PRIVATE HEALTH INSURERS COVERING MIDWIFERY AND HOMEBIRTH ...

@ September 2007

Compiled for Homebirth Network SA, Birth Matters (SA), and the Maternity Coalition

by Lareen Newman

 

Here is the latest information we have collected since August 2005 via mothers and midwives in Australian birth and midwifery networks about private insurance companies who have reimbursed for the services of an independent/private midwife covering homebirth or other midwifery services. Do send advice if you find more recent information, or can add information about other insurers, to matcoalitionsa@yahoo.com.au

Women are advised to check their individual situations with the individual insurer and what level of cover is required for which services; also to check whether smaller amounts may be eligible for rebate (ie prenatal education/care and postnatal care). In some instances it seems that only one staff member in a company is aware of the company’s stance on reimbursement for homebirth or midwifery services. Birth Matters (SA) or the Maternity Coalition may be able to put you in touch with such individuals who have had previously had contact with women seeking or obtaining reimbursement for homebirth or midwifery care. Email matcoalitionsa@yahoo.com.au for contact details or to provide us with updated information.

 

SUMMARY (See below for more detailed information.)

Company - Maximum Homebirth Reimbursement - Date latest Info Recieved.

Australian Unity - Up to $2,000 - August 2007.

Defence Forces Health - Up to $790 - Sept 2007.

Grand United - $2,000 in the past, but in 2006 would not cover homebirth or independent midwifery - October 2006.

HBA - $1,200 (Were having a pilot program on homebirth but current status of this is unknown.) - Sept 2007.

HCF - Unknown.

Mutual Community - $1,500 (down from $2,000) - March 2006.

Manchester Unity - Small amount in the past.

MBF - $3,000 to $4,000 in the past, but currently unclear if reimbursing - August 2007.

Medibank Private - Unknown. Appear to reimburse nothing.

Mt Isa Mines - Unknown re homebirth, have paid for midwifery care.

NIB - Small amount in the past.

NRMA - Partial reimbursement before taken over by another company.

Queensland Country Health - Only if midwife has indemnity insurance.

SGIC - Have covered in the past, but latest news is that it is withdrawn - September 2005.

Teacher’s Federation Health - $1,500 - July 2006.

WA Hospital Benefit Fund (HBF) - Have reimbursed in the past, amounts unknown.

 

AUSTRALIAN UNITY

May pay $2,000 to $3,000 per birth. The most recent information we have is for reimbursement in August 2007. A mum says she: “wrote to AU to “apply" for approval for homebirth coverage. The letter outlined our midwife’s schedule of visits, payment schedule, her AU provider number, etc. We got a letter back from them saying that the usual benefit for midwifery services under our private health insurance level of cover (hospital only, no extras) is $400 plus pre and post natal services, which would generally add up to approx $600 in benefits. But they have the discretion to fund additional costs associated with homebirths. As such, they agreed to fund us up to a maximum of $2,000 for midwifery services for pre and post natal care and attendance at the birth. Our midwife can invoice them directly, or we can pay her and send a receipt to them. The contact is Jane Boag, Manager, Claims Analysis. Ph: 03 8682 4228”.
Another mum, from SA, said that in 2002 she received 100% rebate for a homebirth from AU: the midwife charged $1,200 and AU would have reimbursed up to $1,500 at that time. She needed a certain level of cover – but not the top level. They would also have paid the full fee for an independent midwife to attend at a hospital. She had to apply in writing to be approved the same funding for a homebirth, but she said they were quite happy and there were absolutely no disputes. This mother says that this occurred right at the time of the indemnity insurance dilemmas, and the company was not concerned about that.

 

MUTUAL COMMUNITY

Two SA mothers have received reimbursement for midwifery services for planned homebirth, one in Dec 2005, and another (for $2,000) in March 2006. After March 2006 it seems they dropped to $1,500 reimbursement. The bill may need to be sent to a particular staff member in the policy section.

