Family health insurance can provide coverage to protect your family's needs, however there are some areas that are not always black and white.
If you have children or dependants listed on your family policy, you should be aware at what age they are no longer classified as children. It is also important to understand the conditions outlined for a dependant. Furthermore, newborn babies and private health insurance to cover you during pregnancy can come with certain conditions.
Pregnancy is an exciting time for expecting parents, but there are many new things that need to be considered. One thing that expecting parents should be aware of is what is and isn't covered by their health insurance policy.
Family health insurance in Australia
?Family health insurance provides cover for adults and can cover their children up to the age of 25 depending on their circumstances. It can cover dental check ups, physiotherapy, optical and rehabilitation services.
If there are changes to your family circumstances, for example separation, then you will need to inform your insurance provider as it may affect your health cover.
When comparing family health insurance policies it is important to consider the benefits that best fit your needs. Policies have different rules regarding the maximum age of a child, so if you have a child over the age of 18 that you wish to include in your cover make sure you are aware of what age they will be excluded from the policy.
If your child is over the age of 18 and has already left home or engaged in full-time work, they may no longer be considered dependant and thus not be covered by your family insurance policy.
A dependant child can be defined as a single person in who is 17 years of age or younger. People between the ages of 18 and 24 may be covered based on the fund's stipulations, for example if they are a full-time student.
A young adult dependant is considered to be someone between the ages 18 and 24 who is single not classified as a child by the fund. Your fund may still allow you to cover them on your policy, however it often comes with a higher price tag.
Starting a family
An important thing to consider when you are planning to have a baby is if your newborn will be covered by your health insurance policy. If you have a single cover plan, you may need to change your policy to a family cover.
The Private Health Insurance Ombudsman (PHIO) states that as premature babies are admitted as patients, they are unlikely to be covered on your single cover, so it is important to plan ahead. Healthy babies are not formally admitted to hospital.
Pregnancy and birth-related services (obstetrics) often are not covered in a cheaper policy if you are admitted to a private hospital or meet with a private specialist. To make sure you are covered in this situation it is important to upgrade your existing policy, switch to a family policy. Timing is important and different funds have different rules.
In order for these changes to come into effect before they are needed you will need to plan well ahead of the baby's due date. Health funds have a 12-month waiting period for pregnancy and birth-related policies. The PHIO states that health funds are usually very strict in applying these rules, therefore your new policy needs to have taken effect a full 12 months before you are admitted to hospital.
To make sure your baby is covered immediately after birth, a family policy is necessary. Therefore, if the baby needs emergency surgery or is born prematurely the cost of the service, which can be more than $50,000, should be covered. If you are already on a family plan and plan on having a baby then you may be required to upgrade your policy between one and 12 months in advance.