Health insurance explained

If you're switching to HBF from another health fund and you've already claimed some of your benefits in the same calendar year, any claims you have made with your previous fund this calendar year will result in an adjustment of the annual limit you can claim with us for the rest of the year. For example, if you have claimed $300 on Occupational Therapy with your current fund and you join HBF on Top 70, which has an annual limit of $400, you may be able to claim $100 with us this calendar year. Annual limits reset on 1 January each year.

If your new HBF cover has a service with a lifetime limit, we will take into account all claims you have made for that service previously, regardless of the year they were made.

A benefit is the amount you can claim back for a service from your health fund.

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

A lifetime limit is the total amount you can claim for a service over the course of your lifetime; each person on your policy has their own lifetime limit. At HBF, lifetime limits only apply to orthodontics on select covers. This means that once you've claimed up to your lifetime limit, either at HBF or through claims at another health insurer, you won't be able to claim benefits again even if you change your cover or leave and re-join us in the future.

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.