 

TEACHERS FEDERATION HEALTH

For teachers, or people who have been in the fund since a child and their parents are teachers. 9 month waiting period. An SA midwife had a client (July 2006) who received $1,500 to cover her homebirth ($650 for the home birth, which must be with a registered midwife; rest of money covers pre- and postnatal care. Birth amount not reimbursed if mum transfers to hospital). The midwife had to give the mother an invoice with her ABN on it, detailing amounts charged for antenatal, birth/labour & postnatal, as they were specific about how much they would reimburse for each 'part'. A second mum confirmed that this is what she received – also that services must have been provided by a registered midwife; she also believes that if complications arise and hospital birth is required then they will pay benefits for hospital according to your cover level, and any ambulance transfers required as well as the pre/postnatal care provided by the midwife. This mum had to ask about her care and got sent a personal letter outlining what they would cover/pay.

 

DEFENCE HEALTH

Most recent info Sept 2007. Provides private health insurance for family members of defence personnel; defence personnel themselves are provided with “free” medical care under Dept of Defence policy. Confinement and delivery: Up to $550 if provided by a registered midwife in private practice, whether the confinement and delivery is at home or in a hospital, unless a doctor is required to intervene. Ante/post natal care: $20 per pre-natal visit and $40 per post-natal visit, subject to a $240 limit per person per financial year, if provided by a registered midwife in private practice recognised by Defence Health. We know of military women who have been covered for midwifery care or homebirth and were employed in the AIRFORCE and the ARMY. However, anecdotally each area health service deals with approvals for military women to use medical specialists who are or are not on their “approved list” and women may need to argue their case if they want to have care from a midwife who is not on this approved list.

 

HBA

Has notified some members that they will be rebating on homebirth. One Maternity Coalition member contacted them and they say they will cover up to $1,200 for homebirth. A pilot program covering homebirth was being undertaken - contact re this pilot program was Jenni Doherty (Customer Relations Manager), (03) 9937 4074. Current status of this program is unknown at Aug 2007.

 

MBF

Most recent info August 2007 is that one mum is having considerable difficulties with MBF in finding out whether or not she is covered for homebirth and who to speak to at this company. At one point in time we believed that MBF covered the full amount for homebirth/independent midwifery, but that women need to make an individual agreement with them. Many women in the past have reported having $3,000 to $4,000 reimbursed for a homebirth through MBF. One SA mum who had planned a homebirth had to transfer to hospital where she had private care with an obstetrician and so didn’t receive any reimbursement. Had she stayed at home they would have refunded for the homebirth. Ante-natal appointments can be claimed for as part of the alternative services which includes osteopathy etc so if other services in that bracket have already been claimed for the year, there may not be enough money left to claim for midwifery services as well. Women who have held a policy for some time might like to consider switching to MBF if their current fund gives little or nothing back because as an existing policy holder the waiting times are waived and so they should be able to go to MBF, do a deal and get all the costs back - cover is for homebirths only and MBF cover nothing for the fees of the independent midwife if women transfer to hospital, as they then cover the obstetrician fees instead.

 

GRAND UNITED

In 2005/06 GU announced around $2,000 reimbursement and featured Jan Robinson (a NSW independent midwife) in their brochure. However, in late 2006 one SA woman found they would no longer cover independent midwifery or homebirth.

 

HCF

Nothing so far.

 

MANCHESTER UNITY

Apparently pay something.

 

MEDIBANK PRIVATE

Nothing so far.

 

MIM (Mt Isa Mining)

Have paid rebates for midwifery care.

 

NIB

Rebate a small amount.

 

NRMA

Before being taken over paid part – need to check with the company who took them over if this continues.

 

QUEENSLAND COUNTRY HEALTH

Say that they cover homebirth and have this on their website, but their Customer Service Manager says they do not reimburse for any midwife without the midwife having indemnity insurance to cover her for birth (so in effect they do not at present cover homebirth, or any ante- or postnatal care or other care by an independent midwife as there are insufficient numbers of independent midwives in Australia at present to form a group to buy group indemnity).

 

SGIC

Used to cover, now withdrawn.

 

WA HOSPITAL BENEFIT FUND (HBF)

Cover independent midwifery. The WA govt insurance office also had a rebate system for midwives. One midwife had a client commence care in WA and then transfer to NT midway thru and they paid for the midwifery care.