HCi cover limits
Health insurance limits for extras cover explained
A limit is the maximum you can claim for a service, or a specified group of services, on your extras cover. Each limit may contain sub limits for specific services. Most limits apply on a calendar year basis and reset on 1 January each year.
Having limits helps keep member premiums down and maintain services at a sustainable level.
Various cover limits apply to all of HCi’s extras policies.
The what and why of cover limits
For most extras services, you can claim up to an annual limit which is the maximum amount HCi will pay per calendar year for that service. Limits generally apply per person covered and/or per policy for a specific service or group of services.
For some groups of services (eg general dental), there is a combined limit applied across a calendar year. It doesn’t matter if you use one service a number of times or a number of services once each – the limit applies to the total claimed across that group of services.
Each limit may contain sub limits for specific services. You can’t claim beyond the sub limit for that service type in a calendar year, but other services can be claimed up to the group limit. For example, a group of dental services may have a limit of $1,000 and include a sub-limit of $500 for fillings.
What cover limits apply?
The limits are specific to each service and each type of cover. You can see the limits for various services, or groups of services, in the relevant product summary or by logging into OMS (Online Member Services).
Within OMS, you can also see how much of a specific limit is still available for claiming in the current calendar year.
What happens when a limit is reached?
Claims for amounts above the group limits or sub limits will not be paid in a particular year.
Note that other services are not affected by reaching the limit in one service/group of services. For instance, if you reach the limit for physiotherapy consultations you can’t claim for any more physiotherapy (for that person in that year) but may claim for dental visits, new glasses or a flu vaccine (until you reach those limits anyway!)
The tally starts again each 1 January.
HCi App
The HCi claiming app allows you to easily claim at any time via your mobile!
Download the app and, when you have to claim, simply take a photo of your service provider’s receipts and submit!
