If you are looking to start a new family or have recently started a new one, have reunited with your family after time apart, or simply have someone under your care, you know the feeling of wanting to keep them safe. Medicare, which is the publicly funded health care system in Australia, might not cover all the services your family needs, such as dental work, glasses, and ambulance. Furthermore, the waiting times for common elective procedures may be long in the public system. Data from the Australian Institute of Health and Welfare shows that waiting times at women’s and children’s hospitals were highest in 5 years from the last data source, 2022-2023.

In contrast, private health insurance helps you take care of your family and yourself under one cover. Each member of the family has different needs as they are all at different stages of their lives, like maternity care, pediatric care, or, in unique cases, regular health checkups and pathology tests. Simply put, every family’s situation is different; therefore, in private family health insurance, you can select and add cover based on your own family’s individual needs.

In addition, private health insurance provides families with peace of mind. It covers hospital stays, surgeries, and other medical services like scans, x-rays, and various in- and out-hospital services. Adequate private family health insurance benefits not only ensure health safety but also financial security. Paying hefty fees out of pocket can be very stressful, especially when many families are living paycheck to paycheck. In these circumstances, having adequate private health insurance for the entire family comes in very handy and is also a sensible choice.

When it comes to family health insurance, there are several options available to suit the diverse needs of your family. Each type of insurance can be tailored to provide the necessary coverage for different family members, depending on their health requirements. In general, family health insurance is divided into three main categories: hospital cover, extras cover, and combined cover. Here’s a breakdown of each:

Hospital Cover

Family hospital cover provides protection when you or a family member needs in-patient treatment at a hospital. This could range from day surgeries, such as colonoscopies, to more significant procedures like heart surgery that require longer hospital stays. There are various levels of hospital cover available. For instance, if you’re planning to have more children, a Gold level hospital cover will be required as it includes private hospital care for pregnancy and birth. Alternatively, if your family has fewer health needs and you’ve finished growing your family, you might opt for a Bronze or Silver level of cover, which caters to more basic treatments at a lower cost.

Extras Cover

Extras cover provides a wide array of out-of-hospital services that families are likely to use regularly, such as dental, optical, physiotherapy, and hearing aids. Unlike hospital cover, which you hope you never have to use, extras cover helps offset the costs of services your family will use frequently, such as routine dental check-ups or visits to the optometrist. With extras cover, you can claim back a portion of the expenses for these regular services, making it a cost-effective way to manage ongoing health needs for the whole family.

Combined Cover

Combined cover offers the best of both worlds, including both hospital and extras coverage in a single policy. While there’s no inherent advantage or disadvantage to having a combined policy versus separate hospital and extras policies, combined cover can be more convenient for families who prefer to manage everything under one policy. It simplifies your paperwork and ensures that all aspects of your family’s health needs are covered without the hassle of managing multiple plans.

Ultimately, the choice between hospital, extras, or combined cover depends on your family’s unique needs.

With all these different types of health insurance provided by different companies, it is important to first talk about how to choose the best one for yourself and your family according to your needs. This can be done after you compare family health insurance policies from different companies based on key considerations. There are five key considerations that you should keep in mind:

Current Health Status

Before selecting a family health insurance policy, it’s essential to evaluate the current health needs of each family member. Consider how often you, your partner, or your children have required medical attention recently. Ask yourself: How many GP visits, checkups, or emergency appointments have we had in the last few months? Are there any ongoing health issues or chronic conditions within the family? What medications are you or your family members taking regularly?

By answering these questions, you can better determine the level of coverage your family requires. If your family generally has good health and minimal medical visits, a basic health insurance plan might suffice. However, if there are chronic conditions or frequent medical needs, you may need more comprehensive coverage that includes extras like dental, optical, and physiotherapy to ensure all bases are covered.

Future Health Needs

Beyond the present, it’s important to consider what your family’s health needs might look like in the future. Think about the ages of your children and their potential healthcare requirements. For example, will they need braces in a few years? Are regular trips to the speech therapist or physiotherapist part of their routine? Do they play sports and require annual checkups or protective equipment like mouthguards?

Similarly, consider your and your partner’s health needs in the coming years. Planning ahead allows you to choose a health insurance policy that not only addresses your current situation but also prepares for future medical expenses.

