Family health insurance cover

Exploring your family health insurance options? Ensure you get the best cover for your family.

Compare family health insurance cover options

The health and wellbeing of your family is paramount. Getting the right family health insurance cover is integral and there are many aspects which must be considered. Find out more about how to compare your family health insurance options and how to get the best cover for you and your family’s health and lifestyle situation.

How does family health insurance work?

Family health insurance is specially designed to provide effective health and financial cover for you, your spouse and your children. This cover will apply to medical appointments and medical services or treatments not covered by Medicare. Family health insurance can include hospital cover, extras cover or a combined cover for the most comprehensive health and financial protection.

Family health insurance cover can apply to families of all sizes but dependent children can generally only be covered up until the age of 21 or 25 if your child is studying full-time.

What are the different types of family health insurance?

Family health insurance policy options include the following:

Family hospital cover

Hospital cover for families will ensure you get medical services or treatments as a private patient in both a public or private hospital. Family hospital cover will also provide cover for part or all of your in-hospital treatments by your preferred doctor, in-hospital accommodation and theatre fees should you require surgery.

Hospital cover policies under health insurance are broken down into four tiers of cover: basic, bronze, silver and gold. Each tier has its own benefits and the cost of your insurance premiums will be largely dictated by the tier of cover you choose.

Hospital cover may best suit families who are on a budget with their health insurance. You can get the necessary health and financial cover for the most essential medical treatments and services to protect your family. 

Family extras cover

Family extras cover is largely beneficial for preventative treatment and services out of hospital. Common extras policy inclusions include dental, optical, physiotherapy, and chiropractic amongst others. Extras cover policies come in three different levels: basic, medium or comprehensive. The inclusions at each level of cover will differ between insurers but comprehensive cover is always the most wide-ranging and expensive.

Common extras which are often considered for families include:

  • Dental and/or orthodontics
  • Optical
  • Pharmacy
  • Physiotherapy
  • Podiatry
  • Chiropractic
  • Diet/nutrition services
  • Speech therapy

Extras cover may be most suitable for a family who lives an active lifestyle. If you or your children play sport, you may be more prone to injury so treatments such as physiotherapy or chiropractic will go a long way to protecting your health. 

Combined family hospital and extras cover

A combined family hospital and extras cover is often the best option if you can afford it. A combined policy will allow you to take advantage of a combination of both hospital and extras cover inclusions to better benefit your family’s health and wellbeing. It’s possible to mix coverage e.g., a silver hospital cover policy combined with a comprehensive extras cover policy. This policy will give you and your family the ultimate health and financial protection, ensuring you have peace of mind knowing your family’s wellbeing is taken care of.

Waiting periods for each type of cover may vary but are usually:

  • 12 months for any pre-existing conditions.
  • 12 months for pregnancy or other birth services.
  • 2 months for rehab, psychiatric or palliative care (no matter if it’s a pre-existing condition).
  • 2 months under most other circumstances.

What does family health insurance cover?

The inclusions of your family health insurance cover depends on the type of cover you choose and the level of cover in a hospital, extras or combined cover policy.

Hospital cover will typically include cover for any of the hospital or medical services and treatments which are listed in the Medicare Benefits Schedule (MBS). It’s important you read the Product Disclosure Statement (PDS) of your family’s health insurance policy for a detailed guide to the inclusions. Your cover’s inclusions will depend on the tier of your hospital cover – basic, bronze, silver or gold.

Hospital cover inclusions can include the following:

  • Private patient accommodation in private or public hospitals.
  • Intensive care costs
  • Operating theatre fees
  • In-patient MRIs, x-rays, CAT scans and pathology
  • Other surgeries and procedures including: hip replacements, knee replacements, back surgery, dental surgery, hernia repair, colonoscopies and much more.
  • Cancer and stroke treatment
  • In-patient pharmaceuticals
  • Cardiothoracic surgery for heart, lungs or chest.
  • Rehab services
  • Organ transplant
  • Prostheses
  • Eye surgery
  • In-patient psychiatric treatment
  • Palliative care
  • Gap cover for GP visits

In addition, inclusions on your extras cover will depend on the level of cover you choose – basic, medium or comprehensive extras cover. Inclusions for extras cover can include the following:

  • Ambulance cover
  • Optical. Including glasses and contact lenses.
  • Dental cover. Including check-ups, crowns and bridges, root canal treatment, dentures, teeth removal etc.
  • Physiotherapy
  • Chiropractic
  • Hearing aids
  • Occupational therapy
  • Blood pressure monitors
  • Psychology
  • Podiatry
  • Preventive tests. E.g. bowel screening, bone density testing etc.

The exclusions of your family health insurance cover will depend on the type and tier of cover you choose. Under a basic family health insurance policy with only hospital cover, the common exclusions can include:

  • Heart surgeries
  • Joint replacement e.g. knee or hip replacement.
  • Eye surgery
  • Appointments with any specialists outside of hospital.
 

To get a thorough understanding of a policy’s exclusions, contact the insurer directly or read up on your policy’s PDS to make sure you get cover for what you need.

