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.
With HBF, most annual limits are calculated based on the calendar year. That means if you bought and claimed a pair of glasses in December 2017, you will be able to buy and claim a new pair in January 2018.
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.
For example, HBF’s Easy 8 policy has an $800 combined annual limit, which you can use to help cover the cost of 8 different extras services. Any time you use any of the 8 services, the amount you claim back is deducted from the $800 combined annual limit. If you go to the dentist and you claim $100, you’ll have $700 left to claim on any of the 8 other services you need for the rest of that calendar year.
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.
For example, with HBF, a person with a Standard Extras policy sees an increase in their major dental annual maximum the longer they hold that policy. The annual maximum for major dental on the Standard Extras policy starts at $500 if held for 3 years or less – if that person holds the same extras policy for more than 10 years, they can then claim $2035 for major dental.