When the end of financial year rolls around, many find themselves in the thick of sales, eyeing off those shiny high-res televisions. Or, when the New Year celebrations begin, you might be planning all new adventures overseas.
But, what about that yearly reset for your extras insurance? You probably weren’t aware of it until now.
If you’re like 55 per cent of the Australian population who have extras insurance, your benefits (e.g. dental, physio, and optical) will usually refresh on 1 January or 1 July, depending on your health fund. If you’ve already hit your annual limits for specific benefits, you can start claiming again when either the new calendar or financial year kicks off.
So, how can you make sure you’re getting the most value from your extras cover 365 days a year?
Why do health insurers reset their benefits limits?
Extras cover (also known as ancillary or general treatment), allows you to claim on out-of-hospital medical services (subject to you sitting through certain waiting periods), as outlined in your provider’s product brochure. If you reach the maximum limit of certain benefits, you won’t be able to claim again until those limits reset.
How much can I claim?
Annual claim limits vary depending on your provider and your level of extras cover; whether it’s comprehensive, medium, or basic cover.
Some funds will also impose lifetime limits on certain benefits, 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 provider. 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.
How can I get more value from my extras cover?
1. Don’t forget to claim your benefits
This may sound obvious, but the best way to get value for your money is to claim on the services you use. Visiting the chiropractor isn’t always fun, and neither is the bill. If you’ve been putting off getting treated, however, you’ll at least save yourself some money by ‘taking the plunge’. Carefully check your policy’s product brochure to ensure you haven’t reached your benefit limit.
2. Are your claims relative to your premium?
If your premium is a fair amount higher than what you tend to claim back in benefits – and you don’t expect your health needs will change anytime soon – you might save money by comparing and switching to a different extras policy. There are so many options to choose from that may have (a) higher benefit limits
3. Spread out your claims
A helpful way to get value from your extras cover is to spread out your claims strategically. For example, you might go to your dentist for a regular check-up. Depending on your policy, you may be able to claim back a certain percentage or dollar amount for a check-up, scale and clean, and fluoride treatment. For example, one policy may give you 60% back, or another may give you $150. During this appointment, your dentist might schedule you in for fillings.
If you’ve already used up your annual limit for general dental, you could hold off on getting your fillings until these benefits reset, thereby reducing your out-of-pocket expenses.
4. Take a closer look at higher levels of extras cover
This may seem counterintuitive, as higher levels of extras cover attract higher premiums. However, if you require, for example, regular physiotherapy appointments, you might find yourself reaching the benefit limit early in the year. A higher level of extras cover can increase your benefit amount or limit, reducing your out of pocket expenses. This might offset the extra amount you’re spending on a higher level of cover.
5. Take advantage of no-gap schemes
Some funds offer certain no-gap services; the most common of these is no-gap optical or dental. If you require glasses, for example, and find that your optometrist charges more for your frames or lenses than your benefit limit covers, you will have to pay the outstanding balance – the gap – yourself. No-gap schemes work so that you don’t have to pay for anything. Ask your insurer before heading to your specialist if such an arrangement exists between them.
Could I benefit from extras cover?
If you don’t have extras cover, you could be paying big dollars for services that could be otherwise claimed (i.e. that root canal could hurt your wallet and your mouth). Australians are already taking advantage of this type of cover. According to APRA’s Private Health Insurance Quarterly Statistics, insurers paid $1,229 million in general treatment extras benefits. This included a huge number of claims for the following benefits:
- Dental, with $655 million benefits paid
- Optical, with $190 million benefits paid
- Physiotherapy, with $109 million benefits paid
- Chiropractic, with $76 million benefits paid.
Extras cover offers affordable access to services that aren’t covered by Medicare. You can decide if you want to take out an extras-only cover, or private hospital insurance with extras cover.
To ensure you get value for money with the right level of extras cover, our experts put themselves in your shoes to thoroughly understand your needs, lifestyle, and budget. This means we’ll ensure you won’t be spending money on unnecessary extras, plus we’ll help you reduce any out-of-pocket expenses throughout the year.