isn’t considered a pre-existing condition, so your insurer can’t refuse you coverage or increase your monthly premiums just because you’re pregnant.

When Should I Consider Taking Out Private Health Insurance as an Expecting Mother?

It’s best to consider health insurance before you get pregnant or early on in your pregnancy. This way, you make the most of the coverage available and add your newborn later with less hassle.

If you’re already pregnant, don’t worry. It’s still worth looking into your options. Some health insurers might offer partial maternity coverage or certain benefits, even if you haven’t met the waiting period.

Can Newborns Be Added to an Existing Health Insurance Policy?

Yes, you can usually add your newborn baby to your existing health insurance policy, but there are a few things to consider:

• Most private insurers will allow you to add your baby to your plan, and it’s a simple process of contacting your insurer and filling out the required paperwork.
• It’s best to add your baby as soon as possible after birth. Many insurers offer Medical History Disregarded underwriting for babies added within the first 90 days. Any pre-existing conditions won’t be excluded from coverage.
• If you wait too long, however, the insurer may apply standard underwriting, which means your baby’s health will be assessed, and any pre-existing conditions might be excluded.

Are Scans, Blood Tests, and Additional Health Check-Ups Included in Pregnancy Cover?

Many expectant parents opt to pay for extra scans or blood tests during pregnancy through private healthcare to keep things on track. However, these tests usually come with an extra cost and are not covered by health insurance.

If you’ve had a condition diagnosed before pregnancy, your insurer will usually cover the treatment and tests for that condition. Unfortunately, this doesn’t extend to your unborn child or any pregnancy-related tests.

Is Private Medical Insurance Worth Having During Pregnancy?

It’s a good idea to have it. Private medical insurance provides access to top-tier healthcare for illnesses or injuries that might come up before, during, or after pregnancy.

One of the benefits of health insurance is the extra support it offers for your overall health. Even if pregnancy isn’t covered as standard, you can still get useful information and resources to help with common health issues and advice on living a healthy lifestyle.

Another advantage is the peace of mind that comes with shorter waiting times for treatment. You’ll still need tests, specialist consultations, or support, and private medical insurance will help you access the care you need more quickly. This can be especially reassuring when juggling the demands of pregnancy and preparing for your new arrival.

Final Words

Hopefully, this answers your questions about maternity insurance. In short, private medical insurance doesn’t cover routine pregnancy care. However, it can still be valuable for accessing high-quality healthcare for other medical needs.