Health insurance for kids: how it works and how much it costs

How do I get health insurance for my children?

If you have, or are planning on having children, you can include them on your health insurance by taking out a family, or single parent, health insurance policy.

• A family health insurance policy will generally provide cover for you, your partner, and your eligible children (depending on the fund, it can be up to and including the age of 31).

• If you don’t have a partner, you can add your children to your health insurance by taking out a single parent health insurance policy.

• If you already have a health insurance policy, you may want to contact your health fund for details on how to add children to your private health insurance.

It’s important to know that if you are having a baby, and you have obstetrics cover but are on a single (or couple) policy, your baby’s care in a private hospital will not be covered by your policy. So, if your baby needs to be admitted to the private hospital for extra care, you’ll have to pay those costs.

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How long can children stay on their family’s health insurance policy?

Children can’t be covered on a family policy if they marry or enter a de facto relationship, or turn a certain age (ranging from 21 to their 32nd birthday, depending on the health fund). Keep in mind, not all family health policies allow for this and you may need to pay a higher premium in order to keep your dependents on the family policy. Check the health fund’s policy documents for more information.

Will it cost me anything to add a child to my health insurance policy?

The cost of adding a child to your health insurance policy will depend on a few key factors, such as whether you have to upgrade to a family policy or single-parent policy, and the rules of your health fund. For example, if you:

• Are already on a family policy: In this scenario, adding a child to your existing policy is unlikely to cost more in premiums. However, if you are planning on getting pregnant and need to add obstetrics (pregnancy) cover, this will cost more as you will typically have to upgrade your level of cover to a higher tier. Keep in mind there are 12-month waiting periods for pregnancy cover and there may be rules around the timeframe in which children can be added after they are born, or the child may be subject to waiting periods and other conditions. If you’re adopting a child or adding an older child to a policy, it may not cost any extra but it’s a good idea to check with your fund.

• Need to upgrade to a family policy (without pregnancy cover): This is likely to cost more. According to Canstar Research, for hospital and extras policies, the average cost difference between couple and family policies is $240 annually, or around $20 per month.

• Need to upgrade to a family policy (with pregnancy cover): This is likely to increase the cost of your premiums. Canstar Research found that the cost difference for moving from a couple to family policy could be $318 per year on average, or around $27 a month.

Keep in mind that the amount your premiums could increase will vary depending on the insurance provider and the level of coverage you choose.

National average annual hospital premiums for couples and families

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Source: www.canstar.com.au – prepared on 13/03/2025, data as of 5/03/2025. Based on hospital only insurance policies available for both couples and families on Canstar’s database. OSHC, visitor and corporate policies, as well as policies from restricted funds, are excluded. Excludes plans offering restricted cover for obstetrics. The Australian Government Private Health Insurance Rebate, Base Tier for under 65s, of 24.608% has been applied to premiums. Average premiums based on state averages weighted by proportion of insured population (APRA Quarterly Private Health Insurance).

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What are the benefits of private health insurance for kids and dependants?

Besides the peace of mind of knowing your children are covered if they need medical treatment in private hospital, some other potential benefits to having private hospital and extras cover for your kids, include:

• Having a private room: If available, staying in a private room during a hospital stay can have hidden perks, such as more space for the family when visiting. You may even be able to request an extra bed for yourself during your kid’s stay.

• Choosing your doctor: With private hospital cover, you’ll typically be able to choose your child’s doctor and have more say in what type of treatment your child will receive.

• Avoiding public wait lists: By having private health cover, you can avoid potentially lengthy public waiting lists if your child needs elective surgery.

• Dental cover: The majority of extras policies will have general dental included, which will help subsidise the cost of maintaining your child’s dental health. But keep in mind, you may need to take out a higher level of coverage if your kid needs major dental or braces (orthodontics).

• Cover for sports injury: Sports injuries can be fairly common for children, so it could be handy to be covered for physiotherapy or even podiatry.

• Cover for psychology: Mental health support can be incredibly important for growing kids, but not all extras policies cover psychology, so it’s important to read through a policy’s Private Health Insurance Statement (PHIS) carefully.