Cost

Cost is one of the most important points to keep in mind while choosing a health insurance policy. The reason behind this is that different companies offer different pricing for hospitals, extras, and combined covers. To find the best one, you will need to compare health insurance cost, policies, and their offered premiums, excess, and out-of-pocket costs. Remember, though, the cheapest doesn’t always mean the best. Sometimes, it’s better to pay a little bit more because you’ll end up getting more back in the long run.

Extras Policy Limits

When selecting family health insurance, it’s crucial to pay attention to the coverage limits on your extras policy, as well as the rebates offered. Many people focus on the “yearly limit,” which is the maximum amount you can claim for a particular service in a year. For example, a policy might offer a $300 yearly limit for physiotherapy, meaning each individual can claim up to $300 in physiotherapy services within the health fund year.

However, it’s equally important to understand policy limits, which are sometimes referred to as family limits. These limits apply to the total amount a family can claim as a whole. For instance, a policy might allow each family member to claim up to $600 per year for major dental work but cap the total family claims at $1,200. Once your family reaches the combined policy limit, no more claims for that service will be reimbursed, even if individual members haven’t used their full annual limits.

This distinction between annual limits and policy limits is particularly relevant for families. While single or couples’ cover rarely faces this issue, families with several members may hit the policy limit more quickly if multiple people are accessing the same services. It’s important to review both limits to ensure that your family’s healthcare needs are fully covered without unexpected restrictions.

The Excess Structure

When purchasing a hospital policy, it’s important to understand how the excess works. The general rule is that the lower the excess, the higher the premium, which is why many families opt for a $500 or $750 excess to keep premiums manageable. An excess is a pre-agreed amount that you’ll need to pay upfront when admitted to the hospital. It only applies to hospital admissions and not to extras claims like dental or physio.

However, not all policies treat the excess the same way when it comes to dependents. Some policies require your children to pay the excess if they are admitted to the hospital, while others waive it entirely for children under a certain age. For instance:

• Some policies may not charge an excess for children under 21 or 23.
• Others may require your children to pay an excess only after they reach a certain age, or in specific circumstances.

To avoid unexpected costs, it’s essential to understand how your policy handles excess payments for your family. Knowing whether your children will be charged an excess can help you budget better and avoid surprises when a family member is admitted to the hospital. Be sure to review the terms of your policy to ensure you’re fully aware of when and who will need to pay the excess.

Private hospital insurance for families can offer significant benefits, especially for those looking for faster access to treatment and a wider choice of care. While it may not be necessary for everyone, family hospital cover can provide valuable protection when unexpected health issues arise, offering peace of mind and financial support. One of the key advantages is flexibility—you can choose to be treated as a private patient in a public hospital, a private hospital, or even at a day surgery facility, which can be particularly useful if you prefer control over your healthcare options.

Hospital cover typically includes a range of in-hospital services, such as maternity care, rehabilitation, psychiatric services, heart surgery, joint replacements, dialysis, cataract surgery, and treatments for neurological conditions. For families who may face long waiting times in the public system for elective procedures, private hospital cover offers the potential to access treatment sooner. Additionally, you may benefit from a private room (if available) and the freedom to choose your own specialist.

Financially, private hospital insurance can help reduce the burden of large medical bills, particularly for complex surgeries and treatments. While it may not be essential for everyone, it can be a wise investment for families who want quicker access to care and a broader range of treatment options. Ultimately, the decision depends on your family’s health needs, lifestyle, and budget, but having hospital cover can provide added security and convenience when medical issues arise.

Extras cover is a vital component of private health insurance for Australian families. It provides coverage for a wide range of out-of-hospital services that can help maintain and enhance the overall well-being of your family. These include essential services like physiotherapy, dental care, optical services, and even specific treatments your children may need, such as braces, speech therapy, and medical aids. With the rising costs of healthcare, extras cover ensures that these routine and necessary services don’t lead to overwhelming out-of-pocket expenses.

One of the most significant advantages of extras cover is the potential savings it offers. By claiming services you already know your family will use regularly, you can essentially make a profit on your policy. Take nib’s Core Extras policy in Victoria as an example: for a family, this policy costs around $896.56 per year (with a base tier rebate and direct debit discount). This policy covers preventive dental, general dental, major dental, physiotherapy, optical, and ambulance services.

