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, higher levels of cover may include higher annual limits or benefit amounts. Once you've reached your annual limit for a service, you'll need to wait until your limits reset before claiming for that service again.

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 16 42.

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?

Follow our guide to see exactly how much you can claim back each year, as well as how much you’ve got left: How to check your annual limits.

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 or tap 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.

Learn how to make a claim in the nib App or 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's a good time.

To help you get the most from your cover and keep out-of-pocket costs down where possible, our nib First Choice network should be your first port of call.

It's our community of dental practitioners, physiotherapists, optical providers, hearing providers and mental health professionals who have agreed to deliver quality care at agreed rates and provide No Gap offers on selected treatments.

You can visit any recognised healthcare provider in Australia, but choosing a First Choice network provider may mean lower out-of-pocket costs on selected services compared to providers outside the network.

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

The information in this article is general in nature and doesn't take your personal circumstances into account. Before making decisions about your health cover or treatment, consider seeking advice that's appropriate for your situation.