If you have extras health insurance, you probably have limited time left to use your annual benefits before you lose them.

For most health insurance funds, extras benefits are reset on 1 January. This means that your extras cover will expire and any unused cover will be lost.

What is an annual limit?

An annual limit is the maximum amount you can claim from your health insurance provider for a certain extras service. Annual limits vary between health funds and with different levels of cover.

Annual limits typically apply to many health services within extras cover, including dental (general and major), orthodontics, optical, physiotherapy, chiropractic, osteopathy, podiatry, speech pathology, massage, counselling and health management programs.

There is usually a set benefit per visit or service, with a cap on the annual maximum benefit per type of service. If you have been putting off using a service that is in your extras cover, now is the time to use it!

Typical annual limits for extras are:

  • $700 for general dental
  • $250 for optical (glasses and contact lenses)
  • $450 for physiotherapy
  • $400 for chiropractic
  • $375 for massage

The benefits for each treatment vary between policies, but median health insurance benefits per service are:

  • $33 for general dental (examination)
  • $200 for optical (single vision spectacles)
  • $40 for physiotherapy
  • $39 for chiropractic
  • $30 for massage

(Note that these figures represent the median for the first visit for a service – benefits usually decrease with subsequent services.)

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When do your extra benefits reset?

The annual maximum limits reset each year. Most funds use the calendar year, so the reset occurs on 1 January. Some funds use the financial year (1 July to 30 June) and a few reset on the date you joined.

Health funds that reset their extras benefits on 1 January:

  • ACA Health Benefits Fund
  • APIA
  • Australian Unity
  • Bupa
  • CBHS
  • CBHS Corporate Health
  • CUA
  • Doctors’ Health Fund
  • Emergency Services Health
  • Frank Health Insurance
  • GMHBA
  • HBF
  • HCF
  • HCI
  • HIF
  • Health Partners
  • health.com.au
  • Latrobe Health Insurance
  • Medibank 
  • Mildura Health Fund
  • MyOwn
  • NIB
  • Nurses and Midwives Health
  • Phoenix Health Fund
  • Qantas Insurance
  • RACQ
  • RBHS
  • rt health fund
  • St.LukesHealth
  • Teachers Health
  • Transport Health
  • TUH 
  • UniHealth
  • Union Health
  • Westfund

Health funds that reset their extras benefits on 1 July:

  • ahm health insurance
  • Defence Health
  • Onemedifund
  • Navy Health
  • Peoplecare Health Insurance

Queensland Country Health Fund resets their extras benefits based on the membership year.

Annual benefit limits only apply to extras. Hospital cover doesn’t involve a limit on benefits.

What are combined limits and sub-limits?

Combined limits and sub-limits may also apply to extras cover. A sub-limit is an extra limitation on your medical insurance claim by your health insurance provider. For example, your policy may have a combined annual limit of $500 for dentures, crowns and bridges, and within that there may be a sub-limit of $300 on each service . This sub-limit is deducted from the total annual limit. Therefore you could claim a maximum of $300 for any of those services in the year, and if you claimed $300 on bridges, you would have $200 remaining to claim against one or both of the other services.

A combined annual limit is the maximum amount of money you can claim, distributed across a group of services. For example, your policy may provide a maximum of $300 cover for each of the following services: physiotherapy, chiropractic and osteopathy, and then these services may be put into one category with a combined limit of $700.

Use your extra benefits before they reset

Now is the perfect time to use up those extras services which still have benefits available to you. Find and book your appointments quickly and easily with HealthEngine:

References

  1. Choice.com.au: Make the Most of Your Extras Cover
  2. Finder.com.au: Health Insurance Annual Benefit Limits
  3. Private Health: Compare Policies
  4. Insuranceopedia: Sublimits
  5. HBF: Annual limits explained