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Use it or lose it: Extras benefits reset on 1 Jan

Need a new set of spectacles, dental check-up or massage? Now might be the time to get it.

optical glasses
Last updated: 03 December 2020
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If you have extras health insurance, there may be only a few weeks left to use your benefits before you lose them. Most health insurance funds reset their extras benefits on 1 January, so anything you haven't used before then will be lost.

Extras cover pays benefits for health costs including spectacles and contact lenses, dental check-ups, a set of braces or dentures, physiotherapy, podiatry, chiropractic, massage and counselling. 

It even helps with the cost of non-PBS medication and medical devices such as hearing aids or blood glucose monitors.

Usually you get a set benefit per visit or service, capped at an annual maximum benefit per type of service. 

Most funds reset extras benefits on 1 January

The annual maximum limit resets each year – 1 January for most funds. Other funds reset at the end of the financial year, and a few on the date you joined. 

Only very few funds – such as Police Health and Emergency Services Health – let you claim unused benefits for some services during the next year.

If you have health insurance with one of the funds below, your extras benefits will reset on 1 January and what you haven't used will be gone.

How much could you be missing out on?

You've paid for your extras cover, and if you don't use it, you could be leaving a fair bit on the table at the end of the year.

Here are some typical annual limits for various services – this shows how much you can claim in a year.

What you might get back per service

How much you get back for each treatment depends on your policy, but here are some median figures:

  • General dental: $33 examination
  • Optical: $200 for single vision spectacles
  • Physiotherapy: $40
  • Chiropractic: $39
  • Massage: $30

Note: These are the median benefits per person (single policy in Victoria, November 2019) for the first service in a year – usually the benefits are smaller for subsequent services. Only policies with cash benefits for services were used for this calculation; a number of policies pay a percentage of your cost, usually between 50 and 100%.

Time to start a long-term treatment plan?

If it would help you to receive prolonged treatment for something, and you have extras cover you haven't used, now could be a good time to start.

For example, if you've put off going to the physiotherapist to get treatment for back pain, you could start now and continue in the new year with your renewed cover, and have a longer period of uninterrupted treatment that you can claim on.

Important: Extras health insurance usually only pays a portion of your costs, so we're not recommending you go out and get treatments for things you don't need, because it will still cost you. 

How to get expensive glasses for free

Normally you'll get about $250 a year for prescription glasses or contact lenses, with benefit limits usually ranging from $100 up to $600 on some premium policies. 

Often, that fully covers the cost for single-vision specs, but if you need multifocals (which correct both near and far vision problems), you can be out of pocket by hundreds of dollars.

To double your benefit and reduce your out-of-pocket costs, check whether your health fund will let you claim lenses in the current year and frames in the new year.

We care about accuracy. See something that's not quite right in this article? Let us know or read more about fact-checking at CHOICE
We care about accuracy. See something that's not quite right in this article? Let us know or read more about fact-checking at CHOICE