Health insurance for kids

Does it cost any more to cover my kids? Find out more about health cover for your children.

Most health funds will allow you to include your children on your policy at no extra charge, and many insurers even offer incentives for doing so, such as waiving the excess if your child needs hospital treatment or providing gap-free extras for kids.

But every family is different and whether you will need to adjust your extras to allow for additional dental, optical or podiatry benefits will depend on your individual circumstances and the ongoing health of your family.

Compare health insurance for your children from Australian providers

What age will my children be covered until?

Your children will continue to be covered on your family health insurance policy until they reach the age of 25, after which they must take out their own insurance. Until that time, they will fall into one of three classifications for insurance purposes:

• Child dependant. A child dependant is an unmarried dependent up to the age of 21 who is reliant on the policyholder for financial support.
• Student dependant. A student dependant is an unmarried dependent aged between 21 and 25 who is studying full time and therefore dependent on the policyholder for financial support.
• Adult dependant. An adult dependant is an unmarried dependent aged between 21 and 25 who is not studying full time (many insurers will cover this category, but will charge an additional loading).

Are there children-only policies?

It's rare to find a policy that offers health insurance for kids only. While you may be able to find a fund that is willing to cover just your kids, it may not be the best use of your money. Most policies will provide cover for your children at no extra cost.

What age do you have to be to take out a policy?

Health fund	What age do you have to be to take out a policy?	Find out more
	You must be aged 16 years or older to take out your own policy. Persons under 16 will have to be covered under a single parent or family policy as a dependent.	More info
	You must be aged 16 years or older to hold cover as a principal member with ahm.	More info
Australian Unity	Unless it is otherwise agreed to by Australian Unity, you must be aged 15 years or older to hold membership in your own right.	More info
	Membership as a policyholder is restricted to those aged 16 years or older unless otherwise approved by nib.	More info

For a more comprehensive list of pregnancy benefits from Australian health funds, consult the table at the end of this article.

What should you look for in a policy that covers children?

Child-friendly benefits to look for in a good family health insurance policy might include:

• Cover for an adult dependant up to the age of 25 without having to pay an additional loading
• No excess payable if your child is admitted to hospital (most policies include this)
• No-gap extras benefits for kids (such as dental check-ups, teeth cleaning, fillings and x-rays)
• Cover for pregnancy and IVF treatment if you are planning to have a baby
• Extras cover that suits your family members’ specific needs (e.g. more generous dental or optical if there are orthodontic or vision problems, or more physio and chiro if you are a sporting family)

Do you need extras cover?

While some level of hospital cover is necessary to provide protection if a family member needs hospital treatment, good extras cover is vital for families, as ancillary services are not covered by Medicare and services such as dental, optical, podiatry, physio and chiro are used regularly by most growing families.

While children are automatically covered for extras on a family policy, you need to ensure that the benefit limits offered are high enough to cater for the needs of your family. Ideally you should look for a policy that offers individual benefit limits rather than overall capped limits, which a large family can quickly exceed in a year.

Medicare's Child Dental Benefits Schedule provides $1,000 in dental benefits every two years for eligible children, so it might also be worth looking into this when deciding on how much extras cover you need.

Health insurance and pregnancy-related services

If you’re planning on starting a family, you will need to upgrade your policy as early as possible. Most policies do not cover pregnancy and birth-related services, so you will need to add this benefit on or look for a policy that covers it. All health insurance policies covering pregnancy include a standard 12-month waiting period, so you should upgrade to pregnancy cover at least three months before attempting to conceive.

Pregnancy and birth-related services typically covered by private health insurance include accommodation and labour ward costs and doctors’ fees at a private hospital of your choice, plus full or part payment of obstetrician’s fees during delivery and in some cases prenatal classes. If you need to use assisted reproductive services (IVF or GIFT), private health insurance policies that cover them will typically include in-hospital services related to egg collection and embryo transfer.

It’s important to be aware that pregnancy and assisted reproduction both involve some out-of-hospital services such as specialist consultations and tests, and while some of these can be claimed with Medicare, you should expect some out-of-pocket expenses as private health insurance only covers the in-hospital component.

How health funds determine if someone can take out a policy

Health fund	What age do you have to be to take out a policy?	Find out more
	You must be aged 16 years or older to hold cover as a principal member with ahm.	More info
Australian Unity	Unless it is otherwise agreed to by Australian Unity, you must be aged 15 years or older to hold membership in your own right.	More info
	You must be aged 16 years or older to take out your own policy. Persons under 16 will have to be covered under a single parent or family policy as a dependent.	More info
	To qualify as a policyholder or principal member you must be aged 16 years or older.	More info
	You must be aged 16 years or older to become a policy holder. If you are under 16 years of age you are classified as a dependent and must be covered under a family policy.	More info
	Membership as a policyholder is restricted to those aged 16 years or older unless otherwise approved by nib.	More info
	If you are aged 18 years or older you are free to apply as a primary member for a policy.	More info

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