Set Benefits FAQ

Why is my Extras product changing?

Most extras products will be changing from Percentage back to Set Benefits. We’re making 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 will now cover 100% of what your provider charges, up to your annual limit. Orthodontics will stop being a confusing sub-limit of your annual dental limit, and will now be 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 is changing?

Just to be clear, these changes affect only the extras portion of combined covers. It doesn’t affect your hospital cover.

Changes to extras products include benefit groupings, annual and lifetime limits, and some new inclusions and exclusions.

If your product is affected, you’ll receive an email outlining these changes in detail for your particular policy. You can also access this info by logging in online, or you can let us know if you’d like us to email it to you again.

When will this change happen?

The effective date of this change is 1 Jan 2021. This effective date coincides with the annual resetting of extras limits on 1 Jan of each year, to minimise any confusion.

Your new Private Health Information Statement (PHIS) and Policy Guide

With your email outlining the changes, you’ll receive a new PHIS and Policy Guide. Please take the time to have a read through these to make sure you understand what you’re covered for, and what’s changed. You can also access this info by logging in to your account, or get in touch and we’ll make sure you have a copy.

Introduction of per Policy annual limits and Lifetime Limits

We’re introducing a per policy annual limit 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.

Lifetime limit
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.

What are my other cover options?

If you wish to move to a different policy than listed above, or consider other options for your private health cover, you’ll need to let us know before 1 Jan 2021. Waiting periods may apply for any new services and/or higher limits not held in your current level of cover.