- Frank + health.com.au
- How do I check my limits?
- Cover review
- Updating your details
- What am I covered for?
- Coronavirus FAQ's
- How we're supporting you during coronavirus
- The value of private health insurance in a pandemic
- Adding or removing people from your account
- Authorising another person on your cover
- Pre-existing conditions
- Suspending your cover
- Waiting periods explained
- Private health insurance reforms
- Gap in cover
- Ambulance explained
- Ante/Post Natal Services
- Dental Explained
- Extras limits explained
- Health Appliances
- Health Screening
- HICAPS & HealthPoint explained
- How does extras cover work?
- Natural Therapies
- Non PBS prescriptions
- Optical explained
- Set Benefits FAQ
- Telehealth Benefits
- Travel vaccines
- What is health maintenance?
- Emergency Department Fees
- Going to Hospital
- Hospital Added Costs
- Insulin Pumps
- IVF & assisted reproductive services
- LHC exemptions
- Public vs. Private
- Restrictions & Exclusions
- Understanding out of pockets
- What is an excess?
- What is LHC?
- What is the MBS?
- Where does Medicare fit in?
- Transcranial Magnetic Stimulation (TMS) Pilot
- Mental Health Waiver
- Entry Hospital
- Annual premium review
- Can I lock in my premium?
- I can’t use my cover like I used to...
- What if my cover is currently suspended?
- Where do my premiums go?
- Why does my premium change every year?
- Why does my premium change, if I rarely make claims?
- Why is my price change different to the national average percentage?
- 3 ways to save money on your health insurance.
Set Benefits FAQ
Why did my Extras product change?
Most extras products have now changed from Percentage back to Set Benefits.
We made the move to set benefits for a number of reasons.
Rather than getting a flat percentage back on everything—even the things you’re unlikely to use — set benefits mean you can choose a policy that pays higher benefits for those services that you use most often.
For example, optical benefits now cover 100% of what your provider charges, up to your annual limit. Orthodontics limits are no longer a confusing sub-limit of your annual dental limit, and are now split out into their own benefit.
We're able to provide this additional value by moving to a set benefit structure, as we're able to better manage relationships with providers and ensure better health outcomes for you.
What’s the difference between Percentage back and Set benefits?
A Percentage back benefit is a benefit calculated as the percentage of the fee charged by the provider. A Set Benefit is the same benefit no matter what fee is charged by the provider (up to a maximum of the amount charged by the provider).
What else changed?
Just to be clear, these changes affected only the extras portion of combined covers. Your hospital cover was not affected by the set benefits changes.
Changes to extras products included benefit groupings, annual and lifetime limits, and some new inclusions and exclusions.
Customers on affected covers received an email outlining these changes in detail for their particular policy. You can also access a copy of this email by logging in online.
When did this change happen?
The effective date of this change was 1 Jan 2021. This effective date coincided with the annual resetting of extras limits on 1 Jan of each year, to minimise any confusion.
Introduction of per Policy annual limits and Lifetime Limits
From 1 Jan 2021, a policy annual limit was introduced to some services on your extras cover, in addition to any per person annual limits and lifetime limits that currently apply. There is a difference between a per person annual limit and 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.
A lifetime limit is the maximum benefit we pay over your lifetime towards a service. When you reach this limit, you can no longer 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, in which case you can obtain benefits for the difference in limits after serving any applicable waiting periods.
Have you heard the word?
On 1 July 2021, health.com.au will join forces with Frank Health Insurance.
Learn more about how this may affect your Extras cover here.