5 Best Health Insurance Plans for Children in Australia

Choosing the Best health insurance for Children in 2025 feels like navigating a maze with a blindfold and a screaming toddler. Between the “Gold this” and “Plus that,” figuring out what benefits your child, beyond just a shiny brochure, takes more than a glance.

We’ve reviewed and dissected Australia’s not-for-profit and mid-tier funds to bring you a no-nonsense breakdown of the top five health insurers offering real value to kids. Here’s what we cover:

 

• What Do Kids Need from Health Insurance in 2025?
• Hospital Cover: Which Funds Deliver on Pediatric Care?
• Extras Cover: Dental, Optical, Physio – Who’s Got It All?
• Waived Excess for Kids: A Hidden Lifesaver
• Access and Networks: How Far Does Your Policy Reach?
• Digital Tools and Claims: Apps That Help Parents
• Preventative Care & Wellness Programs for Children
• Beyond the Policy: What Else Should Parents Consider in 2025?

 

and much, MUCH more!

 

What Do Kids Need from Health Insurance in 2025 (and Are You Getting It)?

In 2025, having private health coverage for your child means more than meeting eligibility for the Medicare Levy Surcharge exemption or grabbing a bundled family deal. It’s about knowing what your child might need and whether your policy delivers when it counts.

Between rising dental costs, long public hospital waiting times, and limited bulk-billing availability across paediatrics, your child’s needs aren’t getting easier to manage.

In the past year, almost 1 in 2 children aged 5 to 14 saw a GP for a non-routine health issue, and more than 30% of children under 12 needed dental treatment beyond a standard check-up.

With paediatric mental health concerns continuing to grow, and specialist wait times stretching beyond six months in many public systems, it’s worth checking what level of private support you’d get if your child needed physio, speech therapy, or early intervention.

Private health insurance in 2025 should support dental, vision, rehab therapies, and hospital care in a way that reflects your child’s life, not just what’s listed in a product brochure.

If your plan hasn’t been reviewed in the past 12 months, there’s a good chance it’s already out of step with your family’s needs.

 

 

Hospital Cover: Which Funds Deliver on Pediatric Care?

Waitlists and red tape aren’t negotiable when your child needs to be in the hospital. You want to know who’s covering what, how fast you can get care, and whether you’re staring down a $750 bill—or nothing at all. This is where some health funds start to look more helpful than others.

 

Phoenix Health Fund

Phoenix is one of the few funds that makes family care feel personal. If you’re with them on a Silver Plus Family or Advantage plan, your kids are covered up to 25, and there’s no excess when they go to the hospital.

Whether it’s for ear tubes, asthma treatment, or follow-up care after birth, you’ve got access to more than 550 private hospitals and full ambulance cover. That’s the kind of setup that matters when it’s 2 am and you’re heading to an emergency.

 

 

HCi Health Insurance

HCi keeps things simple, and that’s a win. Kids don’t face any excess at all. Even better, the Gold plan includes everything from birth to complex procedures, and regional families get help with travel and accommodation if they’re far from care. It might be basic, but it’s solid coverage for your kid.

 

 

Health Partners

Health Partners covers maternity and hospital newborn care across their Silver and Gold plans. It’ll be a relief when birth doesn’t go exactly to plan, or when your child needs paediatric surgery later on.

They also make it easy to deal with costs through their Access Gap Cover network, and the feedback from families on response times and clarity is positive.

 

 

RT Health

RT Health leans into family support, especially on the Silver Plus Assure and Gold Optimum plans. There’s no excess for kids up to 22, which makes a difference over time.

If you have a child who needs recovery at home, the Hospital at Home option takes the pressure off. In addition, if you have to travel over 200km for treatment, there’s extra support available.

 

 

St. Lukes Health

St. Lukes does well in terms of paediatric cover. You don’t pay excess for your kids, and the Gold plan includes maternity, postnatal care, and hospital admissions for everything from broken bones to chronic illness support.

There’s a focus on family-first support here, and it seems a bit more tailored than some larger funds.

 

 

Extras Cover: Dental, Optical, Physio – Who’s Got It All?

Extras cover matters when your child needs more than the occasional GP visit. Whether it’s braces, physio after a fall, or a new pair of glasses every six months because the last pair “disappeared at school”, it can become costly. Some health funds include things families use, but not all of them.

 

Phoenix Health Fund

 

• Allows dependents to stay on extras cover until 25.
• You can choose your provider instead of using a set network.
• Offers 100% cover for two yearly dental check-ups, including scale and clean.
• Pays up to $275 annually for glasses and frames, which helps when the breakages keep coming.
• Includes speech therapy, physio, chiro, and osteo under its Comprehensive Extras.
• Covers laser eye surgery and orthodontics, with decent lifetime limits.

