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I've tried doing my best to research this subject on my own. Official resources are giving me conflicting information (more on that below). Unofficial (anecdotal) resources, such as forums, are giving me some worst-case scenarios, and now I'm dreading exorbitant hospital bills. The answer to this question could be the difference between free health care (as it's now in The Netherlands) and $15,000 or more in bills (if I am to believe anecdotal sources).

I'm looking for answers backed by official sources. Anecdotal answers can provide me with information and prepare me for what's coming, but I really want to know for sure.

I'm migrating to Australia from The Netherlands with my daughter and pregnant wife on a 482 Temporary Skills Shortage visa. When we arrive, my wife will be 7 months pregnant. As a citizen from The Netherlands, we are eligible for Medicare under the Reciprocal Health Care Agreements (RHCA). This should give us a Yellow Medicare Card:

A Medicare card is [...] usually green in colour, although interim cards are light blue and cards for Reciprocal Health Care Agreement visitors are light yellow.

To secure the TSS visa, we'll also take out an Australian health insurance that meets the immigration requirements, because it's possible that RHCA Medicare doesn't fully cover those. However, these insurances all seem to have a waiting period for pregnancy coverage, usually at least 12 months before the due date. Since my wife is due to give birth 2 months after we arrive in Australia, the insurance needed for the TSS visa will not cover the childbirth.

So, we can just rely on the RHCA Medicare for that, right?

Well, if you take a close look at the requirements, you'll notice (emphasis mine):

You’ll need to show your passport, evidence of your current visa and:

  • proof you have valid insurance in the Netherlands Health Insurance Scheme, or
  • your valid European Health Insurance Card with the initials NL

So here's the catch: in The Netherlands, you cannot stay insured if you do not receive income from The Netherlands and do not live in The Netherlands. I'll be employed by an Australian employer, only receive income from Australia, and I will no longer be registered in any Dutch municipality.

Hm, that sucks, but what about travel insurance?

Same deal. Our current travel insurance has worldwide coverage, but as soon as we exit The Netherlands, the insurance ends.

Does this mean that in fact I can't secure RHCA Medicare? It seems that I fall into an edge case where I can't get Dutch health insurance, nor travel insurance, nor Medicare, nor Australian health insurance that will cover the pregnancy and birth of our child.

We really do not want to migrate to Australia separately (as in, my wife stays behind in NL to give birth, then come over later). We'd also prefer to not delay the migration entirely, as my employer needs me to fill a position. If I delay, it would have to be delayed by several months (2 months until birth, then recovery before being able to pick up and leave).

You mentioned conflicting information earlier?

Yes. On one hand, not living in The Netherlands and receiving income from The Netherlands means I can't stay insured there. Also, when the intention is to leave The Netherlands permanently (as you usually do when emigrating), you can't stay insured there. On the other hand, the TSS visa is technically temporary, in my case 4 years (482 Medium-term stream). So perhaps even if my personal intention is to emigrate, according to the "rules as written" I'll be living and working outside The Netherlands temporarily. It's unclear to me which situation takes precedence.

What are my options to avoid a ~$15,000 hospital bill for care which would otherwise be free?

  • Doesn't the Dutch health insurance remain valid for 3 months after moving, or is that only within the EEA? – gerrit Nov 8 '18 at 15:28
  • I haven't seen that anywhere. Got a source for me? Dutch sources are fine too. – Marc Dingena Nov 8 '18 at 15:54
  • I may have been confused. This page mentions the 3 months period but that is about the total duration of the stay being less than 3 months. I thought I had read about the 3 months when researching a move from the UK to Germany, but the context may have been different. – gerrit Nov 8 '18 at 16:05
  • Will the child be immediately covered from birth on? – Patricia Shanahan Nov 16 '18 at 14:33
  • In the Netherlands, they would be if the parents are covered. Child health care in NL "piggy backs" for free on parent insurance. – Marc Dingena Nov 16 '18 at 14:47
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I'm afraid you have fallen into a common trap, and one myself only narrowly avoided: our first son was born one (1) day after our 1-year waiting period ended!

As far as I'm aware, and like you we searched far and wide at the time, there is no insurance that covers pregnancy during the first year. Reciprocal Medicare coverage is intended only for short-term coverage and emergency care, not migration and pregnancy.

That said, Australia is not the USA, and it's highly unlikely that giving birth would cost $15,000. My wife gave birth in a top-tier private hospital, where the bill would have been around $5000 at the time, and apparently the average at private hospitals is around $8500 now. Public hospitals as a private patient (yes, this is a thing) would likely have been cheaper.

The other option would be that either you both or your wife alone stay in the Netherlands to give birth, but obviously this is unlikely to be practical if you need to start your job soon.

  • Does your answer regarding costs include obstetrician check-ups and such, or purely the delivery at a hospital? – Marc Dingena Dec 9 '18 at 21:23
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    @MarcDingena Just the delivery. Private obstetricians are very expensive in Australia (~$5000 is typical) and most people don't use them unless they expect complications. GPs and midwifes are much cheaper for prenatal care. – jpatokal Dec 9 '18 at 23:16

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