Act now to reclaim funds on your private health benefits

As we hurtle towards the end of 2023, the clock is ticking for policy holders to reclaim the funds they are entitled to. Source: Getty Images

Australian private health insurance members could be wasting money by not accessing savings owed to them through their policies before they expire. Older Australians should be especially wary as they look to save on costs given their fixed income.

Compare the Market has explained that many people may have an extras or combined extras and hospital health insurance policy that has limits and will reset on a calendar year basis.

As we hurtle towards the end of 2023, the clock is ticking for policy holders to reclaim the funds they are entitled to.

This cautionary message comes in the wake of recent research conducted by Compare the Market, revealing that a significant portion of Australians, approximately one in five, are refraining from seeking necessary medical treatment out of apprehension about the associated high medical expenses.

Lana Hambilton, Head of Health Insurance at Compare the Market, highlighted that numerous health insurance providers typically reset their supplementary benefits at the beginning of the calendar year. Therefore, it is opportune to make certain that you are maximising the value of your investment.

“The amount you can claim back on extras resets every year and for major health insurers like AIA, Australian Unity, Bupa, Frank, GMHBA, HCF, HIF, NIB, Qantas, Union Health and Westfund, that refresh occurs at the end of the calendar year,” she said.

“We know that the industry-wide increase to premiums was 2.9% on average this year and the last thing we want to see is people paying for cover they’re not using. So, if you’ve been delaying that visit to the dentist, you’re overdue for your optical appointment or you’ve pushed back a visit with a physiotherapist, time may be running out to maximise your policy’s benefits this year.”

Depending on policy inclusions and limits, the following services may be claimed for:

  • General dental
  • Major dental
  • Orthodontic
  • Endodontic
  • Optical
  • Physiotherapy
  • Remedial massage
  • Chiropractic
  • Podiatry
  • Orthotics
  • Exercise physiology
  • Psychology
  • Non-PBS pharmaceuticals
  • Lifestyle
  • Eye therapy
  • Occupational therapy
  • Speech therapy
  • Hearing aids
  • Dietician services
  • Health aids and appliances
  • Ambulance

Hambilton further explained that all extras policies have limits and the amount you can claim back may vary based on the treatment or services you’re receiving and the maximum limit of your health fund.

“Your health insurer may cover a percentage of the cost associated with the treatment or a fixed dollar value and may be subject to an annual dollar limit per policy,” she explained.

“For example, your policy may cover 70% of your treatment, meaning you’d foot the bill for the remaining 30%.

“Some policies may even cover 100% of the total cost of listed items, but even this can be subject to an annual limit outlined by your policy.”

For those policies with a dollar limit on how much you can claim per service, it’s important to check if there’s an annual limit per service per policy, a combined group limit or a sub-limit.

Hambilton also added that, typically, higher levels of extras cover boast higher payable benefits for more services but for those who haven’t claimed as much by the end of the year, perhaps a rethink regarding your policy’s scope is in order.

“If you’ve got to the end of 2023 and haven’t claimed as much or for as wide a range of services as you thought you would, you may wish to move to a lower level of cover,” she said.

“The right product for you will still allow you to access the out-of-hospital services you use but for a smaller cost.”

With Christmas just around the corner and health professionals closing or adjusting their operating hours over the festive period, Hambilton recommends booking appointments sooner rather than later to ensure you maximise your policies.



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