Health Insurance for ChildrenHow Health Insurance for Children Benefits Your Family

In Australia, families aren’t required to have health cover, but it certainly helps. Medicare covers Australians for treatment as a public patient in a public hospital, but it can only go so far.

In this guide we’ll explain how health insurance for children can help support your family’s health and finances. Learn more about your options and the benefits of having family health cover.

  • Medicare can cover all or some of a family’s medical costs as a public patient in a public hospital. However, its limitations are evident in long waiting lists for elective surgeries and restricted cover for dental and optical.
  • Children can usually stay on a family policy until the age of 18 or, if they are full-time students, until the age of 25. Higher premiums may apply to insure dependents over the age of 18.
  • Health funds often allow you to add children to your policy for no cost. Other benefits may include no hospital excess for kids and no gap fee on certain services.

Medicare’s Role in Family Health

As a parent in Australia, it’s a relief to know that Medicare provides cover for a range of treatments and services for your child, including:

  • Free treatment as a public patient in a public hospital
  • Free or subsidised care from doctors, including certain specialists
  • 75% of the Medicare Benefits Scheme (MBS) when treated as a private patient (exclusions apply)

However, Medicare does have its limits. For example, Medicare can only cover limited dental and optical services for children. If your child needs orthodontics or glasses, you’ll have to pay out of pocket.

Families who rely solely on Medicare may also find themselves with a bill if they need ambulance services. Unless you’re a resident of Queensland or Tasmania, an emergency ambulance can cost you hundreds of dollars or more.

What’s more, if any member of your family needs elective surgery through Medicare, costs will be covered but you may face lengthy waiting times.

All of these limitations can be avoided with family health cover.


Family Health Cover

For many families, health cover for children is essential. It covers the whole family for in-hospital treatment as a private patient, and also covers all or a portion of other medical services.

Many policies may allow you to add a dependent child onto your policy at no additional cost, which is a major advantage for parents. Health funds may also offer additional benefits for children, such as no hospital excess or gap-free extras services—more on these later.

On a health insurance policy, children are usually listed as dependants. Most policies define a dependent as someone who:

  • Is unmarried
  • Is under the age of 18
  • Is between the ages of 18 and 25 but meets certain conditions (such as being a student)

If your child is a young adult but you would like to cover them under your policy, they may be considered a ‘young adult dependant.’ If your policy allows this, it is usually at a higher premium.

There are several options for making sure that your children are covered by health insurance. Family membership categories that cover children generally include:

Family Health Cover Membership Types



Health Insurance for Children

There are two types of health cover that can apply to children: hospital and extras cover. You are not obligated to purchase both types from the same fund, though you may get a discount for doing so. It’s also more convenient to manage your health cover under the same umbrella.

Hospital Cover for Kids

Hospital cover can help your family skip out on long waitlists for hospital treatments, as well as avoid out-of-pocket costs. Your hospital policy may also include ambulance cover, which covers a certain number of emergency ambulance services each year.

Extras Cover for Kids

Extras cover (also called ancillary cover) looks after the day-to-day treatments that your family uses. These services may include:

  • Optical (including glasses and contacts)
  • Dental
  • Chiropractor
  • Physiotherapy
  • Podiatrist
  • Speech Therapist
  • Osteopath
  • Hearing aids
  • Psychology
Levels of Health Insurance for Children

Most hospital and extras policies are offered in three different tiers. The higher the tier, the more benefits you recieve. Here’s what each level generally offers.


When to Get Health Cover for Children

If you’re just starting your family, it’s important to realise that pregnancy cover is not the same as health insurance for children. Your child is not automatically covered at birth, unless you make certain arrangements.

If you do plan on getting pregnancy cover, be sure you do so at least 1 year before your child’s birth, as pregnancy cover has a 12 month waiting period.

If you are on a singles or couples policy, your child may be covered at birth, but this usually only lasts for a limited time. Check with your existing policy to see if this is the case.

If your policy does not extend to cover your child at birth, you’ll need to upgrade to family cover before the baby is born. In most cases, this needs to be done 1 to 3 months before the baby’s arrival.

As your children grow up, keep checking in on your health cover to make sure that it is a good fit for your family. Not all children have the same health needs, so you may need to shop around and switch to a better policy as your kids get older.

When Does My Child Have to Leave My Policy?

The answer depends on your policy, but children can generally stay on your policy until they turn 18, or until they turn 25 if they are a full time student.

If you want to keep your child on your policy past the age of 18, regardless of their student status, it may mean paying a higher premium.


Advantages of Health Insurance for Children

Health funds offer a range of benefits to encourage families to take out health cover. Some common benefits may include:

Free child cover

Add your children to your policy at no extra cost. Terms and conditions may apply.

No hospital excess

Your policy may include an excess for hospital treatment. This is an amount you pay before you can claim benefits on hospital services. With no hospital excess for children, the excess is waived when your child is the one receiving treatment.

No gap for kids

Even with health cover, you may occasionally have to pay a ‘gap’. Gap fees occur when a medical professional charges more than is covered by the Medicare Benefits Schedule.

Some health funds offer no gaps for kids on services like dental, physio, and optical, meaning there are no out of pocket costs for your children. Yearly limits may apply.

With children, parents quickly learn to expect the unexpected, and this goes for health costs as well. Having family health cover can give you more flexibility with treatment options and reduce out-of-pocket costs for services that aren’t covered by Medicare.

Compare health cover today to find a policy that can offer your family valuable benefits at a low cost.

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