Family Health Insurance: Maternity, Kids Cover & Discounts
Why Families Need Private Health Insurance
For families, private health insurance offers significant advantages: choosing your own obstetrician, shorter waitlists for kids' surgery (tonsils, grommets), and covering dental and optical for children. Many policies also cover pregnancy and birth: a major reason families upgrade from singles cover.
Maternity Cover: What You Need
To have your baby in a private hospital with your choice of obstetrician, you need Gold hospital cover with maternity included. Key points:
- 12-month waiting period: You must hold hospital cover for 12 months before giving birth (unless you're switching from equivalent cover).
- Plan ahead: If you're thinking about starting a family, upgrade to Gold cover at least 12 months before you plan to conceive.
- What's covered: Obstetrician fees, hospital accommodation for you and baby, theatre fees, and postnatal care. Some policies also cover newborn checks.
- Gap cover: Some obstetricians charge above the MBS fee. Check whether your fund has gap cover arrangements with your preferred doctor.
Covering Your Children
Children are automatically covered on a family policy. They can remain on your policy until:
- Age 18: standard dependant definition.
- Up to age 25: if they are full-time students (or in some cases, up to 31 if financially dependent).
Once children turn 18 and are no longer studying, they need their own policy. See our young adults guide for affordable options.
Family Discounts and Savings
- Family discount: Most funds offer a discount (often 15 — 25%) on family policies compared to buying 2 singles.
- Single parent discount: Some funds offer reduced rates for single-parent families.
- Kids' extras free: Some policies include free extras for children on family cover.
- No excess for kids: Many funds waive the hospital excess for children on family policies.
What About School-Age Kids?
Common reasons families use private cover for school-age children:
- Removing tonsils and adenoids: A very common procedure with long public waitlists.
- Grommets: For recurrent ear infections.
- Dental: Braces, fillings, and check-ups. Extras cover helps significantly with orthodontic costs.
- Optical: Kids' glasses can be expensive. An optical limit helps.
Choosing a Family Policy
Start with Gold hospital cover for maternity, then choose an extras level that matches your family's needs. A typical family policy includes:
- Gold hospital cover (for pregnancy)
- Comprehensive extras with dental, optical, physio, and orthodontics
- A moderate excess ($500 per adult, $0 for kids)
Compare using our step-by-step guide and don't forget to check whether your preferred hospital and obstetrician are in the fund's network.
What Family Cover Costs in 2026
A typical family hospital-plus-extras policy costs roughly $300–$500 a month before the rebate, depending on tier, excess and state — and after the 4.41% average rise on 1 April 2026, many families are paying $100–$200 a year more than in 2025. Offsets help: the family discount most funds offer (often 15–25% versus two singles), the government rebate on the family income tier, and free or discounted extras for children on some policies. If your family income is under $202,000 (the 2025–26 base tier), the rebate reduces your effective cost by about a quarter.
The 12-Month Maternity Clock
Pregnancy cover is where the waiting-period mechanism bites hardest: most funds require 12 months of Gold hospital cover before birth-related claims are paid. Because the 12 months runs from when you take out (or upgrade to) eligible cover, the practical rule is to upgrade at least 12 months before you plan to conceive. If you already hold Gold cover and switch funds, served waiting periods carry over for equivalent cover — so changing funds does not restart your clock as long as cover is continuous. If you are not planning a pregnancy, a Silver policy with strong children's inclusions can be a cheaper fit.
Before You Sign
- Confirm Gold cover includes pregnancy, and check the obstetrician gap arrangements.
- Check whether the hospital excess is waived for children (many funds do this).
- Compare orthodontic limits if you anticipate braces — these vary widely between funds.
- Verify ambulance cover for the whole family in your state.
- Ask about the family discount and any multi-child pricing.
Switching Funds Mid-Pregnancy
If you already hold Gold cover with pregnancy included and want to switch funds, your served waiting period transfers as long as the new policy offers equivalent cover and there is no gap. Get written confirmation from the new fund that your 12-month maternity period is recognised before you commit — a simple email request avoids an expensive surprise at claim time.