Family health insurance

Get a better understanding of the specific health insurance needs for new parents, single parents and established families.

Whether you are looking to start a family or already have some toddlers or teens, there's a lot to consider when comparing health fund options. This article discusses topics from how maternity services are covered to how government penalties and rebates work.

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Does health insurance cover pregnancy?

Hospital cover can be used to pay benefits towards maternity services, obstetrics and other related costs. However, there are several key points you should know about private health insurance and pregnancy:

• Cover is expensive. Pregnancy and related services are only fully covered by the highest-level hospital policies. Some mid-range policies may partially cover you for pregnancy as a private patient in a public hospital.
• Don’t wait until you’re pregnant. Many health funds require you to serve a waiting period of 12 months before you can claim for pregnancy. If you’re already due when you purchase a policy, it may be too late to get the cover you need.
• Out-of-hospital services. Hospital policies only cover the costs related to hospital admissions for childbirth. They don't cover expenses incurred outside the hospital, such as GP visits and some scans and tests.
• Take out a family policy. To make sure your new baby receives the same health insurance cover as you, make sure to add them to your family policy.

• What about Medicare?

  You can get cover for many of the costs associated with pregnancy in a public hospital. However, only health insurance can cover unexpected costs, give you access to a private room in a private hospital, and allow you to choose your own hospital, obstetrician and specialists.

How long can children remain on a family policy?

Your children can be covered under your policy until they are considered adults by your health fund. While the rules around dependants vary between funds, there are three main classifications that are typically used:

• Student dependant. A single person aged 21 to 25 who is studying full-time can be covered by a family policy.
• Adult dependant. A single person aged 21 to 25 who is not studying full-time may be covered for an additional fee.
• Independent adult. A single person aged over 25 can no longer be covered by a family policy and needs to take out their own cover. This can often be done without serving an additional waiting period if they choose the same fund.

