What are limits on Extras cover?

A limit is the total amount you can claim over a set period of time, per person or per family.

Time-based limits

Annual limits

Most, but not all, Extras services have an annual limit (per calendar year). Annual limits don’t roll over to the next year*, so come December it’s a ‘use it or lose it’ situation!


Some Extras also have sub-limits within the annual limit (i.e. the maximum you can claim per year for a specific sub-category of that service – like group physio on your Physiotherapy limit).

Specified limits

A few bigger ticket items have specific limits – examples include CPAP machines (claimable every 3 years) and Wheelchairs (every 5 years). 

Lifetime limit

One item, Orthodontia, has a lifetime limit – once you’ve claimed the maximum, you won’t be able to claim for it again, even if you switch health funds later. In other words, fund-hopping won’t re-set your limit on this one! 

Per person/per family

If there’s more than one person on your cover, check for any per person – and on StarterPak (Basic Plus) per family – limits that may apply.


*Apart from 2022, when unused annual limits from 2021 were rolled over (for many members). See more on the 2022 rollover