Medibank may contribute towards fillings, root canal treatment and crowns when the relevant services are included in your Extras policy. These treatments do not all sit in the same benefit category, and the amount payable cannot be established from the treatment name alone.
If you are planning dental treatment in Perth, an itemised estimate will help you check the proposed care against your cover. Our Medibank information for Canning Vale patients explains claiming at the practice.
Fillings can fall into different categories
Medibank lists routine fillings under general dental. Its major dental category includes major restorative fillings, with inlays and onlays given as examples. This is why ‘Does my policy cover fillings?’ can be too broad a question: the actual item being proposed matters.
Ask which restoration is recommended, why it is appropriate and which item number appears on the estimate. Our dental fillings page explains the service, while Medibank’s dental treatment categories explain its general classification approach.
A root canal plan may contain several items
Medibank’s general guidance places endodontic services, including root fillings, under major dental. A course of treatment can involve separate items with different benefits and assessment rules. Your policy schedule is the relevant reference for your entitlement.
Ask the dentist to identify each part of the plan and whether a separate restoration is proposed afterwards. You can then request an estimate for the whole plan instead of assuming that one benefit covers every stage. Read more about root canal treatment at our practice before discussing your individual options.
Crowns need their own benefit check
Crowns are listed within Medibank’s major dental guidance. Having cover for routine check-ups does not by itself establish an entitlement for a crown. Check whether your product includes the proposed item and what conditions apply.
If your plan includes both root canal treatment and a crown, ask for separate fees and benefit estimates. The clinical reasons for each part should also be explained. Our crowns and bridges information is a starting point for that discussion.
Look beyond the headline annual limit
Medibank notes that dental benefits may be affected by shared limits and item restrictions. A balance shown in your account is therefore not a guaranteed contribution towards any treatment you choose. Its limits and restrictions guide explains why an individual estimate is important.
Ask Medibank whether waiting periods have been served, which balance each item uses, and whether previous treatment affects the claim. For replacement work, specifically ask whether a replacement restriction applies. Do not assume that another member’s waiting period or rebate is the same as yours.
Keep the treatment decision separate from the rebate
A benefit category does not establish whether a filling, root canal treatment or crown is suitable for your tooth. Ask your dentist about the reason for the recommendation, reasonable alternatives, important risks, expected maintenance and the consequences of postponing treatment in your circumstances.
Once the proposed plan is clear, check the insurance contribution. If costs are a concern, raise them before treatment so you can discuss the available options without assuming that a particular procedure is fully covered.
This article provides general information. Confirm your proposed item numbers and individual benefits directly with Medibank before treatment.
Clinical Note: Any surgical or invasive dental procedure carries risks. Before proceeding, you should seek an opinion from an appropriately qualified dental practitioner. The information on this website is for general educational purposes only.