Dental limits and restrictions

An annual limit is the total maximum amount you can claim on a service each calendar year. Limits apply to general, major, and orthodontics. Depending on your policy, you might have a separate limit for each type of service, or different services grouped in a shared bucket. In most cases, the limit applies to each member, regardless of how many people are on one policy.

Orthodontics also has lifetime limits. A lifetime limit is the maximum cumulative benefit we pay over your lifetime towards an item or service, or a group of items or services. When you reach this limit, you can no longer claim that benefit again. You may, however, be able to access an additional or increased lifetime limit after you upgrade your cover and serve all waiting periods – contact us to find out more.

It’s important to understand that the benefits we pay are likely to be less than your annual limit and less than your provider’s charge, which means you may have out-of-pocket expenses to pay.

You can check what annual limits you have under “Limits” in the My Medibank app or My Medibank online.

Restrictions on your policy are limited benefits for certain services. This means that benefits may be payable for those conditions, but only to a limited extent. For example, you may only be able to have a certain number of fillings in a single sitting with your dentist.

Some dentists are aware of restrictions and will let you know what they are, but it’s important for you to be clear before your treatment. The best way for you to understand any restrictions that might be in place is for you to get in touch with us before treatment goes ahead.

We can help you understand your benefits and out of pockets, particularly when the treatment is complex. For example, if you need a course of dental treatment, such as a root canal, each part of the treatment will have a different benefit, and in some cases, assessing rules; we can calculate what you’ll get back.

Our restrictions are based on advice from the Australian Dental Association.