Health Insurance for Children with Disabilities

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Health Insurance for Children with Disabilities

Over 350,000 children (7.7%) between the age of 0 and 14 have some form of disability. Special care for both physical and mental wellbeing of a child is needed which could cause great emotional, physical and financial concerns for the parents. But there are many support resources they can rely on in order to ensure that their children can grow up healthy, happy, and eventually, self-sufficient.

There is a wide variety of childhood disabilities such as:

  • Autism
  • Down syndrome
  • Cerebral palsy
  • Fragile X syndrome
  • Hearing impairment
  • Speech disorders
  • Tourette syndrome

Having a good team of medical experts and therapists is critical to care for these children. Thus, picking the right health insurance becomes even more important for the families. Medicare often only covers broader symptoms that could exclude the types of treatments and medicines for special needs.

Private health insurance can provide more tailored schemes to help you minimise out-of-pocket costs for special services such as disability diagnosis, non-PBS medicines, and therapies. There aren’t any separate health insurance products for children with disabilities so parents will have to look at the required hospital treatments and extras (therapies and medicines) for their children and pick a plan that covers the most. There are also various government-led initiatives that provide financial support as well.

For all health insurance policies, the plans are divided into three categories (they can be combined into one): hospital cover, extras cover, and ambulance cover. The emergency ambulance services are often included in the hospital cover for families.

Hospital Covers For Special Needs

Depending on the nature of disability, the hospital treatments your child may need would vary. Consult your GP to assess the types of health issues or treatments the disability may require so you can choose the right plan that covers both present and future needs of your child.

For instance, a child with cerebral palsy, the most common type of physical disability amongst children, may need brain scans for diagnosis. So having ‘brain and nervous system’ category of clinical treatment in their hospital cover. If special pain management is needed, you may want to include ‘pain management’ or ‘pain management with device’ in your plan as well. Rehabilitation could also be another category of interest.

For children with mental disorders such as autism, having hospital psychiatric services would be critical to receive specialised inpatient assessments and treatment. Some hospitals would have more dedicated programs so make sure that you do your research and see which insurance providers those hospitals accept before you make your choice. If frequent hospital visits and receive inpatient treatments are expected, getting policies with lower excess (out-of-pocket hospital costs) for higher premiums will help alleviate the financial burden.

Extras Covers For Special Needs

If non-hospital therapies from specialists would be required, extras cover is where you’d be able to find those benefits. Therapy is highly recommended as an early intervention method. Most common therapies would be occupational therapy, physiotherapy, speech therapy, and others. More comprehensive extras covers would offer a wide range of specialised services, some even offering home nursing which could be useful for working parents.


Additional Support for Children with Disabilities

There are many support programs from the federal and local governments, communities, and nonprofits. The needs of every child are unique and finding the right sets of treatments and professionals require diligence and vigilance. However, the support resources are available to provide faster access to valuable knowledge and financial subsidies to help you get the best care for your children.

Better Start for Children with Disability Initiative

This Australian Government’s initiative provides funding for early intervention services up to $6000 per financial year and $12,000 overall. Those residing in remote/regional areas may be entitled to a one-off payment of $2000 to help cover extra travel expenses to access necessary treatments.

The eligible children are under the age of six with one of the following disabilities:

  • Angelman syndrome
  • Cerebral palsy
  • CHARGE syndrome
  • Cornelia de Lange syndrome
  • Cri du Chat syndrome
  • Down syndrome
  • Fragile X syndrome
  • Kabuki syndrome
  • Microcephaly
  • Moderate or greater vision or hearing impairments
  • Prader-Willi syndrome
  • Rett syndrome
  • Smith-Magenis syndrome
  • Williams syndrome

The program also has Medicare benefits for eligible children which could cover the costs of diagnostic services and treatment services. Those with private health insurance can still access these benefits.

National Disability Insurance Scheme (NDIS)

NDIS is funded by the Australian Government and participating state & territory governments. It provides individualised support packages for qualifying people with disabilities as well as their carers. The support package is pretty comprehensive and could include important health services, funding for early intervention therapies, and wheelchairs.

All participants must be Australian citizens or permanent residents. To be eligible as a child with disability, children aged 0-6 years would need to have a developmental delay or disability. For children aged 7 or older, they must have a permanent and significant disability in order to qualify. Once the child turns 16, they may be eligible for the disability support pension as well.

An eligible family can apply and work with a designated NDIS early childhood partner to devise a personalised support plan based on the child’s unique needs. Once the plan is approved, the family can start receiving funding. The funding will be based on the costs directly associated with additional arrangements required for the child to live his/her day-to-day such as special transport to go to school and necessary medical services.

Carer Payments & Child Disability Assistance Payment

There are various kinds of payments available for carers for loved ones that cannot function day-to-day activities without the carers’ support.

  • Carer Allowance: income-tested payments for those who provide additional daily care to someone with disability or severe illness
  • Carer Payment: income-tested payments for those who cannot work to care for someone who requires assistance for at least 6 months
  • Carer Supplement: $600 yearly payment for carers caring for someone with a disability or serious illness
  • Carer Adjustment Payment: A one-off payment up to $10,000 for when your child under age 7 gets a severe illness or has a major disability

Those who are already recipients of carer allowance and with a child younger than 16 could qualify for the Child Disability Assistance Payment which offers $1,000 each year for each qualifying child.


Helping Children with Autism Program

This program is specifically designed to assist with children diagnosed with autism and provides access to essential diagnosis, assessment, and treatment services through Medicare rebates. It also helps with devising a tailored management plan with access to resources that’ll help educate you on how to best care for your child.