When does my extras health insurance policy reset and what does it mean?
How to squeeze value from health insurance before the extras reset
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?
Depending on your health insurer and when you took out your policy, extras benefits will typically reset at the end of the calendar year (1 January) or the end of the financial year (1 July). Some private health funds reset limits 12 months after you took out cover on your policy anniversary.
Here are the extras reset dates for some of the most well-known health funds:
| Health fund | Reset date |
|---|---|
| Bupa | 1 January |
| ahm | 1 July |
| HCF | 1 January |
| nib | 1 January |
| frank | 1 January |
| Union health | 1 January |
| AIA health | 1 January |
| Qantas health | 1 January |
| GMHBA | 1 January |
| Westfund | 1 January |
| hif | 1 January |
| Australian Unity | 1 January |
Just how much can I claim?
Annual claim limits vary depending on your insurance provider and your level of extras cover. You’ll typically find that there’s a set amount you can claim each time you receive a treatment listed on your policy, up to an annual limit each year.
The amount will depend on the treatment and what’s listed in your policy and will generally be a dollar amount or a percentage of the bill.
All the specific details will be listed in your policy brochure, so it’s critical to read this before taking out a policy.
Do unused limits carry over?
No, unused limits typically won’t carry over if you haven’t used them by the annual reset date. During the COVID-19 pandemic, several health insurers did allow unused limits to carry over, but this was under exceptional circumstances.
When switching health insurance, it’s vital to have a new policy lined up when you cancel your existing one. This will ensure that any waiting periods you have already served will carry over and you will be able to continue claiming on any available limits. Depending on your personal circumstances, the level of cover you’re switching to with your new health insurer, you might need to undergo waiting periods for any upgrades.
How to get more value from your extras
Don’t forget to claim your benefits
This may sound obvious, but the best way to get value for money is to claim on the services included on your policy. For example, visiting the chiro might not be fun, but if you are putting it off, you could be leaving money on the table if you haven’t reached your annual limit before the reset. Remember to check your policy brochure to ensure you haven’t already reached your benefit limit before being treated.
Are your claims relative to your premium?
If your annual premiums are greater than what you tend to claim back on services and treatments – 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.
Plan your claims
A good way to ensure you’re getting the most from your cover is to plan out your treatments in advance to avoid using up your limit early or not using enough before they reset. For example, if you know you require a major dental procedure later this year, you might want to consider claiming less on other services that share a limit with major dental until your treatment. Similarly, if you know you don’t need any expensive medical treatments in the next year, consider scheduling in some regular preventative physio or remedial massage appointments.
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 regular appointments (like physiotherapy), you might find yourself reaching the benefit limit early in the year.
A higher level of extras cover may allow you to increase your benefit amount or limit, reducing your out-of-pocket costs. This might offset the extra amount you’re spending on a higher level of cover.
Take advantage of no-gap schemes
Some funds offer certain no-gap services, the most common of which is no-gap optical or dental. For example, if you require glasses and your optometrist charges more for your frames or lenses than your benefit limit covers, you’ll have to pay the difference as an out-of-pocket expense called the gap.
No-gap schemes work so that you don’t have out of pocket expenses for agreed treatments or services. Ask your insurer if they have a no-gap agreement with any specialists near you.
Compare extras policy limits
Extras cover offers affordable access to a range of services that Medicare doesn’t pay a benefit towards, which is why it’s such a popular product with Australians.
If you’re thinking of taking out extras cover or a combined health insurance policy for the first time or want to switch policies, you can compare extras limits through our free health insurance comparison service, or call our experts directly.
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
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.
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1 The Australian Prudential Regulation Authority: Quarterly Private Health Insurance Statistics. June 2023.