When does my extras health insurance policy reset and what does it mean?

How to squeeze value from health insurance before the extras reset

Average customer rating: 4.3/5
Written by Joshua Malin
Reviewed by Steven Spicer
Updated 19 March, 2024

What are extras limits?

If you’re one of the 55% of people in Australia with extras insurance,1 you’ll find the amount you can claim on health services like dental check-ups, podiatry and chiropractic is limited each year. Once you hit those limits, you won’t be able to claim until the health fund resets your benefits.

For example, if you had an annual limit of $500 for physiotherapy appointments, that’s the maximum amount you’ll be able to claim back on physio appointments within the relevant 12-month period. Any additional physio sessions afterwards will be paid for entirely out of your own pocket until your extras limit resets.

Expert tips for getting value out of your extras cover

Our health insurance expert, Steven Spicer, has some tips on how to handle your extras limit reset.

Steven Spicer
Executive General Manager – Health, Life & Energy

Know exactly when your limits reset

To get the most value out of your extras cover, it’s important to know when your limits will reset. This varies depending on the health fund and in some cases, the specific service that you are planning to claim on. However, most extras limits will reset on the 1st of January or the 1st of July each year.

Consider the reset date when switching

If you claim on your extras policy often and find that you’re regularly using up your annual limits, the date that limits reset can become even more important when switching health funds. This is because switching to a fund with a different claiming year to your current policy, could reduce or extend the time that you will need to wait for your limits to reset depending on the date that you are switching.

Pay attention to how much of your limits you use

If you are often claiming up to your annual limits before they reset each year, or not using much of the limit at all, then it may be time to switch to a new policy. Speak to one of our experts to help you get great value out of your health insurance.

Extras reset

When does my extras health insurance policy reset?

Just how much can I claim?

Do unused limits carry over?

How to get more value from your extras

Don’t forget to claim your benefits

Are your claims relative to your premium?

Plan your claims

Take a closer look at higher levels of extras cover

Take advantage of no-gap schemes

Compare extras policy limits

Other types of limits

Beyond the annual yearly limit, you might have some other types of limits on your extras policy, such as:

  • Sub-limits. A sub-limit can apply to a specific treatment or service. For example, you might have a $1,200 annual limit for major dental services but a sub-limit of $550 a year for dentures.
  • Per person limits. Per person limits set a specific limit for each person covered under a policy. For example, you might have an $800 policy limit for acupuncture, but each person can only claim a maximum of $400. In this situation, you can claim up to $400 yourself, leaving $400 remaining for the other members on the policy.
  • Group limits. On some extras policies, multiple services or treatments (e.g. physio, remedial massage) can be grouped together under one limit.
  • Lifetime limits. Some funds will impose lifetime limits on certain services and treatments, like orthodontics. For example, if you get braces, you may be able to claim $700 per year, with a lifetime limit of $2,000. Once you reach this limit, you will not be able to make any further claims, even if you switch to a different insurer. The exception to this rule is if you find a policy with a higher lifetime limit. Switch to that policy, and you can claim the difference between your old limit and the new one.
  • Service limit. Some extras services will be subject to a service limit, which limits the number of times you can claim for a specific type of service per year. For example, you might only be able to claim back a new pair of glasses once per year.

Multiple limits can sometimes apply at once, such as a group limit of $1,000 for some medical treatments but a $500 limit per person. These limits will vary between insurers, so it can help to compare different policies for a better understanding of what each one covers.

Meet our health insurance expert, Steven Spicer

Steven Spicer
Executive General Manager – Health, Life & Energy

As the Executive General Manager of Health, Life and Energy, Steven Spicer is a strong believer in the benefits of private cover and knows just how valuable the peace of mind that comes with cover can be. He is passionate about demystifying the health insurance industry and advocates for the benefits of comparison when it comes to saving money on your premiums.

1 The Australian Prudential Regulation Authority: Quarterly Private Health Insurance Statistics. June 2023.