When Do My Health Fund Benefits Reset?

One of the most common questions health fund patients ask us is ‘When do my health fund extras reset?’. So, we’ve compiled a guide to Australian health funds reset timeframes and what to remember when your health fund is due to reset to make the most of your health fund extras cover.

Health Funds Expiring December 31 each year – Most private health funds in Australia reset based on a calendar year. These funds include;

nib, Medibank, CBHS, Bupa, GMHBA, HCF Health, HBF, Police Health, ACA Health Benefits Fund, Australian Unity Health, CUA Health, Emergency Services Health, Frank Health Insurance , GMF Health, GUC Health, Health Care Insurance, Health Partners, Health.com.au, Hif of WA, Latrobe Health, Mildura District, MyOwn Health, Nurses & Midwives Health, Phoenix Welfare, Police Health, Railway & Transport Fund, Reserve Bank Health soc, St. Lukes Health, Teachers Federation, Teachers Union Health, The Doctors’ Health Fund, Transport Health, Westfund Health Insurance, Budget Direct and AAMI.

Some funds reset on a financial year basis.

Health Funds Expiring on June 30 each year –

AHM Health Fund, Defence Health, Navy Health, One Medi Fund and People Care.

While others, expire on the member’s joining anniversary.

Health funds that expire on anniversary –

CDH Benefits Fund, Hunter Health Insurance and Queensland Country Health Fund.

What happens to my health fund benefits when they reset?

Extras cover, also called ancillary cover, allows each member to claim on eligible healthcare and medical services (dependent on your policy). At the end of each claiming year, any unused benefits you are entitled to, will be reset and your limits will begin again for the next time period. If you reach the maximum limit during your one year policy period, you won’t be able to claim again until those limits reset.

To make maximum use of your policy, you should always make regular preventative appointments throughout the year.

What is my health fund annual limit?

Your health fund annual limit for extras is the maximum amount you can claim for a specific service, which resets at the start of a new claiming year. The annual limits on your extras policy will depend on your health fund and the level of cover you have.

However, some funds also impose lifetime limits on certain benefits. Once you have reached this threshold, you will not be able to claim any more rebates for those services.

Things to consider when purchasing private health insurance (PHI).

Not all insurance policies are the same. Your Cover, especially your extras (ancillaries), can vary vastly depending on who you are insured with and what level of cover you purchase.

In term of your dental care, here are some things to look out for when researching extras cover:

  • What are the annual limits on general dental treatments?
  • What are the annual limits on major dental treatments?
  • What percentage of benefits are paid?
  • What are the exclusions and what treatments have lifetime limits, such as orthodontics?
  • What kind of waiting periods apply to my cover before I can start claiming?

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