Newborn baby health insurance

Newborn babies are covered by Medicare, but there are benefits to including them on your family health insurance plan.

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Richard Laycock

Updated

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While most Australians know the value of private health insurance when it comes to covering pregnancy costs, the benefits of health cover for newborn babies are less obvious. Like all Australian citizens, newborn babies are automatically covered by Medicare (though they need to be enrolled), but there are still benefits to including them on a family health insurance plan.

The good news is it's easy to add a baby to your private health insurance policy. You just need to give your fund a call. However, you may need to switch to a new policy to cover your newborn, so it's a good opportunity to compare what other products are available.

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A family health insurance policy covers up to 2 adults plus children. You can generally keep children on your policy until they turn either 18 or 25 years old (depending on your fund).

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Are newborn babies eligible for Medicare?

In an emergency, the cost of the medical care your baby receives will most likely be covered by Medicare. If there's an urgent issue, they'll be able to get treatment as a public patient at a public hospital under Medicare.

Of course, every parent wants to be able to give their children the best possible care no matter how old they are, but we’re especially eager to make sure that our babies can always receive the health care they need. Your little bundle of joy is the most important member of your family and has a wide range of specialist medical needs, so how can you make sure all those needs are looked after?

However, Medicare doesn’t provide comprehensive coverage for all the medical expenses newborns will incur, so taking out private health insurance can also be a worthwhile option.

How do you add a new baby to your insurance?

It’s easy to add your newborn to your existing private health insurance policy – just call your health fund and speak to them about your change in circumstances. However, you may need to change to a family policy, so it's a good idea to compare products from multiple health funds to get the best deal. You generally won't lose your waiting periods when you transfer to an equivalent policy, so there's very little risk in switching.

Once you add your child to your private health insurance policy, they will be covered until at least 18 years of age or up to the age of 25 if they remain dependent on you. This means that all those childhood injuries and illnesses, x-rays on broken bones, dental check-ups and fillings will be covered by your private health fund. Private health insurance allows you to give your child the treatment they need, in the hospital you choose, and from the doctor or specialist you select. It can also help you avoid public hospital waiting lists and ensure that you don’t have any out-of-pocket expenses for things like your child’s visit to the dentist.

Do babies need private health insurance?

Although private health insurance for babies isn’t a necessity, it can be a smart long-term investment for you and your family. Family health insurance policies can be tailor-made to suit your children as they grow from newborns into young adults. No matter what unexpected medical emergencies and events may arise in your child’s life, having private health insurance means you’ll have the essential financial protection you need.

Example: How does family health cover benefit babies?

Family health insurance can provide a long list of benefits for babies. Take the example of Brad and Lisa. They added their daughter Sarah to their health insurance policy before she was born. When a severe case of bronchiolitis struck Sarah at 6 weeks of age and the poor newborn was struggling to breathe, Brad and Lisa had no choice but to call an ambulance.

Paramedics arrived within minutes and rushed Sarah to hospital, where she stayed for 4 days before making a full recovery. Not only did Brad and Lisa’s private health insurance cover the cost of their daughter’s hospital accommodation and treatment, but it also covered the ambulance call-out and transport fee of more than $500.

* This is a fictional, but realistic, example.

This is just one example of the advantages private health insurance offers, and it’s best to make sure your baby is covered well before they are born. If your baby is born with birth defects or other health problems and you already have private health insurance in place (and have served any relevant waiting periods), any treatment your newborn requires will be covered by your insurance. But if you wait until after birth to add your child to your policy, your little one’s health problems will be classed as pre-existing conditions and won’t be covered by your insurer.

Of course, private health insurance can provide many other benefits throughout a child’s life, including the following:

  • Getting waiting periods out of the way. By including your child on your health insurance policy as soon as possible, you’ll be able to serve any necessary waiting periods so your loved ones can get the cover they need later in life. For example, if your policy has a 12-month waiting period for orthodontics, you don’t want to wait until their baby teeth start falling out before adding them to your policy – if you do, you could have to cover expensive dental bills out of your own pocket.
  • Protection against the unexpected. Life is unpredictable and you never know what is waiting around the corner. For example, according to the Australian Institute of Health and Welfare Emergency department care 2014–15, a total of 886,718 Australian children aged between 0 and 14 years were taken to emergency departments around the country. Accidents and unexpected illnesses occur all the time, so private health insurance protects against whatever the future may hold.
  • Avoid public hospital waiting lists. In 2014-15, the median public hospital waiting time for elective surgery was 35 days, while 1.8% of patients had to wait more than 365 days to undergo surgery. With private health insurance cover, your child can avoid public hospital waiting lists and receive treatment in a private hospital.
  • Cover for a wide range of expenses. From hospital treatment, surgery and accommodation to ambulance transport, dental treatment, glasses and many other extras, private health insurance can cover an extensive range of healthcare expenses. Private health insurance can help ensure that your kids always get the treatment they need and that your out-of-pocket medical expenses are kept to a minimum.

How to add a newborn to Medicare

Whether you include your newborn on your private health cover or not, you need to enrol them in Medicare as soon as possible. If you had your baby in a hospital, a doctor or midwife should have given you a Parent Pack, which includes a Newborn Child Declaration Form. A doctor or midwife will need to sign the form before you submit it to Medicare.

If you've lost your form or didn't get one, get in touch with Medicare directly – you can call them on 13 20 11. If your child is over 52 weeks old, you'll need their birth certificate instead.

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How much does health insurance cost?

We ask hundreds of Australians what they're paying for health insurance every month. Here's what their bill looked like in October 2024.
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Price based on 500+ responses for single hospital or extras insurance.
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Editor

Richard Laycock is Finder’s insights editor after spending the last five years writing and editing articles about insurance. His musings can be found across the web including on MoneyMag, Yahoo Finance and Travel Weekly. Richard studied Media at Macquarie University and The Missouri School of Journalism and has a Tier 1 Certification in General Advice for Life Insurance. See full bio

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