• Dependant rules by health fund

  Title	Dependant conditions
  ACA Health Benefits Fund	Child dependant. ACA considers children dependent until the age of 21. Student dependant. If your child is unmarried, or in a non-de facto relationship while a full-time student earning less than $20,000 per year, they can remain covered on your family policy until they reach 25 years of age, at no extra cost. Adult dependant. If your child is between 21 and 25 years of age, not studying full-time and is unmarried, they can be covered for an additIonal 30% loading.
  ahm Health Insurance	Child dependant. A child of the policy member who is not married or living in a de facto relationship and is under the age of 21. Student dependant. Someone who is unmarried, is over 21 but is under the age of 25, and is engaged in full-time education. Adult dependant. A dependant who is unmarried, is over 21 but under 25, and is not undertaking full-time study.
  Australian Unity Health	Child dependant. A child aged up to 23 years old who is unmarried. Student dependant. A student dependant can be covered on your family policy until the age of 25, provided they are single and are enrolled in an approved course.
  Bupa Australia	Child dependant. A person who does not have a partner and is under 21, or who is engaged in full-time study and is under 25. Adult dependant. A child of the policyholder aged between 18 and 24, who is not studying in a full-time capacity.
  CBHS Health Fund	Child dependant. A dependant who is unmarried, aged under 18 and is a child, stepchild or foster-child who lives with the policyholder. Student dependant. A student who is at least 18 but under 25 years of age, unmarried and participating in full-time study. Adult dependant. A child of the policyholder who is unmarried, over the age of 18 but under the age of 25, and is not a student.
  CDH Benefits Fund	Child dependant. Children or dependants under 21 years of age. Student dependant. A child under the age of 25 who is studying full-time.
  CUA Health	Child dependant. Any dependant children or young adults are covered on a family policy until their 23rd birthday. Student dependant. Full-time student dependants are covered until they turn 25. They must be registered each year from 23 years of age.
  Defence Health	Dependant child. Someone who is unmarried and under the age of 21. Student dependant. Someone between 21 and 24 years of age and is enrolled in full-time study. Adult dependant. A dependant who is unmarried, is not enrolled in full-time study, and is between 21 and 24 years of age.
  Doctors Health Fund	Child dependant. Children can be covered by your family membership up to the age of 21. Student dependant. Dependants are covered by the family's membership until the age of 24 .
  Frank Health Insurance	Child dependant. Children are covered until they turn 21 years of age. Student dependant. Dependants are covered until they turn 25 years of age, provided they are in full-time study.
  GMF Health	Child dependant. Someone who is unmarried and under the age of 21. Student dependant. A dependant who is aged between 18 and 25, is enrolled in full-time studies, and does not have a taxable income in excess of what is stipulated by HBF. Adult dependant. Children of the policyholder who are under 25, unmarried, fully dependent on their parents, and do not have a taxable income in excess of what is stipulated by HBF.
  GMHBA	Child dependant. A child under the age of 21 who is no longer a student. Student dependant. Refers to dependants who are engaged in full-time study and are under 25 years of age.
  HBF Health	Child dependant. Children are covered at no extra cost until the end of the year they turn 18, unless they are married or in a de facto relationship. Student dependant. A dependant who is unmarried, is not earning in excess of the amount specified by HBF, is under 25 years of age and is studying full-time.
  HCF	Child dependant. Children are automatically covered under family policies until the day before they turn 22. Student dependant. If your child is enrolled in full-time study, they are covered at no extra cost until the day before they turn 25 or until they cease full-time study, whichever comes first.
  Health Care Insurance	Child dependant. Children are covered until they reach the age of 23, as long as they remain unmarried. Student dependant. Financially dependant on the policyholder, aged between 23 and 25, and enrolled in full-time study. Adult dependant. Children between 23 and 25 can be covered on the Family Dependant Plus policy if they are unmarried and are not in a de facto relationship.
  Health Insurance Fund of Australia	Child dependant. Child dependants are covered until 21 years of age. Student dependant. Your child can be covered as a student until 24 years of age if they are engaged in full-time study.
  Health Partners	Child dependant. A child dependant can be covered until they reach the age of 21. Student dependant. Your children can be covered at no extra cost if they are aged between 21 and 25 and enrolled in full-time study.
  health.com.au	Child dependant. Children are covered until they reach 21 years of age. Student dependant. A child who is enrolled in full-time study and aged between 21 and 25.
  Latrobe Health Services	Child dependant. A child can stay on a policyholder's membership until they are 18 years of age, as long as they are unmarried. Student dependant. A child who is unmarried, is under 25 years of age and studying full-time.
  Medibank Private	Child dependant. A child can be covered at no extra cost until they turn 21. Student dependant. A child who is under 25 years of age, is unmarried and studying full-time. Adult dependant. If your child isn't studying full-time, is unmarried and aged between 21 and 24, you are able to cover your children for an additional premium with the families with adult children option.
  Mildura Health Fund	Child dependant. Children who are unmarried remain covered until they reach 21 years of age. Student dependant. Full-time students under 25 years of age.
  National Health Benefits Australia (onemedifund)	Child dependant. Children remain covered as long as they are under 21 years of age. Student dependant. Your child is covered until 25 years of age if they are enrolled in full-time study.
  Navy Health	Child dependant. A child is covered if they are unmarried and under 22 years of age. Student dependant. Students are covered if they are in full-time study, aged between 22 and 25 and are unmarried.
  NIB Health Funds	Child dependant. Children under the age of 21. Student dependant. Unmarried, enrolled in full-time study and between 21 and 25 years of age. Adult dependant. If your child is unmarried, aged between 21 and 25 and not enrolled in full-time study, you can cover them for an additional premium with the Extended Family policy.
  Peoplecare Health Insurance	Child dependant. Someone who is under 21 years of age and unmarried. Student dependant. Under 25 years of age, unmarried and enrolled in full-time studies.
  Phoenix Health Fund	Child dependant. Children are automatically covered until the day before they turn 21. Student dependant. Students in full-time study are covered until they reach 25 years of age or cease full-time study, whichever comes first.
  Police Health	Child dependant. Someone who is unmarried and is under the age of 21. Student dependant. A child who is unmarried, is studying full-time and is aged between 21 and 25. Adult dependant. Children can be covered until the age of 25 under the Platinum Plus policy.
  Queensland Country Health Fund	Child dependant. A child can remain covered under your family policy up to the age of 21. Student dependant. Under 25 years of age, unmarried and enrolled in full-time study. Adult dependant. Dependants aged between 21 and 25 can be covered under the Family Plus policy if they are unmarried.
  Railway and Transport Health Fund	Child dependant. A child can remain covered under your family policy up to age 21. Student dependant. Under 25 years of age, unmarried and enrolled in full-time study. Adult dependant. Dependants aged between 21 and 25 can be included with Premium Hospital cover.
  Reserve Bank Health Society	Child dependant. Dependent children can be covered if they are unmarried and under the age of 21. Student dependant. Under 25 years of age and enrolled in full-time study.
  St.LukesHealth	Child dependant. Children can remain on their parent’s policy if they are under 23 and unmarried. Student dependant. Enrolled in full-time study, fully dependant on their parents and under 25 years of age.
  Teachers Health Fund	Child dependant. Children can be covered under your policy if they are under 23 and not married. Student dependant. Studying full-time, fully dependent on their parents and under 25 years of age. Adult dependant. You are able to get cover for children who are not studying full time, and who are aged between 21 and 25, if you take out Extended Family Cover insurance.
  Transport Health	Child dependant. Someone under the age of 21. Student dependant. Aged between 21 and 25 and enrolled in full-time study.
  TUH	Child dependant. Your children can be included in a family policy if they are unmarried and under 21 years of age. Student dependant. A child under 25 years of age who is unmarried, earns less than $50,000 per year and is enrolled in full-time study.
  Westfund Limited	Child dependant. Children are covered until they reach 18 years of age. Student dependant. Someone enrolled in full-time study and under the age of 25.

How do family types affect the kind of cover you need?

• New families
• Growing families
• Established families
• Single parent families

Health insurance tips for families

• Review your cover. As your children grow up and your circumstances change, so do your health insurance needs. Reviewing your policy each year ensures that you're being covered for the things that matter most to your family.
• Avoid combined limits. When considering an extras policy, try and find one that offers individual benefit limits for each service rather than overall combined limits. Your family may exceed individual limits if they aren't high enough.
• Don’t be afraid to switch. If you find a better policy offered by a different health fund then consider changing. Your benefits and any served waiting periods must be honoured by your new fund.
• Split your cover. If one health fund has your ideal hospital policy, and another has the best* extras policy, there is no law that says you can’t have a separate policy for each.
• Get full ambulance cover. Look for policies that offer full ambulance cover, which pays benefits towards ambulance fees for non-life threatening journeys as well as emergency transport.

Rebates, tax and health insurance for families

• Private health insurance rebate. This was introduced by the Australian government to help more people access health insurance. The rebate amount varies depending on your combined family income and your age. It can be claimed either as a premium reduction through your fund or as part of your tax return.
• Medicare levy surcharge (MLS). The Australian government introduced the MLS to encourage more people to take out health insurance and reduce the strain on the public health system. If you don't have cover you pay an additional surcharge on top of the standard 2% Medicare levy once your combined family income reaches certain thresholds.

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