When do private health insurance annual limits reset?

At nib, your annual limits reset on 1 January each year. That means refreshed amounts to claim on services like optical, physio and dental. It's as simple as: new year, new limits.

Knowing when your annual limits reset can help you make the most of your cover before they renew. Think of it as your yearly reminder to tick off any last-minute appointments or look after yourself by booking in that overdue check-up.

Here are a few other FAQs that might help:

What are annual limits, exactly?

Annual limits are the total amount you can claim back on your Extras – things like dental, optical and physiotherapy. These limits apply to specific treatments or services and sometimes there’s also a limit on how many times you can claim certain Extras within a year - this is called a service limit.

Your level of cover determines how much you can claim. Generally, the higher your cover, the higher your annual limits. For example, if you have Core Extras cover that refunds 60% of your dental costs and you pay $200 upfront for a filling, you can claim $120 back until you reach your annual limit for dental services.

Some of our older health covers work differently, so it’s always a good idea to check your product information in your member account or via the nib App before claiming. You can also call us on 13 14 26.

It's also important to understand that while nib’s annual limits reset on 1 January each year, other health insurers may have different reset dates, so it’s always a good idea to check with your provider.

How can I check my annual limits?

To see exactly how much you can claim back each year, as well as how much you’ve got left, log in to your member account or use the nib App.

What happens to my annual limits if I transfer from another health fund to nib?

The benefits you have claimed with your previous fund in the same calendar year will be deducted from your new nib policy. So if you’ve got an annual limit of $1,000 for major dental treatment and you’ve already claimed $400 in that calendar year, you’ll still have $600 remaining.

If you’ve recently made the switch, your private health insurance annual limits will reset on 1 January.

How can I submit a claim?

If you’re making Extras claims – like when you get a check-up and clean at the dentist – it’s often processed automatically at the point of sale when you swipe your membership card, as long as your provider has a HICAPS terminal.

If not, we’ve made it easy to make a claim using the nib App on your iPhone or Android smartphone. Simply open the nib App, snap a photo of your receipt and hit submit. You can also make a claim online via your member account.

Do I have to submit my claims by the end of the year?

No, you don’t have to have your claims in by 31 December. We pay eligible claims for up to two years from the date you had the service, so there’s no need to rush your claims to take advantage of this year’s annual limits.  

Are you due for a check-up?

If you’re thinking of making an appointment, now is a good time.

To keep your out-of-pocket expenses low, our nib First Choice network should be your first port of call. It’s our community of trusted health professionals who have agreed to provide eligible nib members with skilled healthcare at agreed rates.

It’s your choice which Extras provider you visit, but choosing a First Choice network provider means you could end up paying less for the same treatment than you would with a provider outside the network.

Search the nib First Choice network now to find a provider.