Health insurance limits explained

A limit is the max amount of money we can pay towards helping you with the bills for items and services included in your extras cover, during a specific period of time. Many Private Health Insurers set limits, and there are a bunch of different types.

Standard limits

Limits vary depending on your cover. Some are fairly standard across all funds and types of cover. The best way to get information specific to your limits is to refer to the relevant product guides.

Annual limit

An annual limit is the maximum amount we can help with the bills for your services and items included on your cover within a financial year (1 July to 30 June). Annual limits are subject to per person limits.

abacus

Family limit

A family limit is the total amount that can be claimed by all members on your cover, in a financial year. Each person on your cover can claim up to their ‘per person’ limit, except if a family limit has already been capped by other members on the cover.

Learn more about health insurance for families.

Hands tapping credit cards on a payment device

Per person limit

Each person on your cover can claim up to the per person limit within a financial year - except if a family limit has already been reached by other members on the cover, or if a lifetime limit applies and has already been reached by that person.

Hand holding a credit card

More limits, more choice

Some limits are more flexible and designed to give you more choice.

Flexi limit

The maximum amount of benefits we pay towards a group of included services and items in a financial year– but as the name suggests, it’s flexible. Some people may want a little more physio and a little less osteo for example, and that’s possible with a flexi limit. That means you have more control and choice over the services you want to use your health insurance for.

pie chart of a tooth, leg and spine

Bundle limits

Bundle limits are the maximum amount of benefits we pay across all of the services included in that bundle, within a financial year. Bundle limits are subject to per person limits and family limits. Bundle limits apply to ahm’s choosable extras covers only.

Happy coins

All other limits

Not all limits are created equal. Some don’t reset every year (rude).

Lifetime limit

A lifetime limit is the total benefit you can claim for a service in a lifetime, across all insurers. At ahm, lifetime limits only apply to orthodontics and laser eye surgery. When you reach this limit, we can’t help with the bill for those services ever again, even if you change your cover. It’s important to remember that lifetime limits carry across providers. That means if you were to reach your lifetime limit at ahm, it would not reset if you switch to another insurance fund.

speedometer

Rolling limits

While most limits reset or rollover on 1 July, a rolling year begins on the date a service was first provided, with the limit applying to the 12-month period following the date of service.

Most ahm limits are reset annually, but some services included (such as pre and post-natal services) are based on a ‘rolling’ year, instead of a financial year. Rolling limits are subject to per person limits.

Claims hand and money

Loyalty limits

With loyalty limits, the longer you’re a member, the more you can claim (up to a maximum limit – refer to your product guide). Loyalty limits are only offered on some types of extras cover, and are calculated by using the number of full financial years the Principal Member has continuously held an ahm cover.

graph of value adding up
Billboard stating "Got questions? We’ve got the answers"

Common questions

Find cover that suits your needs

Tell us what you need and we’ll show you cover that suits. You can even choose your payment frequency and excess.