Let’s break it down: Imagine a family of four—two adults and two children—where each member visits the dentist twice a year for check-ups and cleanings. At one of nib’s no-gap dental providers, like Pacific Smiles Dental in Melbourne CBD, a check-up and clean typically costs $192. For eight dental visits (four people with two visits each), the total value claimed would be $1,536. And because it’s a no-gap provider, you wouldn’t pay anything out of pocket.

Now, add in optical services. Let’s say two family members need new glasses, and you opt for $199 frames from Specsavers, another no-gap provider. That’s an additional $398 in benefits claimed without paying extra.

In total, you’d be claiming $1,934 in benefits—more than double the amount you paid for your extras policy. By carefully selecting providers and utilizing your policy benefits, your family can significantly reduce healthcare costs while receiving the essential care you need.

Extras cover is not just about financial savings; it’s also about ensuring that your family has regular access to services that support long-term health and well-being. From regular dental check-ups to physiotherapy sessions, these services can help prevent more serious health issues down the road, making extras cover a smart choice for Australian families.

Family health insurance costs can vary from one insurance provider to another and also depend on what sort of insurance coverage you have for the entire family. There are many different types of costs associated with insurance generally, and understanding what each of them means and entails is important for making an informed decision while buying a policy and, consequently, using it where needed. Here, we explain each type of associated cost:

Premiums

Premiums are the regular payments you make to keep your family health insurance policy active. Depending on your budget and provider, you can choose to pay your premiums fortnightly, monthly, quarterly, or yearly. The amount of your premium will depend on several factors, including the type of coverage you select, the services covered, and any additional features or benefits you opt for.

It’s essential to talk to your provider in detail about your premium structure and payment options. For instance, some providers offer discounts if you pay through direct debit from your bank account instead of a credit card. Additionally, paying annually instead of monthly may also result in a discount. It’s important to note that if you stop paying your premiums, your coverage will cease, leaving your family without insurance protection.

Excess and Co-payments

An excess is an out-of-pocket cost that you agree to pay when you’re admitted to the hospital. The general rule is that the higher your excess, the lower your premium will be. Families often opt for a higher excess to keep premiums more affordable. However, you will only be required to pay this excess when you or a family member is admitted to the hospital for treatment—not for claiming extras services like dental or physiotherapy.

Co-payments, though less common in 2024, are another type of out-of-pocket cost you may need to pay each time you’re admitted to the hospital or use certain services. It’s important to double-check your policy to see if co-payments apply.

When reviewing your policy, pay special attention to how the excess applies to your children. Some policies will waive the excess for children under a certain age, while others will require a payment. Additionally, some policies may waive the excess altogether if the hospital admission is due to an accident. Understanding these details upfront ensures that you’re not surprised by unexpected costs when a family member needs hospital care.

By understanding the costs associated with family health insurance, you can make smarter decisions that ensure your family is protected while balancing affordability. Always review the fine print in your policy to ensure you know exactly what you’re paying for, and take advantage of discounts and options that work best for your financial situation.

Lifetime Health Cover Loading

Lifetime health cover loading is the additional cost for those who take out hospital cover after the age of 31 years. This means that if you have not taken out any private hospital cover after turning 30, and later on you decide to buy one, you will have to pay a 2% LHC loading cost on top of your premium for every year you are aged over 30.

A simple example for you to understand this loading fee is that imagine if you take out private hospital coverage at the age of 35 years old you will then have to pay an extra 20% on the cost of this coverage per year for 10 years. Likewise, if you buy a policy when you are 50 years old, you will pay 40% more per year for 10 years. This is why it is recommended that before you turn 30, you should have private health insurance in place, which will save you a good amount of the loading fee in coming years.

Government Rebates

The Australian Government’s rebate can reduce premiums based on the policyholder’s age and income. In the case of family health insurance, the government rebates can apply and be even more beneficial if the household is dual-income. This page describes various situations of a policyholder and how they may receive their private health insurance rebates. Please check out the page, and if you have any questions, please feel free to email us your inquiries at enquiries@healthdeal.com.au.

