Every month, the extras premium leaves the household account whether anyone has seen a dentist or not. Meanwhile, the benefit limits on that policy run on a yearly cycle, and anything you haven’t claimed by the reset date is simply gone.
APRA figures show more than 55% of Australians had extras cover as of March 2025. That’s a lot of families paying for limits, and most of us only look at them when a claim comes back smaller than expected.
Getting your money’s worth mostly comes down to timing. It also helps to know what the government already pays for, so your health fund isn’t covering things you could have had for less.
Your Guide to Extras Cover Limits and Reset Dates
- Start with what the government already covers
- How extras limits actually work
- Four ways families lose money on extras
- What to do this month
- Put the date in the calendar
Start with what the government already covers
Medicare handles a lot, but it doesn’t pay for everything a family uses in a year. The Australian Government Department of Health explains that private health insurance covers care Medicare doesn’t, such as physiotherapy and glasses, with extras helping with the cost of out-of-hospital services outside Medicare.
So the useful question is which of your family’s appointments fall into that gap, and which ones don’t.
Kids’ dental is the one to check first. Under the Child Dental Benefits Schedule, the government covers part or the full cost of some basic dental services for children, as long as the family gets certain payments.
Your child needs to be aged 0 to 17 for at least one day that calendar year and eligible for Medicare. Your family must also get a qualifying payment.
How extras limits actually work
Extras cover (you’ll also see it called general or ancillary cover) pays toward routine care outside hospital, like dental and optical. Most funds sell it in tiers from basic up to top level, and the limits inside each tier are where the real differences sit.
Annual limits
An annual limit is the most you can claim for a service in one year. Unclaimed benefits don’t roll over; they reset each year, usually on 1 January or 1 July, depending on the fund.
Sub-limits
Sub-limits are where plenty of people get caught out, because they sit underneath a bigger limit. Compare Club’s guide to extras cover gives a neat example: a $200 sub-limit on acupuncture sitting inside a $500 limit for natural therapies, so acupuncture alone can never use the full $500.
Per-person and membership limits
Some limits apply to each person on the policy, while others cap what the whole membership can claim. On a family policy, that difference decides whether one person’s big dental year eats into what’s left for everyone else.
Lifetime limits
Lifetime limits apply to things like orthodontics or laser eye surgery, and they carry across funds. If part of an orthodontic lifetime limit has already been used, switching funds won’t hand you a fresh one.
Four ways families lose money on extras
Leaving limits unclaimed at the reset: say your fund resets on 1 July and nobody in the house has had a check-up since last winter. Whatever sat unused in those limits on 30 June disappears, and the premiums that paid for it don’t come back.
Booking everything straight after the reset: when the whole family piles into appointments in the first weeks of a new benefit year, you’re spending fresh limits while last year’s went to waste. Spreading visits so some land before the reset and some after gets more out of two years of premiums.
Paying for a top tier nobody uses: top-level cover makes sense when someone in the house genuinely claims on the extra services it includes. If last year’s claims only touched dental and optical, a lower tier with decent limits on those two might do the same job for less.
Switching funds without asking about waiting periods: unlike hospital cover, there’s no portability law for extras, so a new fund doesn’t have to recognise waiting periods you’ve already served. Most funds will waive them when you switch, but ask the new fund to confirm it before you cancel the old policy.
What to do this month
Find your reset date
Open your fund’s app or dig out the policy documents and note the date your benefit year starts over. It’s usually 1 January or 1 July, but funds vary, so don’t assume yours matches your neighbour’s.
List what everyone used last year
Go through last year’s claims for each family member and jot down which limits got used and which weren’t touched at all. It belongs with the other habits in 36 Mum-Approved Ways to Save Money, since it’s the same idea of not paying for what nobody uses.
Book check-ups before the reset
If limits are still sitting there and the reset is a couple of months away, book the dental and optical check-ups now rather than after the date rolls over. Little ones count too, and Caring for Your Toddler’s Teeth is a handy read before a first dental visit.
Check the CDBS before claiming kids’ dental on extras
Before a child’s dental goes through your extras, check whether they’re eligible for the Child Dental Benefits Schedule, and ask the dentist how they’ll bill the visit. If the scheme covers some or all of that basic care, your extras dental limit stays free for the rest of the family.
Put the date in the calendar
Your reset date is probably sitting in your fund’s app right now. Pop it in the family calendar with a reminder two months ahead, and every check-up has a deadline to work toward instead of drifting into next year.
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