 

 

HCi Health Insurance

 

• Doesn’t restrict optical claims to “preferred partners”, which gives you more choice.
• Has decent dental coverage, including preventive and major dental when combined with hospital.
• Pays benefits for general therapies like physio and chiro.
• Offers gap-free dental through participating providers on selected plans.
• Allows extra claims online, in-app, or through HICAPS in-clinic.
• Designed around practical use—fewer marketing gimmicks, more useful cover.

 

 

Health Partners

 

• Gives access to their own dental and optical centres, which can stretch your dollar further.
• Pays up to 100% for dental check-ups at partner clinics, and offers solid major dental limits.
• Includes cover for orthodontics, physio, chiro, podiatry, and speech therapy.
• Good for families who use extras regularly and want fewer gaps to manage.
• Offers strong annual limits across most extras, with higher-tier plans giving more flexibility.
• Known for high-value extras, especially for families using dental, optical, and therapy services often.

 

 

RT Health

 

• Offers higher limits for orthodontics under family plans.
• Has a track record of no-nonsense, easy-to-understand extras claims.
• Has portable limits, so if you don’t use one service, others can absorb the balance.
• Allows extras for mental health support services (important as kids grow).
• Covers general and major dental, with access to Medicover extras providers.
• Includes speech therapy, physio, and chiro with generous limits for kids.

 

 

St. Lukes Health

 

• Extras plans pair well with the hospital for smoother management and fewer admin hassles.
• Offers gap-free preventative dental care for kids at participating providers.
• Provides loyalty boosts on certain services if you stay covered over time.
• Easy to manage extra claims via the St Luke’s Connect app.
• Pays benefits for optical, physio, chiro, and podiatry across the extras tiers.
• Supports early intervention therapies like speech and occupational therapy.

 

 

Waived Excess for Kids – A Hidden Lifesaver

When your child requires hospital care, unexpected costs can add stress to an already challenging situation. Some health funds alleviate this by waiving the hospital excess for children, potentially saving you significant out-of-pocket expenses. Here’s how the top five insurers approach this:​

 

🔎 Health Fund	↪️ Waived Excess for Kids?	📌 Age Limit for Child Cover	📍 Notes
🥇 Phoenix Health Fund	✅Yes	Up to 25	No hospital excess for dependents under 25
🥈 HCi Health Insurance	✅Yes	Up to 18	No hospital excess for dependents under 18
🥉 Health Partners	✅Yes	Up to 32	Excess waived for dependents up to 32 on family policies
🏅 RT Health	✅Yes	Up to 22	No excess for dependents under 22 on any hospital cover
🎖️ St. Lukes Health	✅Yes	Up to 31	No hospital excess for child dependents on most hospital plans

 

 

Access and Networks – How Far Does Your Policy Reach?

There’s no point having decent cover if you can’t use it. Where you live, which hospital you want, and whether your child’s doctor is in-network can all affect how useful your policy is when you need it most.

 

Phoenix Health Fund

 

• Gives members access to over 550 private hospitals and more than 36,000 doctors Australia-wide.
• Strong support for families in regional areas, including emergency transport and flexible claim options.
• Allows direct claims through its app, portal, or your provider’s system at point-of-service.
• Doesn’t lock you into a set network for extra providers, which makes it easier to use your trusted dentist or physio.
• Offers Access Gap Cover, which helps reduce or eliminate out-of-pocket costs when your child is treated in a hospital.

 

 

HCi Health Insurance

 

• Covers all private hospitals with agreements with the Australian Health Service Alliance (AHSA).
• Claiming is straightforward through HICAPS or the HCi app, with quick processing for most extras.
• Includes regional support for travel and accommodation where long-distance care is needed.
• You can use Access Gap Cover with participating doctors to avoid additional out-of-pocket hospital fees.
• Doesn’t limit you to a specific hospital group. Your family can access any contracted hospital that suits your location.

 

 

Health Partners

 

• Supports no-gap arrangements under Access Gap Cover to minimise unexpected hospital fees.
• The Extras network includes trusted providers, but you’re not boxed into using them if you prefer someone local.
• Claiming is streamlined through the app, clinics, or on-site claims terminals.
• Includes a strong hospital network via agreements with major private hospitals and day surgery centres.
• Offers access to its own dental and optical clinics in South Australia, with extended partner access elsewhere.