All the above-mentioned costs related to health insurance for a family can be reduced and managed well according to your chosen policy and its coverage. It is, however, very important to balance your costs with benefits from your insurance provider and government rebates for family health insurance. This will help you manage your bills more efficiently and ensure value for money while keeping your loved ones protected.

Tailored Family Policies

Many health insurance providers offer specially tailored family health policies designed to meet the unique needs of families. For example, young families may prioritise coverage for maternity care and services like speech therapy or dental for children, whereas older families might focus on managing chronic conditions or higher-level hospital care. These family-specific policies often include additional benefits, such as no-gap arrangements with preferred providers, meaning you won’t be out of pocket for certain treatments like dental check-ups and glasses.

Health funds like Bupa, Australian Unity, hif, NIB, ahm, and Westfund provide a range of family cover options. Each fund offers unique features; for instance, some may cover children’s mouthguards under dental, while others may have higher limits for speech therapy or physio. These details matter when choosing a policy, as they allow you to customise your coverage based on your family’s individual health needs.

If you want to compare policies quickly and efficiently, tools like Health Deal’s comparison service are invaluable. By using this tool, you can compare policies from multiple providers and find the best coverage for your family’s needs without the hassle of contacting each insurer individually.

Government rebates and incentives are key to making family health insurance more affordable. In Australia, there are two main programs that can help families manage the cost of health insurance: the Private Health Insurance Rebate and the Medicare Levy Surcharge (MLS) exemption.

• Private Health Insurance Rebate is a government program that provides a rebate to most Australians who hold private health insurance, helping reduce the cost of premiums. The rebate is income-tested, meaning the percentage you’re eligible for depends on your family’s combined income and the age of the policyholders. For example, families with lower incomes receive a higher rebate percentage.
• Medicare Levy Surcharge (MLS) is a tax imposed on Australians who earn over a certain income threshold and do not hold private hospital insurance. If you and your spouse’s combined income exceeds the threshold, you may need to pay the surcharge unless you have private hospital cover. However, holding family hospital cover can exempt you from this additional tax, providing a significant financial incentive for those earning above the MLS threshold.

For more detailed information on your eligibility for these rebates and exemptions, you can visit official government websites or consult with your health insurance provider.

We have provided you with a lot of information about family health insurance types, their providers, tiers, rebates, associated costs, and services. However, the question remains: Which are the best health insurance providers for families according to your family’s health and medical needs? While assessing the best insurance provider, you need to consider factors like coverage options, cost, provider networks, customer service, and the ease of the claims process.

To make a careful decision, we suggest you compare family health insurance providers and their products. Each insurance company offers broadly the same policy but with a few changes here and there. We encourage you to read their product disclosure statements carefully and refer to their websites for more information. Additionally, you can also read family health insurance reviews and view ratings of different insurance companies and their customer services on review sites like ProductReview.

A common misconception in the health insurance industry is that there’s a “best” health insurance provider for families. In reality, no single health fund can be considered the best for everyone, as health insurance is a deeply personal choice. While certain health funds may receive awards from sources like Canstar or Choice, it’s important not to rely solely on these accolades. These awards may recognize certain aspects of a health fund, but they don’t necessarily mean it will suit your unique health needs.

For example, a health fund might be highly rated, but that doesn’t mean it will have agreements with every hospital you may want to use. If you choose a provider based solely on awards and later discover that your preferred hospital or surgeon isn’t covered, you could be left with significant out-of-pocket expenses.

When selecting the right health insurance for your family, it’s crucial to go beyond the awards and ask the important questions: Does the health fund have agreements with the hospitals and specialists you prefer? Does it cover services you and your family are likely to need, such as at-home healthcare or additional support services? Tailoring your choice to your specific needs is key to finding the right health fund, so always consider your personal requirements before making a decision.

In today’s world, customer reviews are an invaluable tool when researching health insurance providers. They offer real-life feedback and insights from people who have firsthand experience with the company’s services. While it’s helpful to read about others’ experiences, it’s important not to rely solely on reviews when choosing a health fund. Every family’s needs and circumstances are unique, and what works well for one person may not be the best fit for you.

