Brokers urged to help clients maximise health insurance extras before reset

As the end of the year approaches, Australians with private health insurance extras cover are being reminded to take full advantage of their benefits before many policies reset on Jan. 1. Brokers can play a key role in alerting clients to this deadline, ensuring they make the most of their health cover.

Extras cover, often referred to as general treatment benefits, provides reimbursement for non-hospital services such as dental care, optical services, and physiotherapy, which are not included under Medicare.

According to research by Canstar, more than 80% of health insurers reset these benefits at the start of the calendar year, including major providers like Medibank, Bupa, HCF, and nib. However, some policies, such as Medibank’s ahm extras, reset mid-year on July 1.

Unclaimed extras leave potential savings behind 

Recent data from the Australian Prudential Regulation Authority (APRA) indicated that extras cover is a significant component of private health insurance, with $6.43 billion in benefits claimed in the 12 months ending September 2024. This marks a 5.7% increase from the previous year.

Despite this, a Canstar survey of over 3,500 policyholders revealed that 35% had not made any claims on their extras during the past year.

Sally Tindall, data insights director at Canstar, highlighted the importance of reviewing health insurance usage.

“Extras cover is a great way to stay on top of your day-to-day health, but it only pays off if you use it,” she said.

The APRA data showed that the average policyholder received $475 in extras benefits over the last year, with dental services being the most commonly claimed, averaging $262 per individual.

Practical tips for brokers to share 

To help clients maximise their health insurance benefits before the reset date, brokers are urged to do the following:

• Verify policy details: Encourage clients to confirm the reset date of their policy. Most providers operate on a calendar-year basis, making the end of December a critical time to act.
• Review available benefits: Suggest that clients check which extras benefits they have yet to claim. Popular services like dental check-ups, physiotherapy sessions, and optical appointments may still be available.
• Evaluate policy value: Advise clients to compare the premiums paid against the benefits claimed. If they find they are consistently under-utilising their coverage, it might be worth exploring alternative policies that better suit their needs.

Some extras policies may cover less conventional benefits, such as remedial massage, gym memberships, or weight-loss programs. Clients should review their policy details or consult directly with their insurer to determine what additional services might be covered.

Importance of using extras benefits

Matthew Koce, CEO of Members Health Fund Alliance, emphasised the value of taking advantage of extras benefits, particularly amid rising living costs.

“Something as simple as attending regular dental and optical check-ups can help prevent complex, debilitating, and painful health issues arising into the future,” he said.

He also pointed to concerning trends in delayed healthcare, noting that millions of Australians postpone or skip necessary dental appointments each year.

“If you have been putting off a check-up or persevering with aches and pains, now is the perfect time to make a booking with a healthcare professional,” Koce said.