 

 

RT Health

 

• App and online portal let you track, manage, and submit claims without needing to call every time.
• Travel support and hospital-at-home options increase flexibility for families outside metro areas.
• Gives you access to a national hospital network through its HCF affiliation, which boosts reach significantly.
• You can use any specialist or hospital that agrees to participate in Medicover or Access Gap Cover arrangements.
• RT Health doesn’t restrict extras providers, so you’re not locked into a limited network.

 

 

St. Lukes Health

 

• The app allows digital claiming, benefit tracking, and membership management without calling or posting.
• Strong Tasmanian presence with growing access across other states, especially in regional zones.
• Provides access to most private hospitals in Australia, including regional options where available.
• Offers Access Gap Cover with clear guidelines on participating doctors, which helps with cost transparency.
• You can choose your extras providers – from your regular dentist to your child’s speech therapist.

 

 

Digital Tools and Claims – Apps That Help Parents

Managing health cover shouldn’t take up your Sunday afternoon. A good app can help you juggle school runs, GP visits, and dental bills. Some funds are nailing the digital experience while others are a bit limited.

Here’s how the insurers compare in terms of the basics that parents might need:

 

🔎 Fund	📲 Claims via App	📉 Benefit Usage Tracking	📈 Digital Membership Card	📊 App Usability and Reliability
🥇 Phoenix Health Fund	✅Yes	✅Yes	✅Yes	Reliable, straightforward, not bloated
🥈 HCi Health Insurance	✅Yes	✅Yes	✅Yes	Basic but works well for essentials
🥉 Health Partners	✅Yes	✅Yes	✅Yes	Smooth, family-focused, well-maintained
🏅 RT Health	✅Yes	✅Yes	✅Yes	Fast, functional, fewer bells/whistles
🎖️ St. Lukes Health	✅Yes	✅Yes	✅Yes	Some feedback on navigation, still solid

 

 

Preventative Care and Wellness Programs for Children

Health cover shouldn’t only activate when something’s already gone wrong. The better funds include real support for kids’ development, early detection, and general wellness before the hospital enters the picture. Here’s what each one brings to the table regarding prevention.

 

Phoenix Health Fund

 

• Offers high limits on dental and therapy services to encourage early intervention.
• Gives access to a broad provider network so families can stick with trusted clinics.
• Covers 100% of two yearly dental check-ups, including scale and clean.
• Allows access to speech therapy, physio, and other therapies without GP referrals.
• Includes preventative optical services under Comprehensive Extras.

 

 

HCi Health Insurance

 

• The claims process supports quick access to common allied health treatments.
• Extras plans allow flexibility in using benefits across various health services.
• Offers preventative dental and optical cover on select Extras combinations.
• Covers physio and chiro sessions that support early physical development.

 

 

Health Partners

 

• High limits for speech therapy, physio, and chiro under Family Extras.
• Extras can be paired with in-house providers or external clinics without restrictions.
• Preventive services include early screening and assessments for children.
• Gap-free preventative dental care at Health Partners Dental clinics.
• Optical cover includes testing and replacement for children’s glasses.

 

 

RT Health

 

• Includes Medicover access, helping reduce costs for specialist paediatric services.
• Allows claiming of early intervention services without unnecessary red tape.
• Covers both general and major dental, including regular check-ups.
• Offers speech therapy and physiotherapy under Extras cover.
• Flexible use of extras balances across services to support broader wellness needs.

 

 

St. Lukes Health

 

• Loyalty boosts increase the limits the longer you’re with the fund.
• Recognises and supports early-stage care for chronic conditions.
• Easy claiming for ongoing wellness support via the app or HICAPS.
• Offers gap-free preventative dental under eligible Extras plans.
• Covers services like speech therapy, physio, podiatry, and chiro for children.

 

 

Beyond the Policy – What Else Should Parents Consider in 2025?

Even with solid health insurance, many Australian families navigate unexpected challenges regarding their children’s healthcare. It’s not just about having a policy, but also about understanding how that policy fits into the broader healthcare landscape.

