Millions of Australians could be throwing away their hard-earned money, with Compare the Market warning that now’s the time to maximise the savings available to you through your health insurance extras before they expire on 1 January. Many of the country’s leading health insurers reset their extras benefit limits at the start of the New Year, meaning the clock may be ticking to recoup the cash you’re entitled to.

Whether you have an extras policy or combined extras and hospital health insurance policy, the 1 January deadline will be one to mark in your calendar – depending on your current health fund. Around 14.8 million Australians currently hold some form of extras cover.

Compare the Market’s Chris Ford said if your health insurer resets their extras benefits by the calendar year, time is ticking to make the most of your extras inclusions.

“For some health insurers – including AIA, Australian Unity, Bupa, Frank, GMHBA, HCF, HIF, NIB, Qantas, see-u, Union Health and Westfund – the reset occurs at the end of each calendar year,” Mr Ford said. “If you hold an extras policy or combined extras and hospital health insurance policy with one of these insurers, now’s the time to book in that dental clean, secure your physiotherapy appointment or lock in your final appointments to squeeze as much from your extras policy as you can.

“The fact of the matter is many Australians get to the end of the year not realising that they’ve potentially been paying for services they haven’t used before the reset. So if you’ve put off that dreaded dentist visit, delayed your optical appointment or pushed back other consultations, you need to use it or lose it.”

Depending on your policy inclusions and limits, you may still be able to claim for services like:

• General dental
• Major dental
• Orthodontic
• Optical
• Physiotherapy
• Remedial massage
• Chiropractic
• Lifestyle
• Ambulance
• Endodontic 
• Podiatry
• Orthotics 
• Exercise physiology
• Psychology
• Non-PBS pharmaceuticals 
• Eye therapy 
• Occupational therapy 
• Speech therapy 
• Dietician services 
• Health aids and appliances 

And, with Christmas and New Year just around the corner, Mr Ford advised people to book in their appointments sooner rather than later.

“The last thing we want to see is people leave things to the last minute and miss out on claiming anything they’re entitled to,” Mr Ford said. “Some health professionals do close their practices over the holiday period or work to different hours. You may also find it harder to book an appointment with an influx of people trying to get in before Christmas.

“But, before you do lock in your appointment, ensure you check your health fund’s definition of ‘annual’, as it can vary.”

An insurer’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.

All extras policies will typically have a limit on how much you can claim back each year for each type of treatment included on your policy.

“Essentially, what you’re entitled to will vary based on the treatment or service you receive and the relevant limits and rebates provided by your health fund,” Mr Ford said. “For example, health insurers can cover a percentage of the cost associated with the treatment and you cover the remainder of the cost out of your pocket.

“So, say your policy pays a benefit of 70% towards the cost of your treatment, you’d pay the remaining 30%. But be aware that some policies can even cover 100% of the total cost, subject to any relevant limits set out by your policy.

“In other cases, policies come with a fixed dollar value.”

How much you can claim, will be determined by any limits on your policy, such as:

• 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.

“If you have a higher level of extras cover, you’ll typically have a higher payable benefit for a wider range of services,” Mr Ford said. “If you’ve got to the end of 2024 and haven’t claimed as much as you thought you would, it could be worth opting for a lower level of cover in the New Year. You may find that you’re still able to access the out-of-hospital services that are important to you for a lower premium. “

Mr Ford’s tips for findings an extras policy that meets your needs

1. Don’t just ditch cover – switch to something you’ll use. Some people get to the end of the year and find they haven’t utilised their extras as much as they thought they would have. Use this time to weigh up what you do use, what’s important to you and consider ditching anything you aren’t getting value from.
2. Understand if there are waiting periods to serve. Most extras policies have some type of waiting period, which can vary from two months to several years, but most – including general dental, physiotherapy and chiropractic services – usually have a waiting period of just two months. If you switch your level of cover, particularly for high-cost items and procedures like orthodontics and hearing aids, you may be subject to longer waiting periods.
3. Person or policy? Knowing the difference 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.
4. Know your limits. Some services have other limits in addition to the amount you can claim. There may be service limits (limits on the number of times you can access a service within a set timeframe) or lifetime limits (that don’t reset if the limit is reached).

For more information, please contact:  

Phillip Portman | 0437 384 471 | [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.