Patients frequently ask for my permission to travel overseas during pregnancy. I usually make the comment, “Make sure you have appropriate travel insurance cover for pregnancy”. I had never thought more about travel insurance in pregnancy until recently when I read a newspaper article about a woman who gave birth at 26 weeks pregnant while on holidays in Hawaii. The newspaper reported the likely bill would be in excess of $AU1.35 million.
There are many other reports of similar scenarios and huge costs incurred with preterm delivery while overseas on holidays. The medical bills can be so huge they can even bankrupt a new parent couple.
It appears this couple in Hawaii had access to good neonatal intensive care facilities. They could have been holidaying at 26 weeks pregnant in a country where there were very basic medical facilities. Not only would their baby have had considerably increased mortality and morbidity risk as a consequence of there not being a high standard of newborn care facilities, but also there would be considerable cost in transporting the baby back to Australia.
Pregnancy is a very unpredictable time
Even in the lowest-risk pregnancy there can suddenly be unexpected life-threatening pregnancy complications and preterm delivery. If there is such a crisis, the first consideration of the pregnant woman is to be able to access the best quality medical care and health support services as quickly as possible to safeguard her and her baby’s well being. But this results in considerable financial cost if the crisis happens while overseas and not in Australia.
Appropriate travel insurance is not optional
Because of the unexpected risks of pregnancy and the associated likely and considerable costs of a complication or preterm delivery, I consider appropriate travel insurance not an optional extra but a necessity for any pregnant woman when travelling overseas.
Unless this travel insurance cover can be arranged then the pregnant woman should ask herself, “is the overseas trip really worth the risk?” and “what would be the health and financial implications if there was a pregnancy complication or preterm delivery in the country I am planning to visit?”
Read the fine print
In deciding this, you must look at your own circumstances and the policy fine print. The fine print varies. You may, in all innocence, take out a policy that looks ok, or you could use the same insurance company you have used in the past when you were not pregnant, only to find you now don’t qualify for cover or that what happens to you while on holidays overseas isn’t covered.
- Uncomplicated childbirth and newborn baby care are not covered by almost all policies.
Often a travel insurance policy will cover ‘complications of pregnancy and childbirth’. That means a normal term delivery will not be covered but development of complications of pregnancy (e.g., preeclampsia, gestational diabetes, placental abruption, stillbirth), a complicated delivery (e.g., emergency Caesarean section) or complications in association with a normal delivery (e.g., removal of retained placenta, postpartum haemorrhage) will be covered. Delivery more than eight weeks before an EDC may be covered for the mother (as long as the pregnancy cover period of the policy has not expired). But care on the preterm newborn will not usually be covered. It is care of a preterm newborn that can result in huge expenses.
- Policy duration. Check when your pregnancy cover ends with the policy. ‘Ends’ means you must be back in Australia by that date. This can be as early as 20 weeks pregnant with some policies. It is usually 26 weeks to 32 weeks. Some will cover in advanced pregnancy even up to 40 weeks pregnancy for medical expenses for policy specified ‘complications of pregnancy and childbirth’, but not for claims relating to an uncomplicated pregnancy and normal childbirth, and not for newborn care.
- Check how the policy duration is calculated. Is the duration calculated from your LMP or by using a revised calculated EDC (because you didn’t ovulate two weeks after your LMP)?
- Check what ‘pre-existing’ pregnancy conditions may preclude you from being covered. These could be:
- Complications of pregnancy present before you want to travel.
- Whether the pregnancy resulted from an assisted reproductive program (IVF).
- Twin pregnancy.
- Travel contrary to medical advice.
- Check which pregnancy ‘complications’ that could develop while away are covered.
- Check whether emergency evacuation coverage (in case you have to be medically evacuated off a cruise ship, for example) and if trip interruption and the repatriation costs back to Australia is covered (in case you have to abandon your trip and return home to receive medical care).
- Check whether, in the time between when you take out your policy and you leave for your trip, you are covered for cancellation of your trip if there is pregnancy complication that prevents you from travelling.
Pre-existing and not pre-existing
If you are pregnant and take out the insurance policy then the pregnancy is classified as a ‘pre-existing’ condition. If you take out the policy before you are pregnant, or you conceive while away, then the pregnancy is ‘not pre-existing’. Check with the insurance company what impact your pregnancy being pre-existing or not pre-existing can impact your ability to make a claim.
