In an ideal world, our health fund policies would provide unlimited cover for all the health care we receive. Unfortunately, this is far from an ideal world and therefore all policies have limits on the maximum amount they will pay out on various treatments. These are known as ‘annual dental care benefits limits’ and it’s important to be aware of them – particularly in relation to the coverage that you are looking to take out. With this in mind, let’s take a closer look at how annual limits work.
Firstly, what is an annual benefit limit?
An annual limit is the maximum amount that you can claim for healthcare and dental services over the period of one year. These annual limits for extras cover are restarted at the same time every year. Typically this is on January 1st but can depend on the specifics of your dental health funds policy. Sometimes restart dates fall in April and sometimes in July.
It’s also worth noting that certain dental health funds policies impose lifetime limits on certain treatments or dental services. So once you have reached this threshold, you will not be able to claim any more rebates as long as you hold that particular dental care policy.
What types of services come with annual limits?
Annual limits can apply to a wide range of healthcare services and include medical coverage such as chiropractic services, podiatry, optical care, physiotherapy and other health management programmes.
In addition, however, annual limits can also be applied to a wide range of dental services including:
- General dental care – These consist of common procedures regarded as preventative such as dental check-ups, dental cleaning, fillings, X-rays and fluoride/dental sealant treatments
- Orthodontics – Referring to all procedures and dental services that assist in the alignment of teeth and include orthodontic braces
- Major dental care – This covers pretty much everything else designed to fix damaged, decayed or broken teeth and can include complex fillings, root canal treatment (endodontics), gum disease treatment and crowns
Combined limits vs sub-limits – What you need to be aware of?
When looking into annual dental care benefits and their limitations there’s also something else you may need to bear in mind and that’s sub-limits. Here’s how they work…
Let’s say that the annual limit on your policy for general dental care is set at $1000. In addition, many dental health funds also carry a sub-limit. This is the maximum that you can claim on a particular treatment at any one time – As an example, this may be $250 and is subtracted from your overall annual limit.
However – and just to confuse matters even further – healthcare policies also have something called ‘combined annual limits’. In other words, your policy may provide $300 for each of the following types of care including general dental services, chiropractic treatment and osteopathic care.
But these services may also be grouped together under one combined sum of say $750. Therefore the maximum you can claim for all the general dental, chiropractic and physio services you receive will be $750 and not $900.
For these reasons, it’s important to know the difference between combined and sub-limits.
Can your annual limits for dental health funds increase?
More often than not, this depends upon your dental health funds policy. With some companies, your extras cover remains the same – year in year out. However, with other companies, you may be rewarded with an increase in medical and dental health benefits as a form of loyalty bonus. For example, your annual policy might cover you for $500 the first year but this may increase to $750 in year two, rising annually until a set maximum has been reached.
Even then, there may be some exceptions to the rule and as such, increases may only apply to major ‘extras’ services such as complex dental care or optical care.
The key takeaway
As you can see, annual limits for dental health funds policies aren’t always straight forward, while in some cases, benefits for policies covering dental care are simple and easy. In others they can be quite complex with numerous clauses – all usually stacked in the favour of the insurance provider.
So here’s the thing…
- Have a good understanding of how dental care benefits work concerning annual limits – Hopefully, this article has provided that
- Always make sure you read the small print on your policy so you know where you stand.
and most importantly…
- Understand how you can get the most out of your annual limits so that you pay less for any dental services or dental care you might need.
Some of the ways that you can do this include:
- Remember to claim (use it don’t lose it)
- Consider holding off on any add-on treatments until your benefits reset
- Talk to your dentist about how you can best maximise your extras cover – They’re usually in a good position to help
Here at Beyond Infinity Dental, we want to help you get the dental care you need so come and talk to us about how we can help you to maximise your dental care benefits across a variety of dental services. Whether that’s using your benefits before the reset or whether we can fit in the treatment you need now, we’re here to assist.
Call us on (02) 8806 3799 or book online.