If You Continue Health Insurance Does It Get Reset
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When you take out health insurance, you may have noticed your extras treatments have an annual limit. For example, $300 for dental.
The good news is these reset each year, so you get a brand new limit to spend. Here's the list of each health fund in Australia so you can make the most of your benefits.
| Fund | When Extras Reset | Find out more |
|---|---|---|
 ahm health insurance | 1 July | Get quote |
 CUA Health | 1 January | More info |
 HCF | 1 January | Get quote |
 Medibank Private | 1 January | Get quote |
 NIB | 1 January | More info |
 Qantas Health Insurance | 1 January | Get quote |
 Suncorp | 1 January | More info |
 ACA | 1 January | More info |
 APIA | 1 January | More info |
 Australian Unity | 1 January | More info |
 Bupa | 1 January | Get quote |
 CBHS Corporate | 1 January | |
 CBHS Health Fund | 1 January | More info |
 CDH Benefits Fund | Not stated | More info |
 Defence Health | 1 July | More info |
 Doctors' Health Fund | 1 January | More info |
 Emergency Services Health | 1 January | More info |
 Frank | 1 January | Get quote |
 GMHBA | 1 January | More info |
 Grand United Corporate Health | Policies reset every 12 months from the effective date that you become a member. | More info |
 HBF | 1 January | Get quote |
 Health Care Insurance | 1 January | More info |
 HIF | 1 January | Get quote |
 Health Partners | 1 January | Get quote |
 Latrobe Health Services | Not stated | More info |
 Mildura Health Fund | 1 January | More info |
 MyOwn Health | 1 January | More info |
 onemedifund | 1 July | More info |
 Navy Health | 1 July | More info |
 Nurses & Midwives Health | 1 January | More info |
 Peoplecare Health Insurance | 1 July | Get quote |
 Phoenix Health Fund | 1 January | More info |
 Police Health | 1 January | More info |
 Queensland Country Health Fund | Membership year based on when you joined | More info |
 RT Health Fund | 1 January | More info |
 RBHS | 1 January | More info |
 St.Lukes Health | 1 January | More info |
 Teachers Health | 1 January | More info |
 Transport Health | 1 January | More info |
 TUH | 1 January | More info |
 UniHealth | 1 January | More info |
 Westfund | 1 January | More info |
This depends on your health fund. With some extras cover policies, the annual limits remain the same each year.
However, with other policies, you may be rewarded for your loyalty with a benefit increase each year you remain 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 and then continue to increase each year until you've reached a set maximum.
These increases typically only apply to some of the more major extras services, such as dental and optical.
Yes. Hospital cover does not feature a set monetary limit on the benefit amount you are eligible to claim, so annual benefit limits only apply to extras cover. You can find out more about how hospital-only cover works in our handy guide.
There are a few other extras cover limits you should be aware of. The first is a time limit, if you want to receive a rebate from your health fund for a health care service you've received, you must lodge your claim within two years of the service date.
The second limit you should be aware of is a service limit, as there may be a limit on the maximum number of times you can claim a benefit for the same service, for example an initial consultation with a physio, in a calendar year.
Finally, many health funds will also limit you to claiming one benefit per fund, 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.
Annual limits usually apply to a wide range of general treatments included in extras cover, such as:
- General dental
- Major dental
- Orthodontics
- Physiotherapy
- Chiropractic services
- Osteotherapy
- Optical
- Speech pathology
- Podiatry
- Health management programs
However, there are certain parts of extras cover to which annual limits don't usually apply, for example ambulance cover.
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.
The definition of annual depends on the calendar your fund uses:
- Some funds use the calendar year: 1 January to 31 December
- Some funds use the financial year: 1 July to 30 June
Your benefit tally resets at the end of each year, so check with your health fund to make sure you're aware of what they deem to be the start of a new year.
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Source: https://www.finder.com.au/health-insurance-annual-benefit-limits
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