Set Benefits FAQ

Why did my Extras product change?

Most extras products have now changed from Percentage back to Set Benefits. 

We made the move to set benefits for a number of reasons.

Rather than getting a flat percentage back on everything—even the things you’re unlikely to use — set benefits mean you can choose a policy that pays higher benefits for those services that you use most often.

For example, optical benefits now cover 100% of what your provider charges, up to your annual limit. Orthodontics limits are no longer a confusing sub-limit of your annual dental limit, and are now split out into their own benefit.

We're able to provide this additional value by moving to a set benefit structure, as we're able to better manage relationships with providers and ensure better health outcomes for you.

What’s the difference between Percentage back and Set benefits?

A Percentage back benefit is a benefit calculated as the percentage of the fee charged by the provider. A Set Benefit is the same benefit no matter what fee is charged by the provider (up to a maximum of the amount charged by the provider).

What else changed?

Just to be clear, these changes affected only the extras portion of combined covers. Your hospital cover was not affected by the set benefits changes.

Changes to extras products included benefit groupings, annual and lifetime limits, and some new inclusions and exclusions.

Customers on affected covers received an email outlining these changes in detail for their particular policy. You can also access a copy of this email by logging in online.

When did this change happen?

The effective date of this change was 1 Jan 2021. This effective date coincided with the annual resetting of extras limits on 1 Jan of each year, to minimise any confusion.

Your new Private Health Information Statement (PHIS) and Policy Guide

A new PHIS and Policy Guide were also sent with this notification email. Please take the time to have a read through both documents to make sure you understand what you’re covered for, and what’s changed. You can also access this info by logging in to your account, or get in touch and we’ll make sure you have a copy.

Introduction of per Policy annual limits and Lifetime Limits

From 1 Jan 2021, a policy annual limit was introduced to some services on your extras cover, in addition to any per person annual limits and lifetime limits that currently apply. There is a difference between a per person annual limit and a per policy annual limit.

Here’s a quick rundown on what these limits mean.

Per Person annual limit

This is the maximum amount an individual person can claim on an item or service on the policy per calendar year.

Per Policy annual limit

This is the maximum amount you can claim on an item or service each calendar year for your policy as a whole.

Lifetime limit

A lifetime limit is the maximum benefit we pay over your lifetime towards a service. When you reach this limit, you can no longer claim that benefit again, even if you change your cover with us or move to another insurer, unless the product you move to has a higher lifetime limit, in which case you can obtain benefits for the difference in limits after serving any applicable waiting periods.

What are my other cover options?

If you wish to move to a different policy, or consider other options for your private health cover, please get in touch to discuss. Waiting periods may apply for any new services and/or higher limits not held in your current level of cover.