Health insurance for kids

With family private hospital cover, you’ll receive a benefit towards treatment in a private hospital when the treatment is included on your policy, listed on the Medicare Benefits Schedule (MBS) and you’ve served the relevant waiting periods. When you’re treated as a private inpatient in a private hospital, you can avoid public waiting lists for elective surgery, stay in a private room (on availability) and choose the treating doctor or specialist (on availability).

When your child receives treatment in a private room, you may be able to request a second bed for a parent or family member to stay in during your child’s time there. Choosing a familiar doctor or specialist can also be particularly comforting for children who are going through a stressful time in their young lives.

When you include your child on your extras policy, you’ll receive a benefit towards treatments outside of hospital that Medicare doesn’t cover. This is particularly useful as your kids grow up, as it can provide cover for dental check-ups, orthodontics (for braces), physiotherapy (for sport injuries), psychology (for mental health support) and much more.

Children’s healthcare can get expensive, but with extras cover, you can significantly reduce the out-of-pocket costs associated with treatment outside of hospital. Limits and exclusions may apply, so always refer to the relevant policy documents for the full details of your cover.

In Australia, dependent children can be covered under your health insurance policy, provided you select the correct family status and submit their details on your application. Depending on your policy, your kids and dependants may fall into one of three different categories:

• Child dependants. Children under 21 years old (although some funds allow up to 25, even if they are not studying).
• Student dependants. Single full-time students, generally between 18 and 31 years old. Depending on the fund, this may include a recognised apprenticeship or traineeship.
• Adult dependants. Single adults not studying full-time aged 18-31 years old.

Please refer to your fund’s rules on dependants and children for more information and criteria.

You can list your family status as either a two-parent or single-parent household. How long a dependent child can stay on their parent’s policy varies from fund to fund, so talk to your health fund to ensure your child is covered.

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 information about them and when they came into your care. This also applies to any stepchildren in your care.

If you have a couples or singles policy, you’ll need to upgrade to a family policy for your kids to be covered. Depending on your health fund, you may need to upgrade to a family policy before your child is born for them to be covered from birth. It is a good idea to check with your health fund as these rules can vary.

This is important, as your child may need to be admitted to a special care nursery or intensive care unit, which could come with significant out-of-pocket expenses if they’re not covered.

If you move to a higher level of cover when upgrading to a family policy, you’ll have to serve waiting periods before you have access to the benefits you weren’t covered for previously. In many cases, you can upgrade to a family policy with the same or a similar level of cover, although this will differ between funds.

Any waiting periods you’ve already served on your singles or couples policy will transfer across to your new policy for the same level of cover. For example, if you were covered for heart surgery previously, and your new policy also covers this, you’ll be covered straight away.

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:

• Newborn Child Declaration form. This will be provided by the hospital or midwife in a Parent Pack and must be signed by a doctor or midwife when the baby is born.
• Birth certificate. This is also necessary when enrolling your child into Medicare. You’ll receive a new Medicare card which has their name and Medicare number.

When adding your child to your family health insurance policy, having their proof of birth and Medicare details will help with any paperwork your health insurer may require.

You’ll also need to understand exactly what to do for your newborn to be covered from birth, as these rules differ between health funds. Typically, you will need to reach out to your health fund within a set time to add them to your cover without waiting periods.

If you add your newborn within the required time frame, they will have access to the same coverage you have and won’t need to serve any waiting periods you’ve already served. However, if you still haven’t completed some of your waiting periods, they may also apply to your child.

Depending on your level of extras cover, there may be limits to the amount you can claim per person per year for each treatment covered by the policy. There may also be group limits for certain services (e.g. therapies), and policy limits for the whole family.

Details for these limits should be available in your policy brochure.

There are some health insurers who can provide a private health policy for a child and not for parents or other family members. However, this is rare, and some family policies let you cover your dependants at no additional cost.

Adding additional dependent children and students to your family health insurance won’t typically affect the cost of your health cover, as they’re often covered at no additional cost.

However, adding young adult dependants may increase the cost of your health insurance premiums, and they may have to meet particular conditions to be covered, such as being unmarried and not in a de facto relationship. Some health funds might also have criteria regarding their income or employment status.

Additionally, some health funds don’t charge a hospital excess or co-payment for dependent children admitted to hospital under an eligible private hospital policy, though this may not apply to dependent students and adults.

Conditions vary between health funds, so check with yours for details regarding age limits and criteria for your dependants.

The Australian Government does provide some free or subsidised health services for children who meet their criteria. For example:

• Medicare covers the cost of basic dental services under the Child Dental Benefits Schedule up to a certain limit and within a set time frame. The parent or child must be receiving payments from the government to be eligible. Individual states also have their own dental programs for children.
• The National Immunisation Program provides free vaccines for certain diseases or conditions for children aged 0-19 years old.
• Treatment for cleft lip and cleft palate is covered by Medicare.
• Medicare covers treatment as a public patient in a public hospital.

On top of these, some optometrists bulk bill their eye tests through Medicare, which applies to children and adults. The cost of the glasses themselves aren’t covered by Medicare but an eligible extras policy may pay a benefit.

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 won’t be out of pocket for the consultation. GP visits are not covered by extras policies.

Utilising these free or subsidised services can help reduce the cost of medical treatment.

If you earn above $97,000 as a single or $194,000 as a couple or family – and you don’t have a hospital insurance policy – then you may have to pay the Medicare Levy Surcharge. However, for every dependent child after the first, the family income threshold is increased by $1,500. For example, if you have three dependent children, it’ll increase by $3,000.

No, any Lifetime Health Cover (LHC) loading you or your partner have accrued will not apply to your children.