Use customer reviews as one piece of the puzzle, but balance them with a thorough comparison of coverage, cost, and the specific features of each policy. Always ensure the policy meets your personal and family needs before making a decision.

How To Switch and Save on Family Health Insurance

Switching family health insurance, especially with Health Deal, is super simple. Health Deal will handle the entire switching process for you, so you won’t have to lift a finger. When you sign up for a family health insurance policy through Health Deal, they’ll ask you for information like your Medicare card number, your previous health fund member number, and payment details. Once you click submit on your application, the following will occur:

1. Health Deal will securely transmit all your information over to your new health fund.
2. You will receive a welcome email from Health Deal with your new health fund.
3. Your new health fund will send a transfer certificate request to your old health fund. This is the document that outlines all the waiting periods you have already served.
4. Your old health fund will cancel your ongoing direct debit and will refund you any money you have pre-paid them for the fortnight/month/quarter/year on a pro-rata basis (this takes about 10 working days to receive the refund).
5. Your new health fund will send you a card in the post, and you’ll receive an onboarding welcome call from someone in their customer service team.
6. All your payments will have been set during the signup process, so you can just sit back, relax, and enjoy your new health fund.

Remember, when switching health funds, you will not have to re-serve any waiting periods you’ve already served, and any money you’ve pre-paid will be refunded to you. Please also bear in mind that any claims you’ve made on your extras will follow you across, so if you’ve claimed $100 on your general dental limit with your current fund and switched to a new one, that $100 will be deducted from your yearly limit when you switch across.

Here are the answers to a few of the common questions about family health insurance:

What is covered under hospital and extras cover?

Under this cover, a wide variety of your in-hospital and out-of-hospital services are covered. The specific covered service will depend on your insurance provider and the tier of coverage you select, but the most commonly covered services include hearing aids, dental, optical, and physiotherapy services. Additionally, you have the choice of a public or private hospital, a choice of specialist, and a private room option (if one is available), all chosen by you according to your needs.

If you would like more information on what is covered under hospital and extras, whether covered separately or in combination, here is the Health Deal Insurance Comparison tool. Use it to make an informed decision.

How do I claim the Australian Government Rebate on Private Health Insurance?

There are two ways that you can claim rebates, according to Service Australia. One way is to claim it from your insurance provider, and the other way is to claim it from the Australian Taxation Office. You can claim the rebate from the insurance provider as an upfront reduction to your private health insurance premium, whereas you can claim the rebate through the ATO tax return if you don’t get it as a premium reduction. The choice is yours. You can read more about health insurance rebates for families on this page.

What are waiting periods?

Waiting periods refer to the initial time frames that begin as soon as you take out an Australian private health insurance policy. During this period, you won’t be able to claim or access any benefits covered by the policy. If you require medical services during this time, you’ll need to cover the full cost yourself. The length of these waiting periods can vary depending on the type of condition.

Here are the standard waiting periods for some common health insurance benefits:

• New Conditions: 2 months
• Pre-existing Conditions: 12 months
• Rehabilitation, Psychiatric Care, and Palliative Care: 2 months
• Pregnancy and Birth-related Services: 12 months
• IVF and Assisted Reproductive Services: 12 months
• Weight Loss Surgery: 12 months

Remember, if you’re switching to a new policy and have already served the waiting period with your previous insurer, you will not need to serve it again. For more details on waiting periods for senior health insurance, please visit this page.

How can I reduce my premiums?

There are a few foolproof ways that you can reduce your premiums on your family health insurance policy. These ways include comparing different policies and their rates, switching to policies with lower premiums, only getting cover for services you or your family members will require, and removing the services from the cover that are no longer required. Another way you can reduce your premium is by prepaying your policy premium for at least 12 months. If you have any other family health insurance FAQs, we invite you to email us at enquiries@healthdeal.com.au.

Family health insurance comparison is the best way to choose an insurance provider for you and your loved ones, and you can do that by using the Health Deal Insurance Comparison tool. Here, you can compare family health insurance plans, costs, and providers. For health insurance expert advice, you can contact Health Deal at enquiries@healthdeal.com.au. You can speak to our experts at 1300 369 399 or fill out the online form here. Get in touch now to speak with our insurance experts for tailored advice and support in making viable health insurance decisions for you and your family.

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