When Does Dental Insurance Reset and What to Expect

Dental insurance resets typically occur at the end of the calendar year, on December 31st, for most insurance plans. This means that any unused benefits from the previous year will be forfeited.

If you've been putting off dental work, this is a good time to schedule appointments before the reset. Many people take advantage of this opportunity to get the care they need before the new year.

Some plans may have a different reset date, so it's essential to check your policy to confirm. You can usually find this information in your insurance documents or by contacting your provider directly.

Don't let the reset catch you off guard – review your policy and take advantage of any remaining benefits before they disappear.

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Dental insurance waiting periods are a common feature of many plans, requiring you to wait a certain amount of time before receiving full coverage for certain procedures.

These waiting periods can range from a few months to over a year, varying depending on your specific plan.

They're primarily used for basic and major dental work, but not for preventive care, which is usually covered right away.

Preventive care, such as exams, cleanings, x-rays, and fluoride treatments, is typically covered immediately, without a waiting period.

Some basic procedures, like fillings or non-surgical extractions, may have a waiting period of three to six months.

Major dental work, including crowns, bridges, and dentures, can have a waiting period of three months to one year.

Dental insurance waiting periods help keep costs under control by preventing patients from receiving costly procedures and then dropping coverage.

This helps keep premiums low for everyone.

You may be able to waive a waiting period in certain situations, such as if you had an employer-based policy and are now signing up for a stand-alone plan, or if you had continuous coverage with a new insurer.

Here are some situations where a waiting period might be waived:

Dental insurance waiting periods have a clear purpose: to keep dental insurance costs low. This means that some dental procedures may not be covered right away.

By having waiting periods, dental insurance companies prevent patients from receiving costly dental procedures and then dropping the coverage shortly after. This can result in higher premiums for everyone.

Waiting periods help keep dental insurance affordable for all customers. They ensure that patients don't take advantage of the system by getting expensive treatments and then leaving the plan.

Dental insurance waiting periods are actually a common practice in the industry. They're not meant to be a hassle, but rather a way to keep costs under control.

Here are some key benefits of dental insurance waiting periods:

Dental insurance benefits can reset on different dates depending on your health fund. Most major funds, including Medibank, Bupa, HCF, NIB, Australian Unity, and GMHBA, reset their benefits on January 1st. However, some funds like AHM, Defence Health, and Navy Health reset on July 1st.

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If you switch to a fund with a July 1st reset, your first benefit reset will typically occur on the next July 1st after you join. This means you'll have access to the full annual benefits during your first period with the fund. After the first July 1st reset, you'll fall into the regular annual cycle.

Some health funds, like Queensland Country Health Fund and Hunter Health, reset their benefits on your policy anniversary date. This is the date when you first joined the fund, and it doesn't change. You can find your policy anniversary date on your policy document or by logging into your health fund's member portal.

Here's a list of the most common dates for dental insurance benefits to reset:

Most dental insurance plans do not require a waiting period for preventive care, so you can receive exams, cleanings, x-rays, and fluoride treatments as provided in your plan right away.

Some basic procedures may have a three- to six-month waiting period, which means you'll need to wait before getting fillings or non-surgical extractions.

Major dental work, such as crowns, bridges, and dentures, typically has a three-month to one-year waiting period.

Knowing which procedures require a waiting period can help you prepare and avoid unexpected costs by scheduling your visits accordingly.

It's essential to check your dental insurance plan to understand which procedures have waiting periods and for how long, so you can plan your dental care accordingly.

On a similar theme: How to Bill Medical Insurance for Dental Procedures

Most dental insurance benefits reset on January 1st, which marks the start of the calendar year. This is when many health funds align their benefit periods for simplicity and consistency.

Some health funds, however, reset their benefits on July 1st, which marks the beginning of the Australian financial year. This is typically done for administrative and budgeting purposes.

If you switch to a fund with a July 1st reset mid-year, your first benefit reset will typically occur on the next July 1st after you join. For example, if you switch to Peoplecare on February 15, 2025, your initial benefits will start from your join date, and your first full reset will occur on July 1, 2025.

Here's an interesting read: Benefits of Dental Insurance

A few health funds reset their benefits on the policy anniversary date, which is typically listed on your policy document. You can also check it by logging into your health fund's member portal or contacting their customer service directly.

Here's a list of common reset dates: