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Member Onboarding

What are Annual Limits

Discover how much you can claim on extras and how your benefits can increase over time.

An annual limit, also known as an annual maximum, is the maximum amount of money you can claim for a particular service within a year. Depending on your health fund, an annual limit could be calculated based on the calendar year, financial year, or from the date of taking out an extras insurance policy.

Annual limits only apply to extras services – there are no annual limits for any procedures or services you receive in hospital. Depending on your policy, you may find an extras service has ‘no limit’, which means you can claim for that service as many times as you like.

What is a combined annual limit?

A combined annual limit is the maximum amount of money you can claim, distributed across a group of services.


What is a sub-limit?

A sub-limit is the maximum amount of money you can claim for a specific service, which is deducted from a larger annual limit.

For example, a policy might have a combined annual limit of $500 for dentures, crowns and bridges, with a sub-limit of $300 for each service. That means you’d only be able to claim a maximum of $300 for any one of those services in the year. If you claimed $300 on bridges, you would not be able to claim more for that service during the year, while the remaining $200 could be claimed against one or both of the other services.


Do annual limits change?

Some health funds have loyalty programs that reward members by increasing annual maximums for certain services based on their length of membership. That means someone who’s had extras insurance for 5 years might have a higher annual maximum on certain services than someone who’s only been with the health fund for 2 years.


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