Extras limits explained

On your extras policy, you may see a ‘per person’ annual limit along with a ‘per policy’ annual limit.

Here’s a quick rundown on what these limits mean.

Per Person annual limit
This is the maximum amount an individual person can claim on an item or service on the policy per calendar year.

Per Policy annual limit
This is the maximum amount you can claim on an item or service each calendar year for your policy as a whole.

Lifetime limit
You may see a lifetime limit on services such as orthodontic treatment. A lifetime limit is the maximum benefit we pay over your lifetime towards a service. When you reach this limit, you can’t claim that benefit again, even if you change your cover with us or move to another insurer, unless the product you move to has a higher lifetime limit. If this is the case you can obtain benefits for the difference in limits after serving any applicable waiting periods.

All extras benefit limits run annually, and reset back to their full amount on 1 January each calendar year.

Below are some examples of how you can use your limits, so you can make sure to make the most of your benefits across your policy.


Example:

Let’s say you hold our Active Extras cover.

This cover provides $600 towards General Dental per person annually, and has a $1200 per policy annual limit.

If you have two people on your policy, you can both claim a total of $600 each annually towards General Dental and this will reach the $1200 per policy annual limit.

If, for example, you have two adults and two children on the policy, and you use $600 for one child and $600 for one adult, there is no more left to claim for anyone else as the per policy annual limit of $1200 has been reached.

If you are on a single cover where it is just you on the policy, the per person annual limit is the maximum that can be claimed. In the case of Active Extras as mentioned above, the maximum you can claim is $600 towards General Dental.

You can use any limits as needed for individuals on the policy. However, once either a per person or per policy limit is reached, no further benefits will be payable on those services.

Lifetime limits.

A lifetime limit is the total amount you can claim for a service in your lifetime. (This will apply across any health insurer.)

We apply the lifetime limit to Orthodontic services as part of our extras policies.

Using the Active Extras example, you’ll see that there is a per person limit of $600 towards Orthodontic treatment. There is also a $2100 lifetime limit.

This means that an individual on a policy can claim $600 total annually towards orthodontic treatment. However, once they have claimed $2100 in their lifetime, no further benefits will be payable.

When transferring from another health fund to health.com.au, if you’ve used up your lifetime limit with the previous insurer, you won’t be able to claim for this service on your new policy if you have already reached your lifetime limit.