When Does Private Health Insurance Reset? 

Find out when private health insurance companies reset their extras benefits right here with Savvy. 

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, updated on July 10th, 2023       

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Private health insurance provides coverage for a wide range of healthcare services, spanning hospital admissions to dental and optical services. However, most extras policies have annual benefit limits, which can impact how much you can claim for specific services each year.  

To squeeze the most value out of your policy, it's important to understand how these limits work and when they reset to help you get the maximum value from your policy. Find out all about health insurance reset dates here with Savvy to help maximise your benefits and get the most value from your health insurance. 

When do private health insurance benefits reset?

Most health funds in Australia reset their extras benefit limits either at the start of the calendar year (on January 1) or the start of the financial year (July 1). However, some funds use the date you first took out your extras cover as the annual reset date. Knowing which date your fund uses will help you understand how to get the maximum benefit from the health cover you’ve purchased. 

What are benefit limit reset dates? 

All extras health insurance policies sold in Australia have benefit limits. These can either be annual limits or policy lifetime limits, and they determine how much you can claim on your policy for specific services over a set period. For example, a $500 annual limit on minor dental means that you can claim up to $500 in one year for minor dental treatments.  

A lifetime limit on your policy doesn’t reset and is the maximum amount that you can ever claim on that policy. Once you’ve reached a policy lifetime limit, you won’t be able to claim for that particular service again unless you switch to a new health insurance policy which enables you to do so. 

What happens if I reach my annual benefit limit?

If you reach your annual benefit limits for a specific service, you'll need to pay for any additional costs out of pocket. This means you won't be able to claim any more benefits for that service until your limits reset. 

For example, with the $500 minor dental limit mentioned above, once you’ve claimed up to the $500 limit, you’ll have to pay out-of-pocket for any further minor dental costs you have until your reset date arrives. Once that date is reached, you’ll again have up to $500 to claim on minor dental services in the next 12 months. 

Do benefit limits stay the same for the life of the policy?

Most benefit limits remain the same for the life of the health insurance policy that you buy. However, some health funds may have ‘loyalty’ increases as part of the terms and conditions of their policies. This means that benefit limits can increase for each year you hold the same policy up to a pre-defined maximum amount. These loyalty increases are aimed at encouraging people to remain with the same health fund for a longer period. 

For this reason, it’s important to review the terms of your health insurance policy often to make sure you understand exactly what the policy entitles you to claim. By comparing health insurance policies frequently you’ll gain a deep understanding of the health insurance benefits on offer, which will help you make the best decision about the most appropriate level of cover for you and your family.  

Frequently asked questions about health insurance reset dates

How can I make the most of my private health insurance benefits before they reset?

To make the most of your private health insurance benefits before they reset, try to schedule any medical appointments or treatments you may need in the days and weeks before your reset date. That way, you can gain the maximum benefit from the limits you do have. 

How can I find out what my extras policy reset date is?

To find out your fund’s reset date, either contact your health fund, look up the date online through your fund’s website or look at the Private Health Information Statement which was provided to you when you first took out your policy. 

What happens to my benefit limits if I switch health insurance funds?

When you switch to another health fund, your old fund will send details of the cover you had with them to your new fund. Some insurers will respect any unused benefit limits and apply them to your new policy, while other funds will start from scratch on your policy purchase date and give you the benefit limits that apply to the new policy you’ve chosen. You should check the specific details of the new policy you’re buying before deciding to cancel your existing health insurance

Can I change my private health insurance reset date?

No – the reset date is a health fund company-wide policy and can’t be changed by an individual. The exception to this is when the fund uses your policy purchase date as the reset date. In this case, you do have an influence on what the reset date may be. 

Do hospital cover policies have annual benefit limits?

No – hospital cover policies aren’t structured in the same way as extras policies. They offer coverage for set clinical conditions according to the tier of hospital cover you’ve chosen. They'll pay the agreed cost of all eligible claims regardless of the dollar figure involved, as long as the claim falls within eligibility rules for claiming hospital benefits.  

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