The amount of dental benefits available to eligible patients is capped at $1,000 per eligible patient over two consecutive calendar years. This maximum amount of dental benefits is known as the benefit cap and the two consecutive calendar years is known as the relevant two year period.
The relevant two year period commences from the calendar year in which the patient first receives an eligible dental service. For example, if the patient’s first dental service is on 15 May 2014, the relevant two year period will be the entire 2014 calendar year and, if the patient is eligible the following year, the entire 2015 calendar year. If the patient is eligible in 2016 or a later year they will then have access to a new benefit cap. A patient’s entire benefit cap can be used in the first year if needed. If the entire benefit cap is not used in the first year, the balance can be used in the next year if the child is still eligible.
Any balance remaining at the end of the relevant two year period cannot be used to fund services that are provided outside that period. A new benefit cap will become available only if the relevant two year period has elapsed and the child is eligible in a following year. A patient’s benefit cap can only be used for eligible services provided to that patient: family members cannot share their entitlements. The relevant two year period of a patient who receives their first service in 2014.