Compare the Market is warning millions of Australians that they could be throwing money down the drain unless they maximise the savings available to them through their health insurance before they expire. For many, the amount they can claim back on their extras may reset on 1 January each year.
This means that if you have an extras policy or combined extras and hospital health insurance policy with limits that reset on a calendar year basis and haven’t claimed the total amount that you’re entitled to for the extras portion of your policy, time is ticking to recoup the cash you’re entitled to.
The warning comes as Compare the Market’s latest research found that one in five Australians aren’t seeking treatment for their health issues due to a fear of high medical bills.
Lana Hambilton, Head of Health Insurance at Compare the Market, said many health insurers reset their extras benefits by the calendar year – which is why now’s the time to ensure you’re getting the most bang for your buck.
“The amount you can claim back on extras resets every year and for major health insurers like AIA, Australian Unity, Bupa, Frank, GMHBA, HCF, HIF, NIB, Qantas, Union Health and Westfund, that refresh occurs at the end of the calendar year,” Ms Hambilton said.
“We know that the industry-wide increase to premiums was 2.9% on average this year and the last thing we want to see is people paying for cover they’re not using. So, if you’ve been delaying that visit to the dentist, you’re overdue for your optical appointment or you’ve pushed back a visit with a physiotherapist, time may be running out to maximise your policy’s benefits this year.”
Depending on your policy inclusions and limits, you may be able to claim for services like:
- General dental
- Major dental
- Remedial massage
- Exercise physiology
- Non-PBS pharmaceuticals
- Eye therapy
- Occupational therapy
- Speech therapy
- Hearing aids
- Dietician services
- Health aids and appliances
And, with Christmas just around the corner, Ms Hambilton said Australians should look to book appointments sooner rather than later.
“We know that many health professionals can close over the Christmas period or change their operating hours,” Ms Hambilton said. “There may be an influx of people trying to make the most of their policy as the year comes to a close, so ensure you’re giving yourself plenty of time.
“With the cost-of-living crisis continuing to impact Australians everywhere, we want people to get the most value from the policies they hold. However, it’s vital that you check your health fund’s definition of ‘annual’, as it can vary between providers.”
A fund’s definition of ‘annual’ may be based on a:
- Calendar year between 1 January – 31 December
- Financial year between 1 July – 30 June
- Membership year, which resets each year on the 12-month anniversary of when you take out a policy
- Rolling year, which resets 12 months from when the last benefit was claimed.
Ms Hambilton said all extras policies will have limits on how much you can claim back each year for each type of treatment covered by your policy.
“The amount you’re entitled to varies based on the treatment or service you’re receiving and the maximum limit your health fund provides,” Ms Hambilton said. “Your health insurer may cover a percentage of the cost associated with the treatment or a fixed dollar value and may be subject to an annual dollar limit per policy.”
For percentage limits, your fund will pay up to a set percentage amount for treatment and you pay the remainder out of your own pocket.
“For example, your policy may cover 70% of your treatment, meaning you’d foot the bill for the remaining 30%,” Ms Hambilton said. “Some policies may even cover 100% of the total cost of listed items, but even this can be subject to an annual limit outlined by your policy.”
If your policy has a dollar limit on how much you can claim per service, check if there’s:
- An annual limit per service per policy: If you haven’t exceeded this limit per service and your benefit period expires at the end of the year, this could be where you make the most of your policy.
- A combined group limit: Some policies will group multiple services together and you have a total limit for all those services.
- A sub-limit: Some policies will group multiple services together to a limit and then add a sub-limit for certain services within the group.
“Typically, higher levels of extras cover boast higher payable benefits for a broader range of services,” Ms Hambilton said. “However, if you’ve got to the end of 2023 and haven’t claimed as much or for as wide a range of services as you thought you would, you may wish to move to a lower level of cover. The right product for you will still allow you to access the out-of-hospital services you use but for a smaller cost.
Mr Hambilton said there were things you could do to ensure your extras policy is meeting your needs.
- Switch, rather than ditch. If you’re getting to the pointy end of the year and aren’t sure if you’re getting value from your extras, consider what you do use and if you could save by cutting back on what you don’t.
- Understand the waiting periods. Extras policies can have waiting periods, which can vary from two months to several years, while general dental, physiotherapy and chiropractic services usually have a waiting period of just a few months. Keep this in mind if you’re changing your level of cover, especially for high-cost items and procedures like orthodontics and hearing aids that typically have longer waiting periods.
- Person or policy is important. If there are multiple people on one extras policy, remember that annual limits may apply to a policy, not just per person. Check with your insurer to understand what applies to your circumstances.
- Understand the limits. In addition to the amount, you can claim annually, some services may have other limits. For example, there may be a service limit, which limits how many times you can access a service within a set period. Some services may also have lifetime limits, which won’t reset once you reach the limit.
For more information, please contact:
Phillip Portman | 0437384471 | [email protected]
Compare the Market is a comparison service that takes the hard work out of shopping around. We make it Simples for Australians to quickly and easily compare and buy insurance, energy, and home loans products from a range of providers. Our easy-to-use comparison tool helps you look for a range of products that may suit your needs and benefit your back pocket.