Health Insurance For Kids: How it Works in NZ

ACC covers Kiwis for accidents and children can see their GP for free in NZ up until the age of 13, but what about health conditions that come with a hefty price tag? Canstar breaks down what you need to know about health insurance for kids.

A recent Canstar Blue survey revealed 60% of adult Kiwis buy health insurance as it offers them peace of mind, knowing they will be able to get immediate care when required. But have you considered the value of health insurance for your child?

Having a policy can mean avoiding public waiting lists and getting the treatment your little one needs faster. Coverage for kids is generally included in family health insurance policies, but there are a few things you should look out for if you want to make sure your kids are covered.

What are children covered for by NZ’s health system?

If you are a New Zealand resident or citizen, you’re entitled to free public healthcare when you’re having a baby. Children under the age of 13 are also eligible for free GP visits, so it’s important to enrol your child at a general practice as soon as possible so that your doctor and nurse can get to know you and give you the help that you need.

Most practices provide free health care until your child turns 13, then you’ll have to pay. From that age, ACC covers everyone injured in an accident in NZ. Unfortunately, there are many potential health conditions children can face. And these can come with pretty hefty medical bills if pursued in the private healthcare system. Or the possibility of a long, stressful wait in the public system. This is when a good health insurance policy can be a blessing. 

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Why would I need health insurance for my children?

Ultimately, it’s a personal choice, but kids are relatively easy to add to existing adult policies. It’s likely you’d want to get medical treatment as soon as it’s needed for your child.

To start with, weigh up whether your current budget could cover large unexpected medical expenses. Procedures like getting grommets for your child (for recurring ear infections) are considered a non-emergency treatment, for example, so health insurance can often help you get the treatment you need.

Southern Cross estimates a treatment like this can cost anywhere from $2100 to $2500, and something like tonsil removal from $4300 to $5800.

How can I get health insurance for my child?

The first step: do you already have a health insurance policy for yourself? If you do, contact your provider about adding your child/children. Adding them to your policy may not affect your premiums by too much. However, for some people it may cause a rethink of the level of cover needed, which may see the cost rise accordingly.

If you don’t have health insurance already, there are plenty of family coverage options out there that will package all your family’s health insurance into one policy. It’s a good idea to shop around for policies and to compare benefits and prices. For example, Southern Cross charges for the first two children as part of a family health insurance policy, but then cover for additional children is free.

You can also take out health insurance for just your child (or maybe it’s your grandson, niece, etc) with certain policies. Accuro does this with their kids-only health insurance, KidSmart, a product designed especially for babies and children. It covers things like general surgery (including tests such as CT and MRI scans) up to $500,000 and oral surgery up to $300,000.

How much does health insurance cost for children?

How much you pay for a health insurance policy, whether that’s a family policy or for a child, will depend on several factors, including your chosen level of cover. It’ll vary for that reason. You’ll pay a fee – usually fortnightly, monthly or annually – to your insurer, who in turn will pay out expenses related to medical treatments you are eligible to claim for. The best thing to do is to shop around and get a couple of different quotes.

Kids’ health insurance: what to look out for

So, you ask, is there anything in the fine print you should know about? Well, the technical insurance jargon defines a dependent child as “an unmarried person under the age of 18 years”. Individual health funds can, however, extend that age limit for dependent children up to age 25, providing that the child is still a full-time student and remains unmarried. Each health insurance fund has different Ts & Cs, so here are a few questions to ask when shopping around for hospital and extras cover:

  • At what age will my kids no longer be covered by our family health insurance? Are there any conditions?
  • Do I have to pay an excess if my child is admitted to hospital?
  • Are there any no-gap extras benefits for kids?

How can I decide what level of family health cover is appropriate?

The level of cover best suited to your family’s needs depends on multiple factors, including the age of your family members, your medical histories, and whether you plan on having any more children.

To decide which level of health insurance is appropriate for your family, consider what you currently need cover for, and what you may need cover for in the future. Some common considerations for families include:

  • Cover for pregnancy and related services
  • Cover for general or major dental
  • Your excess. As kids can be more likely to hurt themselves than adults, a lower excess could be appropriate. Having a higher excess can lower your premiums, but contribute to potential higher out-of-pocket expenses. Bear in mind a lower excess could mean paying higher premiums
  • Any waiting periods that apply
  • Any incentives or special offers available

It’s also worth considering the fact that your family’s individual medical needs may change over time. Your children may require glasses or orthodontic work at some point, so you may want to take this into account when choosing a policy.

Based on your personal circumstances, finances, and family needs, it may also be more affordable to consider separating your policies. If you’re pregnant, for example, keeping your partner’s insurance separate until after the delivery could help you avoid paying for an unnecessary higher level of obstetrics cover for them, as well as for you.

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Pre-existing vs congenital: a distinction to be aware of

It’s key to understand the distinction between pre-existing conditions and congenital conditions, as most insurance policies don’t cover congenital conditions. A congenital condition is something that you’re born with, as opposed to a pre-existing condition, something that you have developed since birth. Read your policy carefully about what it will and won’t cover if you’re currently pregnant and are searching for a health insurance policy.

Five points to consider for family health insurance

Here are a handful of points you may want to keep in mind when considering taking out a new family health insurance policy, or adding children to your existing policy:

  1. For health insurance purposes, a dependent child is generally defined as an unmarried person under the age of 18 years. However, health funds can extend that age limit for dependent children, providing the child is still a full-time student and remains unmarried, or not in a de facto relationship.
  2. Many providers don’t charge higher premiums for family health insurance vs couples health insurance. So, if your premiums change when adding a child to your policy, you may want to review your policy closely and consider your options.
  3. Check that your policy provides cover for pregnancy if you are planning to have a baby and want to use relevant private hospital and/or medical services, non-medical and allied health services outside a hospital as part of your care. There’s often a 12-month waiting period on pregnancy and birth-related services, so you’ll need to make sure your policy provides this level of cover around three months before you and your partner conceive.
  4. If you and your children are likely to have medical needs that won’t be covered by a hospital policy, consider if an extras policy may take care of these needs. Check to see if the policy offers no-gap extras benefits for children, on services like dental check-ups, x-rays, etc.
  5. If you’re taking out a new health insurance policy, rather than adding children to an existing policy, bear in mind that you may need to serve all waiting periods on the policy before you can start claiming benefits.

By taking out health insurance for your kids before they need it, you could potentially remove the sting of unexpected and expensive qualifying procedures – and avoid having to wait on public waiting lists for appointments and treatments. Compare health insurance providers with Canstar below:

 Compare health insurance

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