Medibank and Custom Mouthguards: What Should You Check?

Before ordering a custom sports mouthguard, check the proposed appliance’s item number and fee, your Medibank Extras cover, the provider arrangement, any waiting period and your remaining annual limit. Also check whether you have already claimed a mouthguard that year. A sports mouthguard benefit does not automatically cover a night guard for teeth grinding.

For information about claims at our practice, visit our Medibank dental care page. Our custom mouthguards page explains the service available in Canning Vale.

What Medibank says about mouthguard benefits

Medibank advertises 100% back on a mouthguard each year at a Members’ Choice Advantage dentist for eligible members, up to annual limits. Healthy Living Extras is excluded from this mouthguard benefit. Its dental network information sets out the qualification.

This conditional benefit does not mean every Medibank member can obtain a mouthguard with nothing to pay. Check your product, the proposed item, any waiting period, your available limit and whether you have already claimed a mouthguard during the relevant year.

A sports mouthguard and a night guard have different purposes

A sports mouthguard is designed to help protect the teeth and mouth during sporting impacts. The Australian Dental Association recommends wearing one during training as well as competition and explains that a custom mouthguard is made to fit the individual mouth. See its sports mouthguard guidance.

An occlusal splint, sometimes called a night guard, may be used as part of managing teeth grinding or clenching. The ADA explains this distinction in its teeth grinding information. The two names should not be used interchangeably when discussing a health-fund claim.

If your concern is grinding, tell the practice when making the appointment. Our bruxism management page discusses that service. Ask for the correct appliance item number and have Medibank check it separately; a sports mouthguard benefit is not evidence of an entitlement for a splint.

What to confirm before the mouthguard is made

• What type of appliance is being proposed, and what is its item number?
• What is the quoted fee, including any separately charged appointment items?
• Does my product include the proposed mouthguard, and is the provider arrangement current?
• Have I already used a mouthguard benefit this year, and how much of the relevant limit remains?
• What amount would I need to pay if the estimated benefit is less than the fee?

Ask these questions before manufacture rather than relying on the wording of a general promotion. Keep the quote and the benefit response together so the appliance and estimate can be matched.

Fit and condition still matter

A mouthguard needs to fit the person wearing it. Tell the dentist about changes to the teeth, braces or planned dental work before it is made. If you already have a mouthguard, bring it for assessment rather than assuming a new one is needed simply because another benefit may be available.

Follow the care instructions supplied with your appliance and ask when its fit should be checked. The ADA advises keeping sports mouthguards away from direct sunlight and storing them dry in a protective case. Replacement should be based on condition and fit, with any insurance entitlement checked separately.

This is general information. Medibank must confirm your individual entitlement, and your dentist should assess which appliance is appropriate for your needs.