N.B. A recent change (approved by the government) will enable dependants to stay on their parents policy for longer (until the age of 30). However, while many funds are supportive of the move, there’s been no decision on effecting the change – as of October 2021.
If you’re an existing policyholder and you’re welcoming a new addition to your family, there are a few things to sort out to get them added to your Medicare card and health insurance policy:
When adding your child to your family health insurance policy, having proof of birth and Medicare details for your baby will help with any paperwork that may be required by your health insurer.
It’s important that you add them to your policy as soon as you can, as there are time limits before waiting periods will begin to apply to them. For example, you may have two to six months, depending on your insurer, to add your new arrival to your family’s health insurance. Some funds may also require you to add your baby two months before their due date for them to be covered.
Adding them within that time frame gives them the same coverage you have, so any waiting periods you’ve already served will count as being served by your baby. However, if you still have any waiting periods to finish, so will they.
Should you have couples or singles cover, you’ll need to upgrade to a family policy. In some cases, health funds don’t offer the same level of cover to families that they do to singles and couples. This may mean you need to upgrade your cover. Upgrading to a higher level of cover might mean that new waiting periods will apply for additional benefits you weren’t covered for previously.
Any waiting periods you have already served on your singles or couples cover will transfer across with to your new cover. For example, if you were covered for heart surgery previously, and your new policy also covers this, you’ll be covered straight away.
Contacting your insurer a couple of months beforehand can help you start organising your family’s cover. It may also be a good time to review family health insurance policies to ensure yours is still suitable.
Adding additional dependent children and students on your health insurance doesn’t typically affect the cost of your health cover, as they’re normally covered at no additional cost.
However, young adult dependents may attract additional cost to your health insurance premium and they may have to meet particular conditions. They may need to be unmarried and not in a de facto relationship to be covered, and some health funds might have criteria regarding any income or full-time employment.
Additionally, some health funds don’t charge a hospital excess for dependent children admitted to hospital under your private hospital policy, though this may not apply to dependent students and adults.
Conditions vary between health funds, so check with your health fund for details regarding age limits and criteria for your dependents.
Depending on the level of your extras cover there will be limits to how much you can claim for each person in a year, for each treatment covered by the policy. There may also be group limits for certain services (for example, lifestyle services), as well as policy limits for the whole family insured by the policy.
Details for these limits should be available in your policy brochure.
The Australian Government does subsidise the cost of some health services available to children, and can also provide free medical treatments. For example:
On top of these, some optometrists bulk-bill their eye tests through Medicare, which applies to children as well as adults. The cost of the glasses themselves aren’t covered by Medicare but might be under an extras policy.
General Practitioner (GP) visits are subsidised by Medicare, and you’ll get a rebate for some of the cost when taking your family to see the doctor. Some GPs may bulk-bill, which means you will not be out of pocket for the consultation.
Utilising these free or subsidised services can help reduce the cost of medical treatment.
There are some health insurers who can provide a private health policy for a child alone, and not for parents or other family members. This is rare, however, and typically family policies let you cover your dependents at no additional cost.
If you have adopted or foster children in your care, you’ll typically be able to add them to your family policy. You might be required to provide additional info about them and when they came into your care. This also applies to any step-children in your care.
No, any Lifetime Health Cover (LHC) loading you or your partner have accrued, will not apply to your children.
If you earn above $90,000 as a single or $180,000 as a couple or family – and you don’t have a hospital insurance policy – then you may have to pay the Medicare Levy Surcharge.
In good news, for every dependent child after the first child, the family income threshold is increased by $1,500. For example, if you have three dependent children, it’ll increase by $3,000.