Due for new glasses or sitting on a dental quote? Check what your health fund will pay, when your limits reset and how much you’ll be out of pocket.
New glasses, a dental check-up or another physio appointment can leave you with a sizeable bill, even with extras cover. Before you book, it pays to find out how much your fund will contribute and when your remaining annual benefits expire.
Many health funds renew their extras limits on 1 January, so as we get closer to the end of the year it’s a sensible time to check any care you’ve been meaning to arrange.
Other funds use different dates, and some policies let you carry over certain unused benefits.
Start by checking the rules for your cover and what you’ll still have to pay yourself.
Try out our Starts at 60 Extras Value Calculator to help you compare what you paid for extras with what you got back.
Open your fund’s app or member portal and look for your remaining benefits. If you call, ask how much you have left for the specific service and whether it shares a limit with something you’ve already claimed. A balance for a group of services can look generous until you find out there’s a smaller cap on the one you need.
Ask which date the fund uses to assess the claim and how long you have to submit it. Those are separate questions. Peoplecare, for instance, assesses benefits by the date of service and lets eligible members submit claims for services received up to two years earlier.
For a crown, bridge or dentures, ask for an itemised treatment plan with fees and proposed dates. Give the item numbers to your fund and ask for an estimate of what it will pay on each one. Then subtract those benefits from the dentist’s quote to see what you’ll pay yourself.
If your dentist has already proposed doing the work in stages, ask whether it’s clinically appropriate for those appointments to fall on either side of your reset date. If the timing works for your treatment, confirm with the fund which benefit limit each item will come out of. Different policies can treat the same item differently. Follow your dentist’s timetable for any care that needs to happen sooner.
If you’re replacing your glasses anyway, ask whether your policy allows you to claim the frames in one benefit year and the lenses in the next. CHOICE suggests checking this with your fund first. Ask how much it would pay on each item and which date it uses to assess each claim.
Then ask the optometrist whether they can supply and itemise the frames and lenses separately, and get the total cost. Compare that with the gap on a complete pair, including any package price. If you need new lenses straightaway, factor that into when you order.
If you’re replacing orthotics or buying a monitor recommended by your healthcare provider, ask your fund what it covers before you pay. It may require a prescription or letter, a recognised supplier or an itemised receipt. Ask about the exact product, since eligibility can depend on what you buy and where you buy it.
Hearing aids can have a separate limit that runs over several years. Ask when you last claimed, when you’re eligible again and how much your policy would contribute. Get that figure before committing to a purchase.
Check that your fund recognises the therapist and ask what it pays for the appointment you’re considering. If the same $32 benefit applies to a $60 appointment and a $100 appointment, for example, your gaps would be $28 and $68 respectively. The figures are illustrative. Ask for the fee and rebate for the appointment you need before booking.
Some funds offer lower fees or higher rebates on eligible services through a provider network. If you’re comfortable seeing a different dentist or optometrist, check the fund’s directory and ask whether the offer applies to your policy and the service you need. For dental work, compare quotes for the same item numbers. That gives you a fair comparison even when the advertised rebate looks better at one practice.
If the practice can claim on the spot, ask for an estimate of your gap before you agree to treatment. If you’ll be claiming yourself, check what needs to appear on the receipt. Keep the itemised invoice and check your claims history after the benefit is paid, especially if you have another appointment coming up.
Pull up your claims history and compare what the fund paid back over the past year with what you paid for extras. If you have combined cover, ask what an equivalent hospital policy would cost on its own so you can put a figure on the extras component. A year with unusually high dental bills can skew the comparison, so think about what you’re likely to use over the next year as well.
If you’re considering switching, ask the new fund whether waiting periods apply to any new or higher benefits and whether claims you’ve already made will count towards its limits. If you have combined cover, compare the hospital inclusions and excess separately before changing policies.
The Starts at 60 Extras Value Calculator can help you compare what you paid for extras with what you got back.
Compare health insurance with Starts at 60 or call 1300 311 060 to speak with an adviser. The service compares policies from a selected panel of funds. Our consultants say around one in three callers are told their current cover is still the right fit. Eligible customers who switch through the service can receive a $100 gift card. The offer runs until 30 November 2026. Eligibility and offer terms apply.
IMPORTANT LEGAL INFO This article is of a general nature and FYI only, because it doesn’t take into account your personal health requirements or existing medical conditions. That means it’s not personalised health advice and shouldn’t be relied upon as if it is. Before making a health-related decision, you should work out if the info is appropriate for your situation and get professional medical advice.
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