What are limits on Extras cover?
A limit is the total amount you can claim over a set period of time, per person or per family.
Time-based limits
Annual limits
Most, but not all, Extras services have an annual limit (per calendar year). Annual limits don’t roll over to the next year*, so come December it’s a ‘use it or lose it’ situation!
Sub-limits
Some Extras also have sub-limits within the annual limit (i.e. the maximum you can claim per year for a specific sub-category of that service – like group physio on your Physiotherapy limit).
Combined limits
This is a shared annual limit for certain services like chiro, physio, and remedial massage.
Specified limits
A few bigger ticket items have specific limits – examples include CPAP machines (claimable every 3 years) and Wheelchairs (every 5 years).
Lifetime limit
One item, Orthodontia, has a lifetime limit – once you’ve claimed the maximum, you won’t be able to claim for it again, even if you switch health funds later. In other words, fund-hopping won’t re-set your limit on this one!
Per person/per family
Some Extras have per person and per family limits. The per family limit applies to everyone on your cover. Once you reach this limit, you can’t claim for that benefit until it resets.
*Apart from 2022, when unused annual limits from 2021 were rolled over (for many members). See more on the 2022 rollover