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Who is covered by private health insurance?

Whether you’re a single, a couple or you have a family, learn how to choose a private health insurance policy that’s right for you.

While Medicare picks up the tab for a lot of health care treatments and services, it doesn’t cover everything, which is why a lot of people take out private health insurance. The benefits of private health cover include:

  • The ability to choose your own doctor and the hospital where you want to be treated
  • Shorter waiting times for treatment
  • Cover for a range of hospital fees not covered by Medicare
  • Cover for ancillary services such as optical, dental, chiropractic and physiotherapy
  • Cover for some alternative treatments not recognised by Medicare

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What are the different types of private health insurance?

The three main types of private health insurance are cover for singles, couples and for families.

Singles cover provides you with basic coverage and is useful for several reasons:

  • To avoid the Medicare Levy Surcharge (if you earn more than $90,000 p.a.)
  • To maintain your Lifetime Health Cover status (premiums increase by 2% for every year over the age of 30 that you don’t have hospital cover)
  • To take advantage of extras cover for services such as optical, dental and physiotherapy

Couples cover is great for many reasons including:

  • Enjoying the benefits of the singles cover listed above while saving on premium costs by sharing a policy
  • Getting covered for pregnancy services and IVF if you intend to start a family

Family cover is perfect if you have dependants to care for and it provides cover for both single parent families and two parent families. The benefits of family cover can include:

  • Helping to cover the cost of services your children may need such as dental treatments (braces, wisdom teeth, etc) or glasses
  • Ensuring your dependant children have adequate health cover until they are old enough to take out their own (once they turn 25)

Who is covered by a family policy?

A family health insurance policy provides you, your partner and any dependent children with cover. The definition of a dependant varies with insurers, but most take the following view:

  • Child dependant. A dependant child is the child of one or both parents, who is unmarried and not in a de-facto relationship, is reliant on the policyholder for maintenance and support and is under the age of 21.
  • Student dependant. A student dependant is a dependant child who is undertaking full-time education at an Australian institution and is between the ages of 21 and 25.
  • Adult dependant. An adult dependant is a dependant who is not a student, is not married or in a de-facto relationship and is between the ages of 21 and 25.

All three types of dependants are covered by most family health insurance policies, but once your kids reach the age of 25, they are no longer considered dependants by insurers and must take out their own health cover.

Ageing out of your parents health insurance policy

There are several reasons why a dependant child may no longer be eligible for cover under a family health insurance policy:

  • They have reached the age of 25 and are no longer viewed as dependants by the insurer, in which case they must take out their own singles cover.
  • They have graduated from their educational institution, which means they no longer qualify as a student dependant (although they may still be covered as adult dependants if they are under 25).
  • They have commenced full time employment, in which case they no longer qualify as dependants because they are not solely reliant on the policyholder for their maintenance and support.

How long can you stay on your parents health insurance?

FundFamily health insurance conditions for dependantsMore info about fund
hif
  • Child dependant. Child dependants are covered up until 21 years of age.
  • Student dependant. Your child can be covered as a student up until 24 years of age if they are engaged in full-time study.
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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.
More info
ahm
  • Child dependant. A child dependant is the child of the member who is not married or living in a de facto relationship and is under the age of 21.
  • Student dependant. A student dependant is a child who is unmarried, is over 21 but is under the age of 25, and engaged in full-time education.
  • Adult dependant. An adult dependant is a child who is unmarried, is over 21 but is under 25 years of age, and no undertaking full-time study.
More info
Australian Unity
  • Child dependant. A dependant is a child aged up to 23 years old who is unmarried.
  • Student dependant. A student dependant is able to be covered on your family policy until they reach 25 years of age. This is provided they aren't married and are enrolled in an approved course.
More info
GMHBA health fund
  • Child dependant. You can be covered as a child dependant until the age of 21 if you're no longer a student.
  • Student dependant. You can be covered as a student dependant if you're engaged in full-time study and under 25 years of age.
More info
HCF
  • Child dependant. Your children are automatically covered under your family cover until the day before they turn 22.
  • Student dependant. If your child is enrolled in full-time study they'll be covered at no extra cost until the day before they turn 25 or cease full time study (whichever comes first).
More info
nib
  • Child dependant. Your children can be covered until they reach 21 years of age.
  • Student dependant. You're children are covered if they are unmarried, enrolled in full-time study and aged between 21 and 25 years of age.
More info
Transport Health
  • Child dependant. Children can remain on their parent’s policy if they're under 23 and not married.
  • Student dependant. A student dependant is someone who is enrolled in full-time study, fully dependant on their parents and under 25 years of age.
  • Adult dependant. You are able to get cover for your children aged between 21 and 25 who are not studying full-time with the Extended Family Cover.
More info

You can see the full list of Australian health funds and how they define dependants in our family health insurance article.

Are your stepchildren covered by your health insurance policy?

Is your family expanding with the addition of your partner’s children from a previous relationship? If so, you should review your policy to make sure they’re covered. Generally, there shouldn’t be an issue covering stepchildren, as family policies allow you to cover your children under the age of 21, including your stepchildren, adopted children and permanent foster children.

What are the different levels of private health insurance?

Whether your health insurance is for singles, couples or a family, it will cover two main areas of health care: hospital and extras.

There are usually three levels of hospital cover offered by insurers:

  • Basic. Basic hospital cover includes basic in-hospital treatments, but often excludes cardiac-related services, non-cosmetic plastic surgery, rehabilitation, psychiatric services and palliative care.
  • Medium. Medium hospital cover includes those treatments not covered by basic, but often excludes pregnancy, assisted reproductive services, cataract and eye lens procedures, joint replacements, renal dialysis and sterilisation.
  • Top. Top hospital covers every service where Medicare pays a benefit and only excludes cosmetic surgery and treatments outside of Australia.

There are also three main levels of extras cover:

  • Basic. Basic extras cover includes cover for at least one service such as general dental, optical, physio or chiropractic.
  • Medium. Medium extras covers most ancillary services including general and major dental, optical, physio, chiropractic, podiatry and occupational therapy, but often excludes orthodontics, health management and hearing aids.
  • Comprehensive. Comprehensive extras covers all services, including those excluded in Medium cover, and benefit limits are average or above average.

People may choose to have hospital-only cover, extras-only cover or a combination of both. Most insurers will allow you to mix and match combined cover to put greater emphasis on either hospital or extras cover, depending on your needs.

FAQ

Q: Is private health insurance compulsory?

  • A: No. You don’t have to have private health insurance and you can still access the public health system under Medicare. However, you cannot choose your own doctor or hospital and you may have to join a waiting list for treatment.

Q: What is not covered by private health insurance?

Q: Why do I have to serve a waiting period when I take out private health cover?

  • A: Waiting periods prevent people from taking out cover, making a claim and then cancelling their policy, which would increase the cost of premiums for other health fund members.

Q: Am I covered for a condition I had before taking out my cover?

Q: Does hospital cover pay for all of my in-hospital expenses?

  • A: No. You will have to pay for your own personal expenses such as telephone calls and newspapers as well as some high-cost drugs.

Q: Can an insurer refuse to insure me because I am old or chronically ill?

  • A: No. Private health insurers must provide insurance for everyone regardless of their age or health status, but you may have to serve a waiting period.

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Richard Laycock

Richard is the insurance editor at finder.com.au. He is on a mission to make insurance easier to understand.

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