Dental Annual Limits - effective 1st January 2010
Premium Options |
Year 1 |
Year 2 |
Year 3 |
Year 4 |
Year 5 |
5 Years+ |
| General - Unlimited |
No Limit |
No Limit |
No Limit |
No Limit |
No Limit |
No Limit |
| General - Limited |
$1,500 |
$1,800 |
$2,100 |
$2,400 |
$2,700 |
$3,000 |
| Inlay / Onlay |
$1,000 |
$1,100 |
$1,200 |
$1,300 |
$1,400 |
$1,500 |
| Denture, Crown, Bridge |
$1,200 |
$1,300 |
$1,400 |
$1,500 |
$1,600 |
$1,700 |
| Periodontic and Endodontic |
$700 |
$800 |
$900 |
$1,000 |
$1,100 |
$1,200 |
| Orthodontic |
$1,500 |
$1,800 |
$2,100 |
$2,400 |
$2,700 |
$3,000 |
| Annual Limit per Person |
$1,500 |
$1,800 |
$2,100 |
$2,400 |
$2,700 |
$3,000 |
Super Options |
Year 1 |
Year 2 |
Year 3 |
Year 4 |
Year 5 |
5 Years+ |
| General - Unlimited |
No Limit |
No Limit |
No Limit |
No Limit |
No Limit |
No Limit |
| General - Limited |
$1,150 |
$1,350 |
$1,550 |
$1,750 |
$2,050 |
$2,350 |
| Inlay / Onlay |
$700 |
$800 |
$900 |
$1,000 |
$1,100 |
$1,200 |
| Denture, Crown, Bridge |
$900 |
$1,000 |
$1,100 |
$1,200 |
$1,300 |
$1,400 |
| Periodontic and Endodontic |
$500 |
$600 |
$700 |
$800 |
$900 |
$1,000 |
| Orthodontic |
$1,300 |
$1,500 |
$1,700 |
$1,900 |
$2,200 |
$2,500 |
| Annual Limit per Person |
$1,300 |
$1,500 |
$1,700 |
$1,900 |
$2,200 |
$2,500 |
Special Options |
Year 1 |
Year 2 |
Year 3 |
Year 4 |
Year 5 |
5 Years+ |
| General - Unlimited |
No Limit |
No Limit |
No Limit |
No Limit |
No Limit |
No Limit |
| General - Limited |
$800 |
$950 |
$1,150 |
$1,350 |
$1,550 |
$1,750 |
| Inlay / Onlay |
$500 |
$600 |
$700 |
$800 |
$900 |
$1,000 |
| Denture, Crown, Bridge |
$600 |
$700 |
$800 |
$900 |
$1,000 |
$1,100 |
| Periodontic and Endodontic |
$300 |
$400 |
$500 |
$600 |
$700 |
$800 |
| Orthodontic |
$1,000 |
$1,200 |
$1,400 |
$1,600 |
$1,800 |
$2,000 |
| Annual Limit per Person |
$1,000 |
$1,200 |
$1,400 |
$1,600 |
$1,800 |
$2,000 |
Saver Options |
Year 1 |
Year 2 |
Year 3 |
Year 4 |
Year 5 |
5 Years+ |
| General - Unlimited |
No Limit |
No Limit |
No Limit |
No Limit |
No Limit |
No Limit |
| General - Limited |
$750 |
$850 |
$950 |
$1,050 |
$1,150 |
$1,250 |
| Inlay / Onlay |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
| Denture, Crown, Bridge |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
| Periodontic and Endodontic |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
| Orthodontic |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
Not covered |
| Annual Limit per Person |
$750 |
$850 |
$950 |
$1,050 |
$1,150 |
$1,250 |
Please contact HIF before commencing treatment with full details of the necessary dental service as provided by the dentist and we will provide you with an estimate of your refund.