Medical care can be expensive and easily add up, particularly with growing kids. With private health insurance for your kids, you can help to reduce your out-of-pocket costs and have more say in their treatment. But limits and exclusions may apply, so it’s always important to carefully read through a policy’s PHIS before you take out a new policy.

How can I decide what level of family health cover is appropriate?

The level of cover best suited to your family’s needs will depend on multiple factors, including the age of your family members, your medical histories, and whether you plan on having more children.

There are four main tiers of hospital cover available in Australia: Basic, Bronze, Silver and Gold, as well as ‘plus’ options for some of these (which offer more than the minimum level of cover required under the tier). You may also decide to add extras cover onto your hospital policy.

To decide which level of health insurance is appropriate for your family, consider what you currently need cover for, and what you could need in the future. Some common considerations for families may include:

• Cover for pregnancy and related services.

• Cover for general dental, major dental or orthodontics.

• Your excess. As kids may be more likely to hurt themselves than adults, a lower excess could be appropriate. Having a lower excess increases your premium in exchange for a lower out-of-pocket cost when you claim.

• Any waiting periods that apply.

• Any incentives or special offers available.

• Your family’s potential future health needs, for example glasses, orthodontics or elective surgeries.

If you require private insurance cover for pregnancy and birth, you can either take out a Gold-tier hospital policy (which is the only tier that has pregnancy and birth as a minimum requirement), or another hospital tier that can include pregnancy and birth as an addition for the policy. You may also want to consider taking out an extras policy which provides cover for antenatal and/or postnatal treatment.

Based on your personal circumstances, finances, and family needs, it may also be more affordable to consider separate policies for your family members. For example, if you’re pregnant, keeping your partner’s insurance separate until after the delivery could help you avoid paying for an unnecessary higher level of obstetrics cover for them, as well as for yourself.

However, if you are giving birth in a private hospital and want to ensure that your baby is covered when it’s born, you’ll need to add it to your insurance (within the timeframe required by your health fund), and this could require you moving up to a family policy. It’s a wise idea to crunch the numbers and compare the costs before changing your insurance.

How much does family health insurance cost?

How much you pay for a family health insurance policy will depend on several factors, including the level of cover you choose to take out and whether or not you or your partner (if you have one) have ever held health insurance, as this will determine whether you pay Lifetime Health Cover Loading.

To give you an idea of what you might pay, the table below displays the average annual premiums for family hospitals and extras policies in different states and territories across Australia.

Average Annual Hospital Premiums for Families by State

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Source: www.canstar.com.au – prepared on 13/03/2025, data as of 5/03/2025. Based on hospital only insurance policies available for both couples and families on Canstar’s database. OSHC, visitor and corporate policies, as well as policies from restricted funds, are excluded. Excludes plans offering restricted cover for obstetrics. The Australian Government Private Health Insurance Rebate, Base Tier for under 65s, of 24.608% has been applied to premiums.

5 points to consider for family health insurance

There are a handful of points you may want to keep in mind when considering taking out a new family health insurance policy, or adding children to your existing policy, including:

• If you and your children are likely to have medical needs that won’t be covered by a hospital policy, consider if an extras policy could take care of these needs. Check to see if the policy offers no-gap extras benefits for children on services such as dental checkups, x-rays, etc.

• For health insurance purposes, a ‘dependent child’ is a person under the age of 18 years who does not have a partner, as defined in the Private Health Insurance Act 2007. However, health funds can extend the age limit for dependants to 31 years of age, provided the dependant remains unmarried and is not in a de facto relationship.

• Many health funds will let you change from a couples health insurance policy to a family policy at no cost. So, if your premiums change when you add a child to your policy, you may want to review your policy closely and consider your options.

• If you take out a new health insurance policy rather than adding children to an existing policy, bear in mind that you may need to serve waiting periods on the policy before you can start claiming benefits.

• If you’re planning on having a baby, check that your policy provides cover for pregnancy if you want to use relevant private hospital and/or medical services, non-medical and allied health services outside a hospital as part of your care.

According to the Commonwealth Ombudsman, all health funds have a 12-month waiting period on obstetric services. So if you’re wanting private health care during and after your pregnancy, you’ll need to make sure your policy provides this level of cover around three months or more before you (or your partner) conceive.

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