Get the most from your family’s dental cover

The limit you did not know you had

Open your policy and you will usually find dental benefits capped two ways: a limit for each person covered, and a separate limit for the policy as a whole. General dental and major dental normally have their own pair as well.

Take a worked example. A family policy allows $200 per person for preventive dental and $400 for the policy across the year. Four people are covered, so it looks like $800 of cover.

Say each check-up and clean claims $150. Watch the policy limit, not the personal one:

Nothing has gone wrong, and nobody has used their own $200. The policy cap ran out partway through the third claim, so that one came back part-paid — and by the fourth there was nothing left to pay from at all. It is always the smaller of the two numbers that decides.

And there is usually more than one pot

Here is the part that turns this from bad news into a plan. Most policies do not hold one dental limit. They hold separate ones — typically a preventive limit and a general dental limit, sometimes a major dental limit as well — each with its own per-person and per-policy cap. Which pot a service is paid from depends on the item number, and your fund decides that, not the practice.

So the family above has not run out of dental cover. They have run out of preventive cover. The general limit has not been touched.

Done deliberately, one family year can look like this: everyone is examined early, anything that needs restoring is done from the general limit while it is full, and the cleans are spread so the preventive limit covers as many of them as it can. Done by accident, four cleans in December use one pot entirely and leave the other unspent when it expires.

Your fund’s app lists each limit separately. If you are not sure which pot a particular treatment comes from, ask us before it is booked — we quote by item number, and your fund can tell you where that number sits.

This is the single most useful thing to check before you book. Your fund’s app or member account shows all of it:

• Your limit per person
• The limit for the whole policy
• How much of each is left
• Waiting periods still to serve

Limits reset, and they do not roll over

For most funds, dental limits reset at the start of the calendar year, and anything you did not use is gone. Some older products work on a membership year instead, so it is worth confirming which one you are on.

Do things in the right order

1. 1First

   Look

   A check-up for each person. You cannot direct a year’s cover sensibly until you know what is actually there.

2. 2Then

   Fix what needs fixing

   Restorative work comes first. A tooth that needs attention does not improve while it waits for a clean.

3. 3Then keep

   Maintain it

   Preventive care is what holds the result, and it is the part your cover is most likely to pay well for.

This is why a check-up for every family member once a year matters even when nobody has a complaint. It is how a problem is found while it is still small, instead of becoming the emergency that uses the whole year’s limit in one appointment.

Waiting periods decide what you can do this year

nib’s published guidance is that general dental generally carries a two-month wait and major dental twelve months, and most funds are broadly similar. If you have just joined, upgraded, or are thinking about either, the waiting period decides what is actually claimable this year — and that is worth knowing before treatment is planned, not after.

Some funds waive waiting periods for new members on certain products. Whether that suits you is a question for the fund rather than for us, but knowing it exists is useful when you are weighing up a change.

Book the family together

Booking everyone’s check-ups in one go does three things. You find out what is actually needed across the household before any of the year’s cover is committed. You can then direct it where it matters most — the person who needs restorative work rather than the one who needs nothing. And you only take time off once.

At Allura Dental in Truganina we check every family member’s entitlement through HICAPS at the desk before anything begins, and tell you where each person stands. Intraoral photos are included for every patient whatever fund you are with, so you see what we see rather than taking our word for it.

If you are with nib

Allura Dental is a participating nib No Gap dentist and First Choice provider, for eligible nib Extras members. Everything above still applies: nib says the services provided are deducted from your annual limits and service limits, like any other claim. The nib No Gap dentist page sets out what is included and what nib pays.

Ask us how

Bring your card and the question. We will look at where your cover stands, what it sensibly pays for first, and what it makes sense to leave until the limits reset — and you will have the figures before anything is booked in.