With the end of the year fast approaching, Australians with private health insurance extras cover have just weeks left to make the most of their remaining benefits before annual limits reset for most funds on 1 January 2027.
The annual reset impacts the vast majority of the 15.5 million – or 55.5% of the population – with extras cover, which helps pay for the common out-of-hospital medical expenses not included in Medicare, such as trips to the dentist, optometrist and physiotherapist.
The value of extras benefits is substantial, with APRA data showing Australians claimed $7.1 billion in extras benefits in the year ending June 2026, up 6% on the previous year.
Extras benefits claims | |||
|---|---|---|---|
June 25 yr end | June 26 yr end | Difference | |
Total | $6.8 bn | $7.1 bn | $377.1 mil +6% |
Source: APRA Quarterly Private Health Insurance Statistics, prepared by Canstar.
Majority of funds hit the extras benefits reset button on 1 January
Canstar research shows 88% of health insurance funds on the database reset members’ annual extras limits on 1 January, including Bupa, Medibank, HCF and nib. Other funds, such as ahm, have a reset date of 1 July.
Health funds that reset annual extras benefits on 1 January | |||
|---|---|---|---|
AAMI | Frank Health Insurance | ING Health Insurance | Real Health Insurance |
AIA | GMHBA | Latrobe Health Services | RT Health |
Apia | HBF | Medibank | See-u by HBF |
Astute Simplicity Health | HCF | Mildura Private | Seniors Health Insurance |
Australian Unity Health | HCi | nib | St Lukes |
Bupa | HIF | Phoenix Health Fund | Suncorp Health Insurance |
CBHS Corporate | Health Partners | Qantas Insurance | Westfund Limited |
Source: Canstar.
How to make the most of your extras before 2026 wraps up
With just seven weeks until the end of the year, now is the time to check your remaining extras benefits and get any outstanding appointments booked before the reset for many funds on 1 January.
- Know what you can claim: Check your health fund’s app or website to see which services are included in your cover and what you’re eligible to claim.
- Check your remaining limits: Take stock of how much you’ve already claimed and what you have left across services with annual limits.
- Get appointments in the diary: December can be a busy time for healthcare providers, with many operating reduced hours or closing over the Christmas and New Year period. Book ahead to avoid missing out.
- Make sure you claim: Where possible, claim on the spot using your health fund membership card. If you need to submit a claim later, check your fund’s rules around claiming retrospectively, including any time limits and requirements for receipts.
Don’t let unused extras benefits drive unnecessary spending
Booking an overdue dental check-up or snapping up a pair of prescription sunglasses can be a great way to make the most of your extras this year. But even with extras cover, these benefits aren’t completely free of charge.
The average out-of-pocket cost for extras services has risen by 5.6% in the past year, and is now $64.05, according to APRA. Spending more to use your cover may not pay off if your household budget is already hamstrung.
Average out-of-pocket payment per service | ||
|---|---|---|
Jun 25 | Jun 26 | Difference |
$60.67 | $64.05 | +5.6% |
Source: APRA Quarterly Private Health Insurance Statistics, prepared by Canstar.
Still got good extras cover?
If you’ve had your extras cover for some time, you may be wondering if it’s still offering value for money. As your health needs and circumstances change, it’s worth reviewing your policy.
Canstar offers the following tips to help determine if your extras cover still stacks up:
- Request an annual claims statement from your health fund: This will show the total benefits you’ve received over the financial year.
- Compare your claims with your premiums: Look at the total benefits you’ve claimed and any out-of-pocket costs, and compare these with what you’ve paid in premiums.
- Check your annual limits: Find out how much you can claim for each service, such as dental, optical, physiotherapy and remedial massage. Consider whether these limits are enough for your needs and whether you’re making the most of them.
- Review what you’re actually using: If you regularly claim for dental but rarely use optical or other extras, consider whether your current cover reflects the services you value most.
- Compare your options: If your current policy no longer suits what you need, compare others to see whether you could get better value. Look beyond the cost and consider the benefits, annual limits, exclusions, waiting periods and out-of-pocket costs.
Canstar's Data Insights Director, Sally Tindall, says, “The end of the year is hurtling toward us at pace.”
“Thankfully there’s still enough time to sort Christmas and get on top of all those jobs that have been lurking on the to-do list, including booking health appointments you meant to schedule months back.
“For those with extras cover, now is also a great time to check what extras benefits you might still have on the table, which often can be as easy as logging on to your health insurer’s app.
“Whether it’s booking that overdue dental check-up, getting new glasses or seeing a physio, there could be hundreds of dollars in benefits sitting there waiting to be used.
“Most funds reset their annual limits on 1 January, so the clock is ticking if you want to maximise what you can claim this year.
“That said, don’t fall into the trap of booking appointments you don’t actually need, just because you have benefits left — plenty of services have an out-of-pocket amount you’ll still have to pay.
“Check how much your fund will pay for a particular treatment before booking so you’re not left footing an unexpected bill at what is an already expensive time of year.
“If you’re regularly leaving benefits unused, it’s probably a sign your policy isn’t right for you.
“Carve out some time to review what you’re claiming, what you’re paying in premiums and whether your current level of cover still makes sense for your household.
“Realistically, this particular check-up might not happen in 2026, but if you schedule it in for the New Year, it can be a 30 minute task that will hopefully deliver you greater bang-for-buck in 2027.”
