Maternity and fertility cover, waiting periods and limits

Key rules

• Maternity waiting period: Expect about 8 months from the policy start before maternity is covered, and some insurers ask for 10.
• Emergencies: Emergency and urgent care is covered from day one.
• Fertility treatment: IVF and similar treatment is normally excluded, so you pay for it yourself.
• Newborn: Your baby is not always covered automatically, so check the minimum time your policy must be in force and the registration deadline.

Buy before you are pregnant

A policy can only support a birth if you buy it well before you conceive. Maternity cover has a long waiting period (a "carencia"), commonly 8 months from the policy start date. Some insurers ask for 10. A policy bought during pregnancy will not cover the birth.

If you are already pregnant, you can normally still buy a policy. Pregnancy, childbirth and related complications will be excluded, or the insurer will decline maternity cover. You must declare the pregnancy on the health questionnaire. Hiding it lets the insurer refuse claims or cancel the policy. Other care is covered once its own waiting periods pass.

Other waiting periods that matter in pregnancy

Waiting periods are set per product, so read the table in the policy. Typical patterns:

• Emergency and urgent care: covered from day one.
• Consultations and basic tests: usually no wait.
• Advanced tests such as MRI or CT scans: commonly 3 to 6 months.
• Surgery and hospital stays: commonly 6 months, sometimes 8 to 10 months for some operations.
• Assisted reproduction: 12 months or more.

Some insurers apply no waiting periods at all, or only on some services.

What maternity cover usually includes

• Prenatal check-ups, routine ultrasounds, standard blood tests and screening, including the first-trimester combined screening.
• Amniocentesis, often only when medically indicated.
• Delivery, vaginal or caesarean, in a hospital on the insurer's list, usually with a private room, plus the hospital stay for you and the baby.
• A post-partum check-up and paediatric care for the newborn in hospital.

Common limits: a restricted hospital list, and extras that may cost more. These include antenatal classes, pelvic-floor physiotherapy and non-invasive prenatal DNA tests, which are often only for high-risk cases or sold as an add-on. An epidural is usually included.

Many cheaper copayment or reimbursement products exclude maternity or cover it only partly. Check this before you buy.

Fertility treatment

Most private policies exclude assisted reproduction: IVF, artificial insemination and egg freezing. Some cover basic diagnosis, such as first consultations, hormone tests, semen analysis and ultrasounds. A few offer an optional add-on or discounted rates at partner clinics. You normally pay for treatment yourself.

The public system also offers assisted reproduction, with age and other criteria that vary by region. Ask your regional health service.

Your baby after birth

A newborn is not automatically covered under every policy. Many insurers that include maternity will enrol the baby with no health questionnaire or waiting periods. Usually this needs your policy to have been in force for a minimum period, often 6 to 8 months. You must also register the baby within a short deadline, commonly 15 to 30 days after birth. Cover then usually starts from the birth date.

If you miss the deadline, the baby may be treated as a new applicant, with a questionnaire and waiting periods. Get the exact period and deadline in writing before you buy.

Before you buy

Use the checklist below to compare policies, and the planner to work out when you can try to conceive.

Timeline and deadlines

• Buy a policy that includes maternity before you are pregnant: at least 8 months before the expected birth

• Wait for the advanced tests waiting period if you need scans such as MRI: commonly 3 to 6 months from the policy start date

Plan a pregnancy around your policy's waiting periods

The order that works

Buy the policy first, wait out the maternity period, then try to conceive.

Step by step

1. Choose a policy that includes maternity. Some basic policies leave it out. Find the maternity waiting period in the policy's conditions before you pay. Some insurers ask for 10 months instead of 8.
2. Note the start date. The waiting period runs from the day the policy begins, not the day you apply.
3. Add the waiting period. A policy starting on 1 January with an 8-month wait reaches its maternity date on 1 September.
4. Conceive after that date. This is the safest plan. It works whether the policy counts from the delivery date or from conception.
5. Keep paying without gaps. A lapsed policy can restart the waiting periods.

Counting from delivery or from conception

Most policies measure the wait against the delivery date, so the birth must fall after the waiting period ends. Some measure it against conception, so the pregnancy must start after the wait. Ask the insurer which one applies, and get the answer in writing before you plan around an earlier conception.

If you are already pregnant

You can usually still buy a policy. Pregnancy and childbirth will be excluded, or maternity cover will be refused. Declare the pregnancy on the health questionnaire. Hiding it lets the insurer refuse claims or cancel the policy. Other care becomes available as its own waiting periods pass, and emergency and urgent care is covered from day one.

Plan for the baby too

A newborn is not automatically covered under every policy. Many insurers that include maternity will add the baby with no health questionnaire and no waiting periods. This usually needs your policy to have been active for a minimum period, often 6 to 8 months. You must also register the baby within a short deadline, commonly 15 to 30 days after birth. Cover then normally starts from the birth date. If you miss the deadline, the baby may be treated as a new applicant, with a questionnaire and waiting periods. Put the deadline in your calendar before the due date.

Checklist

• Check that the policy includes maternity and is not a cheaper copayment or reimbursement product that excludes it.

• Find the maternity waiting period in the policy table and confirm it is about 8 months or shorter.

• Ask which hospitals you can use for delivery and whether a private room is included.

• Confirm that prenatal check-ups, ultrasounds, blood tests and screening are covered.

• Ask whether extras such as antenatal classes, pelvic-floor physiotherapy and non-invasive prenatal DNA tests are included or cost extra.

• Look in the exclusions list for assisted reproduction, and ask about any fertility add-on.

• Ask how long the policy must be in force before your baby can be enrolled, and the deadline to register after birth.

What to watch out for

• A policy bought during pregnancy will not cover the birth: Pregnancy, childbirth and related complications will be excluded, or the insurer will decline maternity cover. The maternity waiting period of about 8 months from the policy start date also runs past the birth. Plan for the birth another way, such as public care or paying privately.

• Hiding a pregnancy can cost you the policy: If you do not declare the pregnancy on the health questionnaire, the insurer can refuse claims or cancel the policy for an inaccurate declaration. Declare the pregnancy honestly when you apply.

• Maternity cover has limits even when included: Cover is often limited to a restricted list of hospitals, and extras such as non-invasive prenatal DNA tests may be only for high-risk cases or cost extra. Check the hospital list and the extras before you sign.

Frequently asked questions

Is my newborn covered automatically under my private policy?

Not always: many insurers that include maternity let you enrol the baby without a health questionnaire or waiting periods, but only if your policy has been running for a minimum period, often 6 to 8 months.

Does a private policy pay for IVF or other fertility treatment?

Most private policies do not pay for IVF, artificial insemination or egg freezing, so you normally pay the treatment yourself. Some include basic fertility tests such as hormonal tests, semen analysis and ultrasounds.

How long is the waiting period for fertility treatment?

Where assisted reproduction is covered at all, the waiting period is commonly 12 months or more. Ask the insurer for its waiting-period table before you pay.

Do cheaper copayment policies cover maternity?

Many cheaper copayment or reimbursement products exclude maternity or cover it only partly. Check the exclusions list before you choose one if you plan a pregnancy.