YEARLY LIMIT

This is the maximum amount you can claim for a service in a calendar year, from 1 January to 31 December.

If you don’t claim your full limit for the year, it does not roll over to the next year – it will reset 1 January. If you claim your full limit in a calendar year, no further benefits will be payable until 1 January the next year.

SUB LIMIT

This is a limit within a limit. It applies to a specific service, per person, per calendar year.

For example, if you have Dental Cover, there is a yearly limit for all dental treatment. A sub limit applies to orthodontic of $600 per person, so once you reach that limit you can no longer claim orthodontic for that year. However, you could claim a further $400 in claims for other dental services.

PERSON LIMIT

This is the maximum limit each person on a membership can claim in a calendar year.

If you are on a policy that includes more than one person, each of you have your own individual limit.

MEMBERSHIP LIMIT

This is the maximum amount that can be claimed collectively, by everyone covered by a membership within a calendar year, for a specific service.

Remember that these limits apply in addition to your individual per person limits. This limit may not be high enough for all of the family members to claim their full individual limits. For example, you may have a person limit of $540 with a membership limit of $1080. If there are more than 2 persons on your membership, they may not all be able to claim their full person limit.

LIFETIME LIMIT

A lifetime limit applies to orthodontic treatment and applies to an individual.

Once this limit has been reached, no further benefits will be payable by MHF. This limit does not reset, even if you leave us and start your cover again at a later date.

SERVICE LIMIT

Limitations apply to some types of extras services, in particular dental services.

For example, you can only claim a periodic consultation with your dentist every six months. These limits apply from the date you receive the treatment not from the date you submit the claim.

Benefits are not payable for the following:

• Extras treatment or services covered by Medicare
• Treatment or services received within your waiting periods
• Treatment received at a hospital emergency department
• Care and accommodation in an aged care facility
• Treatment or services that are not medically necessary nor clinically relevant
• Treatment or services received from a provider who is not recognised with Mildura Health Fund i.e. not registered with the Department of Health or the Australian Regional Health Group
• Treatment or services covered by Work Cover, damages legislation or any type of insurance (i.e. third party or sports club insurance)
• Treatment, goods or services received or sourced outside of Australia
• Treatment that has been provided by a family member, relative, business partner, or yourself
• Treatment or services that have been paid for but not yet received
• Services that you haven’t been charged for
• Surcharges, delivery costs and credit card processing fees
• Services provided for sport, recreation or entertainment
• Non-Prescription glasses, sunglasses or contact lenses
• Hire of Health Aids and Appliances with the exception of crutches
• Purchase of replacement parts or components in relation to Health Aids and Appliances i.e. CPAP mask replacement
• Purchase of second-hand, pre-owned goods or equipment
• Health Aids must have 100% manufacture warranty from new purchase date
• Cosmetic treatment or services