General Health

Understanding Private Health Insurance and What Cover Families Should Explore

Kids… the reason we have coffee addictions, grey hair, and an endless supply of bandaids. Also, the reason we need private health insurance. 

After all, once you have kids, you discover just how many unexpected accidents and health expenses come into play. Is there blood? Is a tooth missing? Is anything broken? So many uncertainties!

But what is private health insurance? How does the coverage work? How much will it cost me? There’s a lot of mumbo jumbo out there when it comes to health insurance, so let’s break it down and clarify what parents need to know about choosing private health insurance funds

family health insurance

First things first, what do I need? 

Let’s start with the basics. You probably know that all Australians are entitled to basic health care through Medicare. But maintaining private health insurance can provide Australian families with additional coverage for everyday health needs as well as hospital care, specialists, and more.

There are two types of health cover options. Many families will opt for both. 

Hospital Cover

This covers you when you’re admitted to hospital. It will help pay for things like specialist fees, accommodation, and theatre fees for treatments that are included on your cover. Cover is arranged by tiers from Basic, Bronze, Silver, and Gold, and the associated hospital treatments will apply. Plus, once you have served any waiting periods, it’ll fast track the wait for elective surgery in most cases.

For growing families, there are some stand out treatments to seek cover for:

  • Pregnancy and birth, and gynaecology – If you’re planning on having a baby, then this coverage is a massive benefit. Hospital cover may also include in-hospital coverage for assisted reproductive services, and miscarriage and termination of pregnancy(included on Gold tier).
  • Tonsils, androids and grommets – You’d be surprised how many children have trouble with these and will need surgery to correct it. Hospital cover may also include ear, nose and throat, hernia and appendix, and digestive system treatments (included on Bronze tier and above products).
  • Bone, joint and muscle cover for when you’re facing broken bones from their bike / skateboarding / trampolining / couch-jumping – you know … because #kids!
  • Plus, care involving the heart and vascular system, bloodlung and chest, skin, and back, neck and spine


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Extras Cover

This covers a bunch of everyday health care services Medicare doesn’t. How much you are covered for will depend on the cover you choose but, here are some of the Extras services you could be covered for

  • Preventative, general restorative, orthodontics, and major dentalGot a serious toothache? Perhaps your toddler fell down the stairs and knocked his front teeth out (hey, it happens!). With the right cover, you can see a dentist without stressing about paying the full cost.
  • Optical – glasses and contacts
  • Podiatry – consults, procedures and foot orthoses
  • Physio, exercise physiology, remedial massage and chiropractic– Ideal for when you’ve pulled your back out attempting to prove to your daughter that you can still do a cartwheel.
  • Healthy living programs – including weight management, quit smoking and flu vaccinations.
  • Natural therapies – Acupuncture, hypnotherapy, myotherapy and traditional Chinese medicine.
  • Psychology With private health insurance, you can get help for mental and behavioural disorders such as anxiety, depression and eating disorders or stressful life events such as relationship breakdowns, without worrying about paying the full cost out of your own pocket.
  • Plus, more – speech therapy, eye therapy, hearing aids, occupational therapy, osteopathy, etc.


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What to consider when looking for private health insurance 

Now, here’s where private health insurance gets a bit cool – there is no one-plan-fits-all option. Instead, to help families cut down on the costs, health insurance providers offer different levels of health cover so you can pick and choose what coverage level you want.

HBF, for example, has five Hospital plans:

  • Basic Hospital Plus
  • Bronze Hospital Plus
  • Silver Hospital
  • Silver Hospital Plus, and
  • Gold Hospital

They also have five Extras plans: 

  • Basic Extras
  • Flex 50
  • Flex 60
  • Complete 60 and
  • Top 70

Some health insurers will give you the option of reducing your Hospital premium by increasing the excess on your product. At HBF, an excess is a set out-of-pocket cost which is payable once per year per person when you are admitted to hospital for treatment. A higher excess is a good way to save if you are in good health, however you will need to ensure it fits into your budget in case you do need treatment.  Keep in mind, when you’re in-market for private health insurance for your family, there’s no excess for kids on the hospital cover available for purchase at HBF.

Benefits for Extras services are calculated by either a percentage or a set amount. HBF’s Flex 50, for example, gives you 50% or more back when you claim. HBF’s Flex 60 gives you 60% or more back. This makes it easy to know what you’re getting back each time you make a claim. If you see a physiotherapist and they charge you $90, HBF will pay a benefit of $45 on Flex 50, and $54 on Flex 60.

Generally, benefits for Extras services have a maximum amount per person on the policy that you can claim per year (it’s known as an ‘annual limit’).  These limits usually reset on 1 January each year.


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Choosing the right health fund 

In general, we all want the same thing – affordable health cover, a trusted health fund provider, and an easy no drama claims process.

There are a number of health funds out there, but our top pick is HBF. It is one of Australia’s largest not for profit health insurers and run to benefit members rather than shareholders. 



HBF has been supporting members for 78 years now and has one of the highest satisfaction rates of all major health funds*. During the recent pandemic, HBF was also the only major health insurer to cancel its 2020 premium increases entirely, whereas other majors have just postponed their premium increase. That speaks volumes in our world.

You can use your extras the way you want with the Flex 50 and Flex 60 cover and with Top 70 Extras, you get a benefit of least 70% back at a provider of your choice.

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This is a sponsored post for HBF.

*State of Health Funds Report –

Across all HBF products and services, benefits are payable up to applicable annual limits and only for services and programs approved by HBF and delivered by providers that are approved by HBF. Waiting periods may apply before benefits are payable.

Avatar of Jenna Galley

Born and raised in Canada, Jenna now lives in Far North Queensland with her tribe. When the mum-of-three is not writing, you can find her floating in the pool, watching princess movies, frolicking on the beach, bouncing her baby to sleep or nagging her older kids to put on their pants.

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