Health insurance for families

Typically, insuring your family members under a family health insurance policy means they’re covered for the same treatments and services as you.

There are generally three family health cover options available to you in the market, and the right choice for you will depend on your family’s health needs and financial circumstances. Your options are:

• Hospital cover. Hospital cover contributes towards the cost of surgeries and hospital treatment for you and your family. There are four tiers of hospital cover: Basic, Bronze, Silver and Gold, with each level of cover offering more inclusions and contributing towards a wider range of services. You can also get Basic Plus, Bronze Plus and Silver Plus if your insurer offers a policy with cover above that tier’s minimum requirements.
• Extras cover. With an extras cover policy, you’ll be able to claim a rebate on various medical expenses outside of the hospital that Medicare doesn’t pay towards. This includes dental, physio, podiatry, some natural therapies and more.
• Combined hospital and extras cover. If you want family health insurance that pays towards treatment both in and out of hospital, you can take out hospital and extras cover as combined health insurance.

If the price of premiums makes you hesitant to invest in private health insurance, you’ll be happy to hear that in Australia, the government can cover some of the cost of health insurance.

The private health insurance rebate is based on your household’s taxable income and applies to hospital, extras and standalone ambulance policies. If eligible, you can claim your rebate on your tax return or as a discount on your health insurance premium.

Having a family private hospital insurance policy can also save you paying the MLS. If you and your partner have a combined income that triggers that MLS, you may pay between 1% and 1.5% extra at tax time if you don’t hold private hospital cover.

Keep in mind that the Australian Government rebate for private health insurance and the MLS are generally based on income thresholds and may not be applicable to everyone.

You can’t add your parents to your family health insurance policy – only your spouse or de facto partner and dependent children.

Your parents may therefore want to consider taking out their own health insurance policy.

Some health insurers do provide cover for children only, though these policies are rare. Most family health insurances cover nearly all immediate family members (bar your parents and siblings), including birth children, stepchildren, adopted children and foster children. In some of these instances, you might need to provide additional information about when your dependents entered your care.

When it comes to dependants, age limits on family health insurance policies can range from 18 to 31 years old. While this may depend on several factors, such as whether they’re studying, in a de-facto relationship, married or employed full-time, you may be able to keep them on your policy even after they’ve moved out.

Once they leave the nest and are no longer covered by your private health insurance, it’s time to contact your health fund to discuss moving to a singles or couples policy, depending on your situation.

There’s no particular health insurance policy that’s best for all families, as everyone’s needs are different. Comparing policies based on their coverage and price against your family’s medical needs and budget can help you find a policy with great value.

One extra thing to look for is whether a particular health fund has a no-gap or known gap agreement with a hospital or doctor. Going to that doctor or hospital for treatment can help you avoid or reduce out-of-pocket costs, or at least know what they’ll be beforehand.

If your child is injured at school, it’s important to note that while the school should have liability insurance, it might not have accident insurance to cover the cost of healthcare. Schools have a duty of care and will provide first aid, call an ambulance if needed and notify parents.

Any expenses relating to care, including emergency ambulance trips, are borne by you. In situations like these, ambulance cover and private health insurance can pay a benefit towards these expenses and help to provide peace of mind.

Having your first child is something special, but it also means it’s time to start preparing. Anyone hoping to start a family should consider taking out hospital cover well in advance. If you don’t already have an appropriate level of health insurance, you’ll need to take out cover and serve a 12-month waiting period prior to the baby’s arrival if you want to give birth in a private hospital and claim a benefit from your health fund.

You should also check with your health fund to understand what you need to do for your child to be covered from birth. You may need to upgrade to a family policy up to 12 months before your due date for your newborn to be covered.

For more information on health insurance for new families, see our guides for couples planning a family or health insurance for single parents.

When it comes to your second or third child, you may be able to add them to your family policy at no extra cost. If you’re not planning on having any more kids, you may want to consider whether it makes sense to move to a lower level of cover so you’re not paying extra to be covered for pregnancy and birth.

This is also a good time to consider extras cover so your children have access to subsidised services, such as dental. This is because it’s recommended by the Australian Dental Association that your child has their first dentist appointment when their first tooth is visible or they turn one year old.¹

When you share an extras policy with your children, you may also be subject to per person limits on top of your standard sub, group, lifetime and annual limits.

As your kids go through school, prepare for some new and unexpected expenses. They may require orthotics from a podiatrist, glasses from an optometrist or orthodontic work like braces and aligners. All these treatments fall under extras cover, with orthodontics typically being included on more comprehensive policies.

If your child plays sports, you’ll also want to consider if they need to be covered for physiotherapy, chiropractic or remedial massage in case of a sports injury. Other extras policies might include cover for counselling and psychology to help look after their mental health.

The age your child can stay on your policy will differ between health funds, with some funds covering eligible dependants until 31. Your children may need to meet specific criteria to be included on your cover, such as being a student dependant, not being married or in a de-facto relationship and more.

While they’re still classified as a child or student dependant by your health fund, they can generally be included on your policy at no extra cost. Just because the kids grow up doesn’t mean they don’t need looking after. Once they’re old enough, though, consider encouraging them to take out their own policy.