How are my family health insurance premiums calculated?

Not sure what factors determine the cost of your family health insurance? Find out what impacts your family health insurance premiums and how much you might be paying.

Pros and cons of family health insurance

Weighing up your family health insurance options? Consider these pros and cons.

PROS

Claim additional benefits

Depending on your coverage, often-costly health services like dental, physiotherapy and optical will come at a cheaper price, or no cost at all, through your family’s health insurance cover.

No Medicare Levy surcharge

You will avoid paying the Medicare levy surcharge of between 1-1.5%.

Avoid the public hospital wait lists

Taking out family health insurance will help lower your waiting time for elective surgeries.

Can be eligible for private hospital rooms

Depending on your cover’s policy and coverage, you may be eligible for a private hospital room upon request. It’s important to check with your insurer to see if they will cover the full cost or just part of the cost of a private room.

Choice of doctor or surgeon

Family health insurance will allow you to choose your preferred doctor or surgeon.

Peace of mind

Having family health insurance will provide you and your family with peace of mind. Should an unfortunate medical event occur, you will know that your health and finances are protected.

CONS

Can be expensive

Family health insurance can prove very expensive. Cover for your family will often cost as much as $5000 a year and sometimes not a single benefit will be claimed.

Often a great deal of exclusions

The exclusions tied to health insurance can be extensive. In the event of an injury or illness, you might find that you are in fact not covered for something you thought you were. Therefore, it’s important you are aware of your exclusions and know your policy in depth.

Children over 21 years old can’t be covered

Even if you’re child lives at home, they cannot be covered under your family health insurance policy once they’re over 21 years old. Exception to this is if they’re a full-time student.

Wait periods

When you have taken out your family’s health insurance for the first time, you will often find there is a wait period. In certain situations, it may be possible to reduce or waive these waiting periods, but they can be difficult to avoid.

Top tips for comparing family health insurance

Follow Savvy’s top tips to compare and get the best family health insurance.

Compare the cost of family health insurance premiums

When deciding on a family health insurance policy, it’s vital you compare your options broadly to get the best price for you. However, although the cost of your family health insurance is important, you mustn’t let that come at the cost of certain other features which are important to your family’s health.

Compare the total coverage of your family health insurance options

In the decision-making process, make sure you look at the total coverage relevant to each policy. It’s best you choose a policy with wide-ranging cover so your health and finances will be covered no matter the situation.

Understand the amount of cover for your family health insurance inclusions

It’s valuable to know the amount of money you’ll be covered for with each inclusion in your policy. While some policies may provide cover for every inclusion which matters most to your family, they may still leave with you with out-of-pocket expenses depending on their limits.

Take into account your family’s age and health situation

Does a family member have a pre-existing health condition or an underlying medical history? If so, you will undoubtedly need to prioritise cover for that condition or illness.

Consider your family’s lifestyle situation

If you have kids who play sport and are highly active, you may need to consider extras cover for physiotherapy or perhaps podiatry. Taking out extras cover for orthodontic treatment with your children should also be considered in order to save you a significant amount of money.

Frequently asked questions about family health insurance

Have any remaining questions about family health insurance? Here Savvy gives the answers to the most common ones.

What’s the best family health insurance cover option for me?

A combined cover is usually the best option in terms of health and wellbeing, but it comes at the greatest cost and may not be feasible for everyone. If you can afford it, you should consider choosing combined cover for the protection of your family’s health and finances going forward. However, the best family health insurance cover depends on your family’s health and financial situations. Every family’s needs will be different, so it’s best you choose the best cover for your family by analysing a policy’s coverage, price and your family’s medical requirements.

What age must my child be to be considered as a dependent on my family health insurance cover?

Your child can usually be covered under your family health insurance cover up until the age of 21. If they are a full-time student, they can usually be covered up until the age of 25.

Are my children covered for wisdom tooth removal?

Yes! Wisdom tooth removal can be covered under your hospital cover, extras cover or perhaps a combination of the two, depending on where the procedure is completed and its complexity. Wisdom tooth and general tooth removal are both considered general dental. The ins and outs of wisdom tooth removal and its relevant cover can get complicated so talk to your insurer to understand what you are covered for and whether a gap payment may be required.

Can parents be included under my family health insurance?

No. Parents can’t be included in your family health insurance. Family health insurance only applies to you, your spouse, and your dependent children.

 

Are there any tax benefits on a private family health insurance policy?

By taking out family health insurance, you may be eligible for a rebate from the Australian government. This rebate is determined by your income. As your income increases, your eligible rebate will reduce. If you earn over the rebate threshold, you won’t be eligible for a rebate. In addition, by taking out private family health insurance you will avoid paying the Medicare levy surcharge of between 1.5-2%.

What sort of family health cover should I get if I'm planning on having a baby?

If you’re planning on having a baby you should highly consider taking out a gold-level of hospital cover. This will give the best level of private hospital care for you and your baby throughout the pregnancy process. In addition, it’s vital you take out this cover at least 12 months before your expected hospital admission date as a 12-month waiting period applies. If you don’t, you may not be covered in the event of a premature birth.