 

Public Hospital Wait Times

In 2023–24, the median wait time for elective surgeries in public hospitals was 46 days, up from 39 days in 2019–20. Moreover, 6.4% of patients waited over a year for their procedures. For children needing timely interventions, these delays can be particularly concerning.​

 

Rising Chronic Conditions

Approximately 45% of children aged 0–14 have at least one chronic condition, such as asthma or anxiety disorders. Managing these conditions often requires ongoing therapy and regular check-ups, which can strain both time and finances.​

 

Mental Health Concerns

Mental health issues are on the rise among children, with conditions like anxiety and depression becoming more prevalent. Accessing appropriate mental health services can be challenging, and not all insurance policies provide adequate coverage for these needs.​

 

Out-of-Pocket Expenses

Even with insurance, families often face additional costs. Specialist consultations, therapies, and medications might not be fully covered, leading to unexpected expenses.​

 

Key Considerations for Parents

 

• Policy Details: Understand the specifics of your coverage, especially regarding chronic conditions and mental health services.
• Network Limitations: To avoid unexpected costs, check which hospitals and specialists are within your policy’s network.
• Waiting Periods: Be aware of any waiting periods for specific treatments or services, especially if considering switching providers.
• Additional Support: Look into supplementary programs or services offered by your insurer that can aid in managing your child’s health.​

 

Overall, navigating the healthcare system requires more than just a policy. You also need awareness and proactive planning. By staying informed and understanding the broader context, you can ensure your child’s health needs are met effectively.

 

 

The 2025 Private Health Insurance Climate: Are Families Still Being Prioritised?

The short answer? Kind of – but not consistently, and not without effort. If you’re a parent trying to keep your household covered, the private health insurance space in 2025 feels more like navigating a policy jungle than a family-first system.

Some reforms have genuinely helped. Dependants can now stay on a family policy until they’re 31. That’s good news if you’ve got kids in study, early careers, or still figuring things out.

The tier system (Gold, Silver, Bronze, Basic) was meant to clarify policies. In some ways, it has. But simplicity doesn’t always equal value when your kids need more than a basic hospital stay every few years. What families face in 2025:

 

• Premiums are up by around 3.73% this year, before you add extras like orthopedic care or ongoing therapies.
• Gap payments are still a pain point. You’re often paying out-of-pocket even with solid hospital cover.
• Extras caps haven’t kept pace with dental, optical, or allied health costs. In many cases, they’re the same limits you saw five years ago.
• Wait times for paediatric specialists (even privately) are blowing out in regional areas.
• Public system pressure hasn’t eased. Elective surgery waits are still long — median 46 days, with 1 in 16 patients waiting over a year.

 

The policies themselves aren’t always the issue. The problem is how they translate into care when you’re using them, with a kid in pain, an urgent referral, or bills stacking up across multiple providers. Many families are paying more, but feeling like they’re getting less.

 

If you’re reassessing your cover this year, here’s what to look for:

 

• Does your policy waive excess for your kids? That one’s non-negotiable in most family situations.
• Are the included extras relevant to what your kids will use, like dental, glasses, speech therapy, not acupuncture, and homeopathy?
• Is your local hospital or paediatric clinic covered under your fund’s agreements?
• Are your kids’ therapists or specialists eligible under your extras policy?
• How long are you waiting for benefits to kick in, and is that manageable with your current needs?

 

In 2025, the private health system isn’t ignoring families, but is not always designed for them. If you want your cover to work, you must stay informed and be ready to jump ship when the numbers stop making sense.

 

 

In Conclusion

Choosing health insurance for your child in 2025 is about what works for your family now, not finding a “perfect” policy. Look for flexible cover with real, practical benefits: dental, optical, physio, speech therapy, and mental health support.

Hospital access should be timely and affordable, not months away or financially draining. Keeping kids on your policy until 31 helps, but rising costs and limited extras mean you need to stay informed.

If you’re paying more but still covering big bills, it’s time to reassess. Health insurance is a tool – review it yearly. Prioritise what your child uses. And don’t hesitate to switch if a better fit is out there. The right cover works for your family, not just on paper.

 

Frequently Asked Questions

 

Do I need private health insurance for my child in Australia?

Private health insurance can help with faster hospital access, lower wait times for elective procedures, and covering out-of-pocket costs for extras like dental and physio. It’s not compulsory, but it can reduce pressure.

 

Is hospital-only cover enough for a child?

Not usually. Hospital-only cover protects against serious events, but without extras cover, you pay full price for dental, glasses, speech therapy, and physio, which kids often need regularly.

 

Does private health cover mental health services for kids?

Some extras policies include psychology and counselling sessions, but not all. Hospital cover may include inpatient mental health stays, but you must check if outpatient therapies are included separately.

 

How do I know if my policy covers my child’s specialist or hospital?

Always check the insurer’s preferred provider list or hospital network guide. Even with private insurance, not every doctor or hospital is automatically covered without extra costs.

 

Why are gap payments still a problem even with private health cover?

Gap payments happen when a specialist charges more than what Medicare and your insurance policy cover combined. Some policies negotiate better rates to reduce this, but gaps are still common across Australia.