Three good websites for extra information on travel insurance policies for pregnant woman are:
I suggest you go to an insurance company’s own website for more policy information rather than relying exclusively on information on these sites. Also look at reviews of others’ experiences in dealing with the insurance company you are considering.
The insurance cost will vary because of …
- Which insurance company you choose.
- Which policy with that insurance company you take out. I suspect the basic cover will not be enough and you will need a premium policy.
- Where you are going. Cover for the USA is often more expensive.
- How long you will be away.
- How many weeks pregnant you will be when you travel.
Make sure it is in writing
If you are told something when you speak to a travel insurance company representative when taking out the policy, when the crisis happens it is very easy for the travel insurance company to deny what was said or say you misunderstood. Check their website and their policy document carefully. If you are still not sure then send them an email with your question. If there is a vague reply saying it is up to their medical assessor at the time you put the claim in then ‘give them the flick’. They have an ‘out opportunity’ and it is likely they will not support you when needed. If the details you need are in writing and specific and it is the answer you want then it is likely to be safe to proceed with that policy.
If you are travelling in the…
- First half of pregnancy. There are many insurance options that cover complications of early pregnancy and miscarriage.
- Second half of pregnancy and especially in more advanced pregnancy. There are less insurance options. As well the risk and potential costs are more. So choose carefully.
Columbus Direct, in information on their website, state that they cover childbirth and newborn care up to 30 weeks gestation. They will cover delivery and newborn care as long as there are not certain specified pre-existing conditions. You should take out their Pregnancy Extension Option. In email communication with me, Columbus Direct advised 30 weeks is calculated either from the LMP (LMP + 210 days = 30 weeks) or from the EDC (EDC – 10 weeks). Medical care, including newborn care, is up to $20 million in expenses with their Pregnancy Extension Option. They cover the repatriation costs of mother and baby back to Australia.
But my understanding is there is no extension of the Columbus Direct policy beyond 30 weeks so if you are travelling and deliver beyond 30 weeks this policy will be no use for you and baby.
Bupa Global in information on their website and in response to my email enquiry, state they will provide pregnancy and delivery cover up to and including 36-weeks pregnant. (mothers expenses but not baby expenses). Your baby can be added to your travel policy after a waiting period of three days by contacting Bupa Global, but newborn care costs will not be covered. Bupa Global and Bupa Australia are both in the Bupa Group but are not the same company. Bupa Australia has its own travel insurance policy, which only covers you to 24 weeks pregnant. They cover the repatriation costs of mother and also baby back to Australia (as long as the baby is stable).
InsureandGo Australia in information on their website and in response to my phone enquiry, state they will cover pregnancy and childbirth until the 32nd completed week. As well, they will cover medical complications of pregnancy until 40 weeks such as emergency Caesarean section, antepartum haemorrhage, postpartum haemorrhage, and retained placental removal. But they will not cover normal childbirth after 32 weeks. They will not cover newborn care at any gestation, and that is where the huge potential costs can be if your baby needs neonatal intensive care facilities.
But don’t take my word for it – make your own enquiry with the insurance company you choose and make sure all your questions are answered satisfactorily before taking out the policy. I still have some confusion from my enquiries about their fine print and will leave it to you to sort out with whoever you choose. I am not personally endorsing any of these insurance companies and have no personal information on how good they are at processing claims.
There may be other good options that I am not aware of as there are many travel insurance companies. If you find a better pregnancy cover option, can you please advise me.
Finally – is that trip really necessary?
‘Babymoons’ have become very popular. But, when a pregnant woman travels in advanced pregnancy, there are increasing risks and she is playing the odds and hoping nothing adverse happens while away. If something adverse happens, it can have dire ongoing consequences. The advice from so many in the travel industry, including doctors involved in overseas emergency care and travel insurance companies, is to avoid overseas travel in pregnancy, especially in advanced pregnancy.
If you want or need to go overseas while you are pregnant, the safest time to travel is in the mid-trimester. You are over the initial miscarriage high-risk period, you have had all the early pregnancy checks, and you are not too advanced that the trip will be too uncomfortable. As well, the chances of preterm delivery are less. But make sure you have adequate insurance cover!