When do health insurance benefits reset?

When do health funds reset extras benefits?

Extras benefits reset on 3 different dates: January 1st, July 1st, or the anniversary of your policy start date. This table lists the dates that each fund uses, as of April 2024.

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What other limits can apply?

There are a few other extras cover limits you should be aware of.

• Waiting periods: All extras policies have a waiting period before you will be able to claim (with a few exceptions). This period is typically 2, 6 or 12 months, but can be as long as a few years for things like hearing aids or braces.
• Claim time limit: You need to make a claim within a certain time after you get a service. This time limit is typically 2 years.
• Service limit: There may be a limit on the number of times you can claim a benefit for the same service in a year. For example, you may be allowed to only claim 2 dentists appointments per year.
• Daily claim limit: Some health funds limit you to claiming one extras benefit per day. So if you receive multiple services within one consultation, you may only be able to claim the service which attracts the higher benefit.

What are the types of services that have annual limits?

Annual limits usually apply to a wide range of general treatments included in extras cover, such as:

However, there are certain parts of extras cover to which annual limits don't usually apply, for example ambulance cover.

"I've found that my go-to health providers are always busiest in the two months leading up to the time that extras benefits reset (Nov-Dec and May-Jun). So I don't miss out on making my claims before my extras reset, I make sure to plan ahead and book my appointments outside of these busy periods, particularly for my optom and dental visits. I find it easy to avoid these busy periods by pre-booking my next appointment in advance when I go for my check-up. I can then reschedule my appointment if needed once I've been sent a reminder to confirm attendance. "

Nicole T

Finder crew member

What is the difference between a combined limit and a sublimit?

When comparing extras cover, it's important to be aware that sub-limits and combined annual limits may also apply. While your policy may have an annual limit of $1,000 for general dental services, there may also be a sub-limit that sets the maximum amount you can claim for a specific dental treatment, for example a routine checkup or a basic extraction. This sub-limit is subtracted from the larger annual limit.

However, combined annual limits may also apply. For example, your policy may provide up to $300 cover for each of the following services: physiotherapy, chiropractic treatment and osteopathy. However, those services may also be grouped together into one category with a combined annual benefit limit of $750 – so the maximum yearly amount you can claim for all the physio, chiro and osteo services you receive is $750.

• Do extras limits increase?

  Generally, your extras benefits will be the same each year. However, some policies reward you with a benefit increase each year you are a member. For example, your annual general dental cover limit in your first year of membership may be $500, but it may rise to $750 in your second year of membership. It may then continue to increase each year until you've reached a set maximum.

• Do these limits only apply to extras?

  Yes, annual benefits are only relevant for extras cover. Hospital cover does not feature a set monetary limit on the benefit amount you are eligible to claim. You can find out more about how hospital-only cover works in our handy guide.

To make sure you get accurate and helpful information, this guide has been edited by Tim Bennett as part of our fact-checking process.

Written by

Gary Ross Hunter

Journalist

Gary Ross Hunter has over 6 years of expertise writing about insurance, including life, health, home, and car insurance. Having reviewed hundreds of product disclosure statements and published over 800 articles, he loves simplifying complex insurance topics for everyday readers. Gary has contributed to major outlets like Yahoo Finance, The Sydney Morning Herald, and news.com.au, and holds a Bachelor of Arts (Honours) in English Literature from the University of Glasgow, along with a Tier 2 General Advice certification, ensuring his work adheres to ASIC’s RG146 standards. See full bio

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